How We Hear and Understand Them in Our Narcissistic Society
Léia M. Cardenuto
Bioenergetic Analysis • The Clinical Journal of the IIBA, 2026 (36), 127–150
https://doi.org/10.30820/0743-4804-2026-36-127
www.bioenergetic-analysis.comGiven the difficulty of the topic of addictions and dependencies, based on a history of extensive research, this article will address the treatment of individuals with compulsive behaviors and addictions. Its objective is to show how Bioenergetics can be a valuable tool in cases where sensoriality is impaired. Grounded in the psychodynamic understanding of the processes involved in these behaviors, and through the understanding of the role of the “characterological muscular armor”, the understandings of Reich and Lowen can help these patients reconstruct their ego structures of containment and restore the “tonic envelope of emotions” to make their defense mechanisms better and more flexible.
Keywords: impulsive/compulsive behaviors, addictions, narcissisms and the “tonic Envelope” (Tonella, 2019)
Personalidades Impulsivas/Compulsivas
Como as Ouvimos e Compreendemos em Nossa Sociedade Narcisista (Portuguese)
Dada a complexidade do tema das dependências e vícios, e com base em extensa pesquisa histórica, este artigo abordará o tratamento de indivíduos com comportamentos compulsivos e vícios. Seu objetivo é demonstrar como a Bioenergética pode ser uma ferramenta valiosa em casos de comprometimento da sensorialidade. Fundamentada na compreensão psicodinâmica dos processos envolvidos nesses comportamentos e na compreensão do papel da “armadura muscular caracterológica”, a abordagem de Reich e Lowen pode auxiliar esses pacientes a reconstruir suas estruturas de contenção do ego e restaurar o “envoltório tônico das emoções”, tornando seus mecanismos de defesa mais eficazes e flexíveis.
Personnalités impulsives/compulsives
Comment les percevoir et les comprendre dans notre société narcissique (French)
Compte tenu de la complexité du sujet des addictions et des dépendances, et s’appuyant sur de nombreuses recherches, cet article aborde la prise en charge des personnes présentant des comportements compulsifs et des addictions. Son objectif est de démontrer comment la bioénergétique peut constituer un outil précieux en cas d’altération de la sensorialité. Fondée sur une compréhension psychodynamique des processus impliqués dans ces comportements, et grâce à la compréhension du rôle de la “cuirasse musculaire caractéristique”, la théorie de Reich et Lowen peut aider ces patients à reconstruire leurs structures de confinement du moi et à restaurer leur “enveloppe émotionnelle Tonique”, rendant ainsi leurs mécanismes de défense plus efficaces et plus flexibles.
Personalità impulsive/compulsive
Come le sentiamo e le comprendiamo nella nostra società narcisistica (Italian)
Data la complessità del tema delle dipendenze e delle dipendenze, sulla base di una storia di ricerche approfondite, questo articolo affronterà il trattamento di individui con comportamenti compulsivi e dipendenze. Il suo obiettivo è mostrare come la bioenergetica possa essere uno strumento prezioso nei casi in cui la sensorialità è compromessa. Basandosi sulla comprensione psicodinamica dei processi coinvolti in questi comportamenti e attraverso la comprensione del ruolo della “corazza muscolare caratterologica”, le teorie di Reich e Lowen possono aiutare questi pazienti a ricostruire le strutture di contenimento dell’Io e a ripristinare “l‘involucro tonico delle emozioni” per migliorare e rendere più flessibili i loro meccanismi di difesa.
Impulsive/Zwanghafte Persönlichkeiten
Wie wir sie in unserer narzisstischen Gesellschaft wahrnehmen und verstehen (German)
Angesichts der Komplexität des Themas „Sucht und Abhängigkeit“ befasst sich dieser auf umfangreicher Forschung basierende Artikel mit der Behandlung von Menschen mit zwanghaftem Verhalten und Suchterkrankungen. Ziel ist es aufzuzeigen, inwiefern die Bioenergetik hier ein wertvolles Instrument sein kann, insbesondere bei Beeinträchtigungen der Sinneswahrnehmung. Ausgehend von einem psychodynamischen Verständnis der Prozesse, die diesen Verhaltensweisen zugrunde liegen und dem Verständnis der Rolle der „charakterologischen Muskelpanzerung“, können die Erkenntnisse von Reich und Lowen diesen Patienten helfen, ihre Ich-Strukturen der Selbstkontrolle zu rekonstruieren und die „tonische Hülle der Emotionen“ wiederherzustellen, um ihre Abwehrmechanismen zu verbessern und flexibler zu gestalten.
Импульсивные/компульсивные личности
как мы слышим и понимаем их в нашем нарциссическом обществе (Russian)
Учитывая сложность темы аддикций и зависимостей, основываясь на истории обширных исследований, эта статья будет посвящена лечению людей с компульсивным поведением и зависимостями. Ее цель – показать, как биоэнергетика может быть ценным инструментом в случаях нарушения сенсорной чувствительности. Основанные на психодинамическом понимании процессов, связанных с этим поведением, и на понимании роли “характерологического мышечного панциря”, идеи Райха и Лоуэна могут помочь этим пациентам реконструировать свои эго-структуры сдерживания и восстановить “тонизирующую оболочку эмоций”, сделав их защитные механизмы более эффективными и гибкими.
Personalidades impulsivas/compulsivas
Cómo las percibimos y comprendemos en nuestra sociedad narcisista (Spanish)
Dada la complejidad del tema de las adicciones y las dependencias, y apoyándose en una amplia trayectoria de investigación, este artículo aborda el tratamiento de personas con conductas compulsivas y patrones adictivos. Su objetivo es mostrar cómo la Bioenergética puede convertirse en una herramienta valiosa en aquellos casos en los que la sensorialidad se encuentra alterada. Desde una visión psicodinámica, estos comportamientos se entienden a partir de los procesos internos de la persona y del papel que juega la llamada “coraza caracterial y muscular”. Las ideas de Reich y Lowen ayudan a comprender cómo esta “coraza” actúa como una protección, pero también limita la expresión emocional. Trabajar sobre ella permite que los pacientes reconstruyan formas más sanas de sostenerse a sí mismos, recuperen su capacidad de sentir y regular sus emociones, manejen mejor el estrés y desarrollen mecanismos de defensa más flexi.
冲动型/强迫型人格
在自恋社会中我们如何倾听与理解它们 (Chinese)
鉴于成瘾与依赖这一主题的复杂性，本文基于大量研究历史，将探讨强迫行为及成瘾患者的治疗方案。其目的在于阐明躯体动力学如何成为感官功能受损病例中的有效工具。基于对这些行为相关心理动力学过程的理解，并通过解析“人格肌肉盔甲”的作用机制，运用赖克与洛温的理论框架可帮助患者重构自我结构的容纳性，恢复“情绪张力包膜”，从而提升其防御机制的效能与灵活性。
Impulsywne/kompulsywne osobowości
Jak je słyszymy i rozumiemy w naszym narcystycznym społeczeństwie (Polish)
Biorąc pod uwagę złożoność tematu uzależnień i zachowań kompulsywnych, a także opierając się na obszernej historii badań w tym obszarze, niniejszy artykuł podejmuje zagadnienie terapii osób z zachowaniami kompulsywnymi i uzależnieniami. Jego celem jest pokazanie, w jaki sposób bioenergetyka może być cennym narzędziem w przypadkach, w których sensoryczność jest zaburzona. Opierając się na psychodynamicznym rozumieniu procesów leżących u podstaw tych zachowań oraz poprzez zrozumienie roli “charakterologicznej zbroi mięśniowej”, koncepcje Reicha i Lowena mogą pomóc tym pacjentom odbudować struktury ego odpowiedzialne za kontenerowanie oraz przywrócić “toniczny kokon emocji”, ak aby ich mechanizmy obronne stały się bardziej adaptacyjne i elastyczne.
In this article, I will discuss the theme of compulsions, which encompass a variety of self-destructive behaviors, such as addictions to alcohol, drugs, food, gambling, and the internet. These behaviors, often referred to as addiction include eating disorders and excessive consumerism, as well as harmful habits like self-harm, toxic relationships, and self-blame. Especially in contemporary societies, we observe an almost epidemic manifestation of these behaviors, which include new issues such as orthorexia and vigorexia.
The term “addiction” was initially used in England, referring to a type of impulsive abuse of alcool and substances. Joyce McDougall understood the role of sexuality in her work “L’économie Psychique de l’addiction” (McDougall apud Pirlot, 1998). She proposed a view of these disorders from the perspective of psychic economy, rather than focusing solely on topical and dynamic aspects, such as the conflicts between the Ego, Id, and Superego. Her approach emphasized the importance of a bodily perspective, rather than merely a symbolic one, regarding the intensities involved. (Pirlot, 2021, pp. 15–20)
I do not intend to detail all the related disorders, such as substance addictions, anorexia, and bulimia, nor all the obsessive disorders that cause intense suffering to patients and their families. Many of these conditions already have specific therapeutic strategies, both individual and group-based, as seen in the cases of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), especially in the field of behavioral therapies. With the growing interest in integrative solutions, psychotherapies are emerging that seek synergy between new psychopharmaceuticals, sometimes derived from research on recreational drugs, and psychedelic medications, alongside traditional practices of indigenous peoples (Leite, 2022). This is a complex field, where the effectiveness of approaches is not always guaranteed.
Anna Lembke, in her recent book “Dopamine Nation”, explores the social mechanisms that encourage consumerism, revealing how the food and technology industries add addictive factors or substances to their products, activating dopamine receptors in the brain. Children and adolescents, the most vulnerable, have fewer resources to resist such abuses, which can lead to an increase in mental health problems in society, justifying the terminology of “epidemic.”
French philosopher Alain Touraine addressed similar issues in his work “Critique of Modernity” (1992), where he argues that “newer and more impulsive generations are gradually forming in relation to the weakening of the social superego” Guy Debord, in turn, criticizes alienation and narcissistic consumerism in “The Society of the Spectacle” (1967). Both authors reflect on the complexity of current demands and their impacts on individual formation.
The growing demand for help in my professional practice, as well as that of my fellow therapists, is one of the impulses to explore this theme. Many have sought support to cope with the sufferings that emerge from the intersection of impulsive and compulsive behaviors.
My objective is to propose a bioenergetic view of the processes that are at the root of these afflictions and the impulsive behaviors that almost always accompany them. Although there are significant differences between Narcissistic and Borderline issues, in this article I will approximate those structures. In terms of ego structure, Narcissists are well constituted characters, as Lowen define in his book (Lowen, 1982). They are very different from the characters at end of the spectrum of narcissism, as he proposes. As we go further to the end of this spectrum, there we will find the presence of more impulsive, borderline aspects.
The impulsivity commonly observed in compulsive behaviors reflects the complexity that contemporary life has acquired. To seek a precarious psychic balance, the individual resorts to something, an “act” (for example, a tic) or substance, be it alcohol or drugs, legal or not. “These are resources at first, which may later become addictions. Let us call them ‘prostheses’, used to cope with a situation in which we feel limited. Thus, compulsions function as ‘chemical prostheses’” (Freud apud Edler, 2016), attempting to maintain an energetic balance, regardless of how harmful they may be.
In clinical practice, the difficulties faced by patients with addictive behaviors, unlike some psychopathic individuals, include the constant presence of shame and guilt. Perhaps precisely for this reason, compulsive behavior is rarely cited as a reason for consultation, unless it is at such an advanced stage of addiction that it involves suffering in family relationships, work, and social interactions. Often, these patients come to the therapy with other complaints, due to family appeals, or because an affective relationship is under threat.
One of our goals is to help therapists listen to these patients, expanding their capacity to understand the sufferings they face so that the patients feel free to express them. Another aim is to contribute to the discussion surrounding the psychopathological diagnoses frequently attributed to these individuals. A common trait that we can find in them is this impulsive/compulsive unit (Barlach et al., 2015). In our 2015 article, we proposed renaming these manifestations as impulsive/compulsive characters, since they have traditionally been designated as borderline personalities or edge cases. We believe that the concept of borderline is too broad and difficult to encompass, providing little practical utility for the analyst. Furthermore, by revisiting W. Reich’s theory on impulsive character, we found ideas that can be valuable for understanding our compulsive characters.
After graduating in Psychology, I began my training in Reichian Analysis, organizing classes and seeing clients in São Paulo, Brazil, since 1975. During a brief period living in the United States, I had the opportunity to familiarize myself with the work of Alexander Lowen. Attending one of his workshops and watching him work with clients in individual sessions sparked a deep interest in me. When I returned to Brazil, I joined a training group in Bioenergetic Analysis, which later became a society (SOBAB, Sociedade Brasileira de Analise Bioenergética). I had the privilege of learning from excellent trainers, such as Frank Ladky and Rainer Steckel, and earned the title of C. B. T. (Certified Bioenergetic Therapist). Afterwards I continued my training process to become a local trainer at IABSP (Instituto de Analise Bioenergética de São Paulo), with Len Carlino and Ron Robbins. I always made a point of participating in International Conferences and, whenever possible, I stayed for a few days with the group to have sessions with Lowen.
In one of those sessions, I had the opportunity to question him about a topic that intrigued me. As an eager student who devoured all his books and articles, after an incredible session, I gathered my courage and asked, “Dr. Lowen, I recognize you as one of the most influential followers of Reich in the field of mental health. Why haven’t you written about an Obsessive-Compulsive Character Structure in any of your books?” He replied, “Oh, but those traits are now spread across all the other character structures.”
At that time, I did not understand the importance of what he was telling me. Lowen was predicting the development of narcissistic society, referring to the lack of consistency and the “emptiness” that we often find both in ourselves and in our patients. As a follower of Wilhelm Reich, Lowen believed that the narcissistic society was generating the types of character necessary for its own perpetuation (Reich, 1933). I left the sessions in a grateful mood, but with the feeling that I hadn’t received a conclusive answer to my question about obsessive personalities.
My in-person experiences with Lowen were brief, as I did not stay long in the United States and returned only a few times. In Brazil, I became involved in the training for C. B. T. and had the privilege of learning from many notable trainers. Ron Robbins, who was conducting training at our institute at the time, talked to me about that character, and besides reading his articles (Robbins, 2000) I got to see him working with those structures, me as an example.
I was relieved to discover that this issue had not been forgotten by bioenergetics. However, I still had not fully understood the Obsessive Character, their anxieties and compulsive behaviors, their tics, and the immense anxiety of this character structure to which I also belonged. Only now, in attempting to understand and work with addicted and compulsive individuals, I realize how visionary Lowen was. What he told me, in all those words, contained the answer I had been searching for. Today, I can observe that characteristics such as obsessive control, coldness, and perfectionism – common traits of anal characters – are present across many different character structures. It seems that the spirit of our time favors these characteristics.
It is interesting to note that, as an illustration of what Lowen said, the DSM1, in each of its revised editions increasingly shows a wider range of disorders that are rooted in the spectrum of Impulsive/Compulsive structures.
But to understand this increase, we need to refer to a historical view of the concepts of Compulsions and Obsessive-Compulsive Disorders, as Freud first named them in the late 19th century.
Freud and Reich were pioneers in addressing emotional suffering, situating it as a result of the conflict between the internal world, with its impulses, and the external world, with its demands. The hysterical characters and obsessive-compulsive personalities described by Freud and Reich emerged in the society of the late 19th and early 20th centuries, during a period of intense repression of sexuality and scarce opportunities for sexual expression. These conflicts took on a moral tone, challenging established authorities, while bodies were prevented from expressing themselves freely.
The society, at that time, demanded a great deal of labor and moral restraint of sexuality. These conditions generated symptoms that were treated through psychoanalysis. The analytical understanding was that the unconscious mind was responsible for provoking certain distortions in the perception of reality, sometimes manifesting as physical or emotional symptoms. The collection of these symptoms formed a system of defenses against suffering, aiming to accommodate the individual to the repressive environment. Freud articulated this idea brilliantly in his work “Civilization and Its Discontents,” where he stated that “civilization is repression” (Freud, 1930).
This situation changed profoundly after World War II. In the United States, Lowen’s homeland, where Reich moved to, greater freedom of expression of bodies and sexual liberation presented new contours to psychic processes.
In Freud’s time, narcissistic issues were not sufficiently clear, and a rigid superego prevailed among his patients. The predominance of hysterical neuroses is understood as a consequence of the repressive sexual education that accompanied the prevailing Victorian morality. In contemporary society, the repression of sexuality has diminished, but superego demands remain; they have simply transformed.
“Many of Freud’s patients suffered from what he called a ‘very rigid superego’ filled with internal judgmental observations […]. On the other hand, contemporary patients have fewer critical internalizations but feel empty and are more concerned about ‘not fitting in.’” (McWilliams, 2014, pp. 198–199).“It seems that nowadays societies favor two types of psychological character: the impulsive, narcissist, where the superego is more isolated from the other components of the psychic apparatus, and the compulsive, obsessive, where the superego, although often excessively austere, is incorporated into the ego, constraining it within the structure of personality” (Barlach, 2009).
Lowen, working as a therapist, noticed these transformations through the complaints of the individuals who sought him. In one of his later books, he observed:
“In these 40 years of work as a therapist, I have noticed a profound change in the type of personality problems individuals bring to me. Neuroses of ancient times, manifested mainly by guilt, anxiety, phobias, or incapacitating obsessions, are not as commonly seen today. On the contrary, I see more people complaining of depression; they describe a lack of feeling, an inner emptiness, and a deep sense of frustration with what they have accomplished […] and some are very successful. Their lack of achievement does not manifest itself. Their social, professional, and sexual performance seem efficient, mechanical, devoid of humanity” (Lowen, 1983).Zygmunt Bauman argues that Freud understood the instinctual renunciation of modern man as the foundation of civilization. The individual sacrificed a measure of immediate pleasure in favor of a more secure, albeit less fulfilling, pleasure.
Today, it can be stated that the field represented by the right to satisfy one’s urges – including instinctual and sexual satisfaction – has expanded, no longer able to be seen merely as something dissipative of energy and destructive. The gains and losses have shifted: postmodern men and women have negotiated a part of their pulsional freedom in exchange for greater security.
“The evils of modernity derive from a type of security that tolerates little freedom in the search for individual happiness, while the evils of postmodernity result from a kind of freedom to the pursuit of pleasure that, in turn, tolerates little individual insecurity” (Bauman, 2011).Now, if the values that constitute the superego, which defend the ego from the impulses and abuses of the id, are weakening, it can be argued that the ego is increasingly responding to the dictates of the id.
The term narcissistic society emerged in the United States, through an author who criticized the role of advertising and the cult of the narcissistic idealization of American heroism. A society that privileged hard work on one hand and industrialized sports and entertainment on the other. This anthropologist, Christopher Lasch (Lasch, 1978), was concerned about the excessive individualism of society and saw the substitution of the family by the “factory.” He feared what appeared to be the personality of our time, the Narcissist. He also stated that leisure functioned as “escapism,” which leads us to ponder: Is this an era in which the pleasure principle may prevail? If so, how would Reich define the concept of armor in contemporary times?
Are we witnessing a weakening of the social superego?
Lowen already foresaw the existence of an “analgesic society” (Lowen, 1983). To avoid the pain and discomfort of confronting social truths at all levels, superficiality in analyses and a lack of critical reflection and contact are favored. Defenses such as splitting, which isolate imagination from feeling and body – and therefore from actions – are activated more radically to prevent contact with the suffering that an unequal society provokes. (Lowen, 1983)
Byung-Chul Han, a South Korean philosopher, analyzes how contemporary societies deal with suffering, pain, and frustration. Han argues that modern society seeks to minimize pain and suffering at any cost, creating a culture that avoids failure and promotes “zero error”. This relentless pursuit of efficiency and happiness results in a society that refuses to deal with pain, leading to what he describes as an “anesthesia” of human experiences.
“Individual as Entrepreneur of Oneself”: Han suggests that in the analgesic society, the individual transforms into an entrepreneur of oneself, feeling the pressure to always be productive and optimized. This pressure generates a state of exhaustion and burnout, where people become their own sources of pressure, resulting in psychic and emotional suffering. These characters are also suffering from what is called the Uberization of society.
In a world without guarantees, also referred to as the “liquid” world (Bauman, 2000), human relationships weaken and emotional ties diminish or lose significance, as material qualities prevail. The characters described by Lowen in his book “Narcissism: Denial of the True Self” were, according to him, the result of a society that cared much more about money and appearances than about human qualities such as tenderness, love, and solidarity. He noticed that in these individuals, neurosis reached a degree of unreality that, in some cases, approached a psychotic state.
The real world, with its myriad challenges – ranging from individual and social competition to environmental violence – can seem less intimidating when viewed solely through the lens of a screen or media. Often, these overwhelming emotions manifest in compulsive behaviors as forms of escape.
In a technology-driven society, where the allure of reduced physical effort entices the workforce, we face a curious contradiction: an ever-increasing availability of inexpensive, convenience foods alongside narrowly defined beauty standards that celebrate extreme thinness. This is merely one of many paradoxes we encounter. In what Guy Debord, the French philosopher, refers to as the “Society of the Spectacle,” images and appearances take precedence over substance. What has shifted is not the fundamental exploitation inherent in capitalist labor, but rather the transformation of that exploitation into one focused on performance and outcomes.
The echoes of the transformations in social life and the expansion of technology have provoked profound modifications in the constitution of the superego in contemporary times. If, in Freud and Reich’s era, the figure of the father was the “repressive pole of sexuality and the privileged object of the subject’s identification” (Santos; Azeredo, 2005), the 20th and 21st centuries reveal a woman who is less submissive, integrated into the labor market, and often away from home, alongside paternal figures more susceptible to failure due to the global reorganization of this very marketplace. This, along with an existence that rely on social networks is favored by the expansion of the internet. The predominance of image over other human attributes, privileging appearance at the expense of feelings, is a reality. The burden of this shift appears in the psyche. This is only possible through splitting, which simultaneously isolates imagination from feeling and action. Lowen, while writing his book on Narcissism, was processing these transformations of the human psyche as he delved deeper into ego psychology theories.
As the psychoanalytic field evolved from the Oedipal paradigm to the object relations paradigm, along with the development of self psychology, the three main diagnostic fields of psychoanalysis – neurosis, perversion, and psychosis – began to transform into neurosis, borderline, and psychosis. Perversion, which was often attributed to anal structures, was almost completely absorbed by the main category of “borderline personality”. The latter is also referred to as “borderline condition,” as it cannot be asserted that it constitutes a stable “form” of character (or personality), due to the structural deficiencies presented by these patients.
In his book on depression, written long before “Narcissism,” Lowen observed that obsessions serve as defenses against depression. “To be obsessed is to be trapped in a paralyzing emotional conflict” (Lowen, 1983). At the bodily level, this manifests as a diminished contact of the feet with the ground.
When studying the oral character structure described by Lowen, we know that feelings of emptiness, dependency, lack of grounding, and substance abuse or other dependencies constitute the main difficulties faced by these structures. Many patients we encounter in our clinics deal with these issues. However, today we also find in these patients the lack of structure typical of the borderline condition, which presents numerous impulsive traits, alongside narcissistic characteristics.
Freud in his time described obsessive-compulsive clients – such as the famous “Rat Man” (Freud, 1923) – who faced conflicts between moral standards and desires. He termed this set of symptoms “Zwangsneurose,” (Zwang, in German, means compulsion). The publication of this case introduced the idea that obsessive-compulsive sufferings stem from an extremely rigid moral and religious upbringing that combats the impulses generated by the child’s sexual development and its fluctuations.
The Psychoanalytic field, at Freud’s era, has not distinguished between neurosis and personality disorders. Now we know that neurotics are more able to recognize that their symptoms are irrational and may seek help to cope. Daily functioning can be affected, but not to a severe extent. On the other hand, Personality Disorders can include many types of dependencies (such as alcohol abuse, drugs, both legal and illegal, gambling, eating and sexual disorders, hoarding, shopping compulsions, internet abuse), and as conditions worsened, even dissociative traits, such as paranoid thinking.
In the beginning, the compulsive act is a resource, but as it lasts, and our societies favor it, they became an addictive behavior. While OCD, consists in patterns of thought and behavior that can arise at different stages of life, but more often in childhood and adolescence individuals experience anxiety, insecurity, and emotional discomfort but maintain a connection to reality.
The patient with OCPD (Obsessive Compulsive Personalilty Disorder) may not recognize the severity of their behaviors and how they impact their lives and the lives of others. It is a lasting pattern of thoughts, feelings, and behaviors that deviate from cultural expectations and can cause significant distress or impairment in social, occupational, or other important areas.
The last DSM, 5, brings a discussion if these disorders can be considered, similarly to autism or ADHD, as neurodevelopmental disorders, but it is unconclusive up to now.
Bioenergetic therapy, that privilege the psychodynamic of the disorder, can be an important tool into this field.
An example of these is the compulsive acts, and its developments we can describe the hand-washing ritual. In a deeper analysis of the interaction between guilt, compulsion, and acts and behaviors, linking elements of Shakespearean literature to Freudian psychoanalysis, we can understand that hand-washing as a compulsion act, as symbolized by Lady Macbeth (Freud, 1920).
In this text, Freud uses the character from Shakespeare as an example of obsessive disorder, illustrating the psychological torture accompanying moral transgression. Lady Macbeth, who tries to wash the “stains” of blood from her hands after instigating the murder of Duncan, symbolizes the struggle against guilt and obsession. The act of washing her hands becomes a compulsive ritual that reflects her inability to cope with the guilt of the crime. Freud acknowledged that these obsessions may represent a form of an attempt to control psychic suffering, highlighting the connection between obsessive thoughts and compulsive behaviors.
Thus, Lady Macbeth is a significant example in discussions about the psychology of human behavior, especially regarding the psychic suffering caused by guilt and the desire for redemption. Furthermore, the relationship between obsessions and compulsions is a central theme in psychopathology. Another example is patients undergoing bariatric surgery as an attempt to control dysfunctional eating behavior. This can lead to new forms of compulsion, where the focus of obsession shifts to new areas, such as shopping, drinking, or sex, instead of being addressed at the root. This highlights the complexity of these disorders, where the superficiality of solutions can actually exacerbate the situation.
Understanding the role of compulsive behaviors as coping mechanisms, albeit flawed, is fundamental for therapeutic approaches and for understanding human suffering. These displacements point to the need for a more comprehensive and careful perspective, which can address not only the symptoms but also their origins and connections. (Guest & Parker, 2010)
Many of the earlier historical records regarding descriptions of Obsessive-Compulsive Disorders (OCD) can be found in religious literature rather than in medical texts. It is evident that during the 14th to 18th centuries, obsessive fears related to religion were common. During this period, a new word emerged to describe obsessions and compulsions: “scrupulosity”. Later, in the 17th century, obsessions and compulsions also began to be interpreted as symptoms of melancholia.
Reich, in his early writings, (1923/1974) proposed the concept of Impulsive Character, as named by Franz Alexander. These structures, lacking consistency in parental education, develop an isolated superego, which is a mechanism responsible for moral behavior but presents serious functional problems despite this. Its intense characteristics do not prevent the impulsive person from committing abominable acts against others. We say that this type of Superego functions more like a very harsh judge, isolated in an internal tribunal, or in an altar, than as a guide to orient the subject’s actions in the external world.
Wilhelm Reich, in the first half of the 20th century, was one of Freud’s most radical followers, sharing the conviction that human mental suffering was caused by the internal struggle between morality and desires. However, they diverged when Reich began to confront all authorities, positioning himself alongside desire, which he saw as repressed by patriarchal capitalist society.
Reich argued that sexual repression, upheld by puritanical and religious ideals, served to maintain the oppression of the lower classes and generated illness. For him, fighting for sexual freedoms and human rights, opposing capitalist oppression, was one of the main tasks that the youth of the 20th century should undertake.
In the field of mental health, Reich’s ideas about increasing life and energy within the body through expanded breathing and the release of the orgasm reflex attracted many followers, including Lowen. Reich began his extensive work “Character Analysis,” discussing the formation of the superego in children. His premise was that the ignorance of parents and educators about child psychosexual development often led them to mistakes in raising their children.
Based on the phase of the Oedipus Complex described by Freud, Reich argued that the child forms their moral instance, the superego, as they attempt to cope with feelings of love and hate provoked by desire towards their parents, as well as the desire to please them and not lose their love. However, in the pursuit of establishing limits without harming the child’s fragile ego, parents often ignored these complex feelings.
The impulsive gratification occurred without appropriate parental guidance. When inappropriate behaviors manifested, they often went unnoticed or resulted in delayed and severe punishments that the child could not integrate. Reich referred to this as inconsistency in educational standards. Such situations involved all the defense mechanisms of the mind, whether conscious or unconscious.
Reich’s theory regarding the ego of impulsive patients relates their ambivalence and lack of control to disorganized parenting.
The Internal Moral Judge (Superego), no matter how terrifying it may be to the individual, is unable to inhibit antisocial or psychopathic behaviors. This dissociation – which can sometimes reach psychotic levels – explains the compulsive behaviors of serial killers, as well as the violent acts perpetrated by some adolescents in school shootings (Ceroni & Abud, 2019). Furthermore, individuals who may be considered part of the narcissistic spectrum of personality disorders can present severe cases of compulsions. We can say that these individuals suffer from a sustaining ego structure; they lack a “well-formed” ego.
This view of a central superego, responsible for pulsional containment, has been transforming as psychoanalysis advances from the Pulsional Paradigm to the Object Relations Paradigm. Attachment theory (Bowlby et al. in Fonagy, 1989), the studies of Margaret Mahler, and Self Psychology, by Kohut and Kernberg, began to circulate from the 1970s onwards. In these developmental studies, we see a shift; “shifting the issue of sexuality from the center of organization in favor of a maturational perspective of the self, of which sexuality is part. The concept of Interrupted Development was propagated, meaning that in the face of a traumatic situation or the lack of certain experiences during the appropriate phase, a “hole” would be left in the personality. This hole would constitute the individual’s narcissistic wound” (Weigand, 2006).
As the psychoanalytic field progressed from the Oedipal paradigm to the object relations paradigm and the development of self psychology, the three main diagnostic fields of neurosis-perversion-psychosis began to shift to neurosis-borderline-psychosis. Perversion as a diagnosis, often found in anal structures, was significantly absorbed by the main category of Borderline Personality or Borderline Condition, as we cannot assert that this is a “form” stable of character, characterized exactly by the lack of structure presented by these patients.
Guy Tonella, in his article on Borderline States, describes the “narcissistic type” or “borderline state” as an intermediate organization that lacks the solidity or rigidity present at psychotic and neurotic structures. He characterizes this narcissistic arrangement as unstable, maintained by multiple reaction formations, which can give the appearance of “hyper-normality” while, in reality, it conceals a hypersensitivity to abandonment, depression, loss of security, self-confidence, and self-esteem.
According to Tonella, Freud already recognized in 1931, in his work “The Libidinal Types,” the existence of a “narcissistic” type that does not fit into either psychotic or neurotic structures. He describes this organization as endowed with an incomplete superego (surmoi = superego), strongly influenced by an ideal ego, and marked by the use of splitting and denial mechanisms. This formation results from intense affective frustrations experienced in childhood. According to Tonella, Freud characterized this narcissistic type as intolerant of frustrations, predisposed to psychosis, and to disorders now considered ingenious or perverse. (Tonella, 2022)
What Reich described as the muscular armor has been more aptly renamed by Guy Tonella as the “tonic envelope.” Didier Anzieu, in 1985, in his book “The Skin-Ego” (Le Moi-peau), formulated a theory about “psychic envelopes” (including the ego envelope) and their pathologies. Anzieu starts from the hypothesis that “all psychic activity is based on a biological function” (the skin). The child, from their experience of the surface of the body, represents themselves as an Ego delineated by a “skin-ego,” capable of marking their psychic contents. The skin, with its dual face – one inner and one outer – implies that the pathology of the borderline state consists of a distortion of these faces, resulting in “an interior/exterior confusion.” (Anzieu, 1985).
The contributions of Anzieu, as well as those of other theorists, have significantly influenced our bioenergetic literature. At the same time, our understanding of the importance of traumatic experiences and the early experiences of the infant is expanding, especially with the tools and research brought forth by the field of Neuroscience.
Child development from a relational perspective is heavily evidenced in the research of Daniel Stern. He exemplifies this in his neuroscience laboratory experiments, demonstrating how an infant perceives the world around her/him through human relationships. It is the interest in the other that is present from birth, and continues as the motor of growth. The baby finds its first sense of belonging in the body and the gaze of the mother. This intimate experience plays an organizing role, allowing the gradual emergence of the infant self, which structures itself in increasingly profound levels of connection (Stern, 1996).
As the baby nestles in the body and gaze of the mother, this initial intimate experience builds an essential bond for the development of the self, which, in turn, will progress toward autonomy. They will differentiate as a completely autonomous individual when this process occurs successfully. Hence the importance of early bonds.
On the other hand, if the mother or caregivers fail to provide this consistency, the baby will perceive this incongruence as a discontinuity. In this context, the small ego may feel “empty,” and this sensation of emptiness becomes increasingly evident. It is not just the object of desire that eludes the baby but the “other” that constitutes her/him. Because of this advanced understanding of early childhood experiences, we can no longer accept the traditional view that attributed exclusive responsibility for the narcissistic wound to Oedipal issues, and a review on Freuds and Reichs propositions about the rigidity of the Superego function becoming less important, although in some cases we can see the Isolated superego (Reich, 1923/1974) playing an important role on disconnected addictive behaviors.
Heinz Kohut (2009) is recognized as the founder of Self Psychology and emphasized the importance of empathetic experiences in object relations for the formation of the self. Along with Otto Kernberg, he highlighted the failures in the constitution of the self structure from the earliest experiences of life and studied the disorders and disconnection failures of the self that may arise during development. It is in these cases, which include our impulsive/compulsive individuals, we find a poorly constructed narcissism (Green, 1988; Fiorini, 1999).
Hector Fiorini used to say that is very different to treat a narcissistic disorder of that kind than to treat a case where we can find a well constituted narcissism.
Winnicott stressed the immense influence of early relationships, particularly the emotional bond with the mother, on personality formation. The baby’s ability to feel secure and accepted in their emotional experiences is paramount for the development of a cohesive and well-adjusted self. The primary narcissism, or the Narcissism of Life, as posed by André Green (Green, 1988), will be responsible for the nuclei of self esteem, and is not well preserved on the impulsive/compulsive individuals, were we find a poorly constructed narcissism (Green, 1988; Fiorini, 1999).
We can find them more on the side of a non neurosys. And so it is important differ the from the well constitued narcissistic personality.
Addictions, particularly to alcohol and drugs, are among the most devastating disorders for an individual’s life and often affect everyone who relates to them. It is impossible to think of effective treatments or even a “cure” without considering the entire context of these patients. Many forms of intervention are necessary beyond individual psychotherapy. Medication, family therapy, group therapy, and occupational therapy are indispensable adjuncts, and even then, the success of interventions is not guaranteed due to the strength of the brain mechanisms involved in dependencies.
The dependence on pharmaceuticals has significantly increased, indicating that depression in our society has reached seemingly epidemic proportions. Lowen observed that depression, oral fixation, and obsession are interdependent disorders. We already know how early childhood experiences play a crucial role in determining an individual’s energy level in adulthood.
It is evident how narcissistic perfectionism and excessive self-awareness can deplete a person’s energy. In neuroscience, we find various elements that help us understand the biochemistry of addictions, allowing comprehension of their physical and emotional triggers. However, it is in the realm of relational psychology that we can integrate our knowledge with bioenergetic practice, promoting a deeper understanding of this epidemic and the weakening that the social superego has been undergoing.
In this sense, Donald Winnicott’s contributions to psychic development are fundamental and multidimensional. In the early stages of life, the baby and her/his mother, according to this author, form a fusional unit. This complete dependency is discussed by Daniel Stern (Stern, 1991). The baby’s dependence on the mother or essential caregiver is total. Gradually, the baby develops and creates its own existence, breaking that symbiosis.
Winnicott believed that the mother (or caregiver) must be “good enough” to meet the child’s emotional needs. This emotional availability is fundamental for the child to develop a sense of security and self-esteem. If the maternal figure fails to provide adequate support, the child may develop a fragmented self, which can be associated with conditions such as borderline personality disorders, and those we have been describing as impulsive/compulsive.
Winnicott introduced the concept of the “transitional object” (Winnicott, 1974), which refers to objects, such as blankets or toys, that help children transition from a state of total dependence on their mother to greater autonomy. These objects provide comfort and security, allowing the child to explore their environment while maintaining an emotional connection with the mother.
Although the term “transitional objects” does not directly refer to objects of compulsion, it can be associated with the fact that, in contexts of compulsive behaviors, individuals often form emotional bonds with certain objects or practices as a way to cope with anxiety, loneliness, or insecurity. Compulsion could be seen as an attempt to restore a sense of control or security, similar to the role that transitional objects play in emotional development.
Thus, we tend to see the object of compulsion as this transition, which, in reality, does not occur. Alcohol, drugs, games, porn and even “innocent” cell phones, for example, often function as Transitorial Objects rather than transitional ones. Compulsions need to be constantly activated and do not allow for the development of the creativity necessary to fill the void of the lack of the object.
This incessant search for the object and the encounter with absence are significant; for the simulacrum (the object of compulsion) will never correspond to the true object of desire, which inevitably leads to frustration. Winnicott highlighted the immense influence of early relationships, especially the emotional bond with the mother, on personality formation. The baby’s ability to feel secure and accepted in their emotional experiences is paramount to developing a cohesive and well-adjusted self.
While a perfect mother cannot exist, as at some point the child will inevitably experience some discomfort, many mothers do not allow the child to experience the world without their mediation. When the mother-baby fusion period lasts longer than necessary, it affects the development of transitional phenomena and creates in the baby the fear of developing their own psychic resources to cope with tension and the fear of loneliness. This prevents the baby from developing the healthy ability to be alone.
Often, it is the mother who is unable to do so; with her anxieties and fears, she becomes dependent on the baby. Thus, she creates in the baby an addictive relationship with her presence and her caregiving function. The experience of difficulties and frustrations is equally important, as it helps the child create a “good internal Mother” – a part of themselves that nurtures and protects. The failure to develop this internal figure can be exacerbated by an excessively anxious mother, who prevents the child from facing frustration, thereby hindering the emergence of this good internal Mother (MacDougall, 2001). It is common to hear that many addicts have difficulty growing up and practicing self-care.
We have always known the importance of establishing a primary bond of trust with caregivers. But if the anxious mother creates this dependency in the baby, the baby cannot establish an internal representation of a maternal figure (and later a paternal one) that will endure in their adult development, fulfilling the functions of containing and dealing with psychological pain and states of hyperarousal. In times of tension, the adult individual is unable to self-soothe, and in the absence of internal caregiving objects, will seek solutions in the external world that may include food, alcohol, drugs, etc.
In the incessant quest for new and better ways to work with these patients, the tool of Bioenergetics stands out, especially for its ability to anchor sensations and perceptions in the body. Corrective Emotional Experiences (CEE), along with the practice of grounding, can offer significant pathways for therapeutic intervention.
Several colleagues have achieved success in treating patients with borderline personality disorder, sharing valuable experiences related to touch (Guest & Parker, 2022). The same authors (2001) present interesting research about the relationships between drugs of choice, compensatory behaviors, routes of administration, and the severity of addiction and character structure.
Also in the field, there is the contribution about working with somatic countertransference (Cryns, 2017).
The application of grounding exercises, as the gentle expansions and contractions, suggested by Ben Shapiro (Shapiro, 2008), and the work with the shadow (Heinrich-Clauer, 2020) can be effective strategies to reconstruct the tonic envelope. However, it is important to recognize that this is not always feasible due to the difficulties imposed by the severity of the clinical presentations.
Regarding the treatment of compulsions, there are some valuable tips gathered from various approaches that can help. Regardless of what therapeutic space is available, even if it’s just a computer screen, it is essential that the environment allows the patient to experience play and to fantasize. Opening space for the construction of positive experiences and trying to avoid as much as possible making the patient feel that the therapist depends on them is crucial. Striving for a balance between complete autonomy and symbiosis is vital – a finely tuned point to be found together. As a corrective emotional experience, Winnicott’s model of the “good enough mother” is very relevant. An anxious therapist who feels the need to be “perfect” and must cure their patient at all costs may evoke distrust. It is more beneficial if they can promote a climate of camaraderie, where the therapeutic activity flows lightly and unburdened, similar to the process of artistic creation.
There are various ways to support patients with these impulsive/compulsive characteristics, utilizing the understanding and techniques of Bioenergetics. It is advisable not to face this challenge in isolation, but rather to seek the support of a multidisciplinary team that attends to the socio-emotional context of the patient and can address it. Additionally, a proper supervision is important to help mitigate countertransference obstacles. Working in the therapeutic relationship openly and sincerely, free of judgments and in a welcoming environment, constitutes the central foundation for the care of these patients, promoting the development of an increasingly cohesive and functional self.
Bioenergetic therapy, when applied to cases of impulsive/compulsive characters serves as a valuable intervention. Rooted in psychoanalytic psychodynamic, bioenergetic emphasizes exercises designed to help those character structures that need to develop a stronger sense of self-structure, increased energy, and enhance the capacity for emotional containment. This approach focuses on building these skills rather than merely releasing emotions and tensions through cathartic expressions.
Recognizing the communication difficulties and lack of self-awareness that these clients face, we must prepare ourselves for the possibility that our efforts may not always be met with immediate appreciation. Such patients can be particularly challenging for inexperienced therapists. However, as we cultivate empathy and gain insight into the formation of their defenses, they may begin to reward our efforts with small increments of trust. Alongside the process of rebuilding what can be termed an “armored” structure – now more appropriately referred to as a “tonic envelope” or “skin-ego” – we also confront the challenge of helping them let go of outdated defenses. By understanding how these defenses were constructed and identifying the right moments for them to begin relinquishing them, we can approach these challenges with greater empathy.
Understanding the demands of our narcissistic society, which often glorifies achievers and self-centered behaviors, can foster a necessary empathetic stance. Frequently, and perhaps even most of the time, these patients may relapse into old negative patterns before finding their way back to recovery. In terms of countertransference, it is essential for us to maintain an unjudgmental attitude, as the focus should not be on ourselves. We must remember how challenging it can be for individuals to regain a healthy tonic envelope in such an environment.
1 DSM- (2023), Diagnostic and Statistical Manual of Mental Disorders, that is in its fifth edition, was created by the APA and, while it is much more valued by psychiatrists and behavioral psychotherapists, and is constantly modified and expanded, it has been published and revised since 1952 and serves as an interesting map of how we understand mental suffering. Around the issue of Compulsions, The DSM-5 includes a new chapter with four new disorders, namely: excoriation, hoarding, trichotillomania, body dysmorphic disorder, obsessive jealousy, and body-focused repetitive behavior.
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Léia M. Cardenuto, Psychologist and Psychotherapist especialized in Reichian and Bioenergetic Therapy. CBT and Local trainer and Coordinator of the Course of Compulsions and Toxic Passions at the IABSP, São Paulo, Brazil.
leiacardenuto52@gmail.com