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Women’s Bodies in Psychoanalysis

by Rosemary M. Balsam. New York, Routledge, 2012, 224 pp., $40.95 (paper).

Reviewed by Elizabeth L. Auchincloss, M.D.
Am J Psychiatry 2013;170:688-689. doi:10.1176/appi.ajp.2013.13020265
View Author and Article Information

The author reports no financial relationships with commercial interests.

New York, N.Y.
Dr. Auchincloss is affiliated with the Department of Psychiatry, Weiss Cornell Medical College, New York.

Accepted March , 2013.

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In her book Women’s Bodies in Psychoanalysis, Rosemary Balsam invites us to see and hear what we know but continue to deny: that the experience of growing up in and surrounded by the female body is at the center of inner life. As a female reader, it is impossible not to respond personally to this lovely (and very personal) book, which is mainly about women. However, everyone who treats women (which means most of us) will learn a lot from reading it and, equally important, enjoy doing so. Indeed, pleasure is one of Balsam’s main themes.

Balsam takes on several overlapping themes as they relate to the psychological life of women: 1) the experience of the body is at the center of inner life; 2) the experience of the mother’s body is at the center of inner life; and 3) women-to-women experiences of all kinds are at the center of inner life. Throughout, Balsam brings us back to the important observation that these themes have been largely ignored, or rather actively denied, through a conspiracy of silence about women’s bodies that permeates many cultures. When the experience of the female body has been examined, it is largely through the lens of pain, inferiority, and suffering rather than through that of pleasure and power. While Balsam is most interested in the girl’s/woman’s experience of the female pregnant body, her ideas can be generalized to include other body experiences, as well as the body experience of men. Her ideas also fit nicely with the emphasis on the embodied mind in neighboring disciplines, from anthropology to cognitive neuroscience.

Balsam begins by telling us the story of Maryam, a young woman in modern Iran, whose headscarf covers self-inflicted burns on her scalp. Her burns speak a painful truth: Maryam would rather burn to death than face the life of abuse prescribed for her. She uses her body to express feelings that cannot be spoken aloud. Maryam’s mother colludes with her silence, as do all in the surrounding culture. Next, Balsam takes us to Charcot’s clinic in the 19th-century Salpetriere Hospital, where we find the master examining his silent and cooperative patients. Like Maryam, these women express their secrets through the body. Medical objectification colludes in their silence. In many centuries and in many cultures, we find a conspiracy of silence surrounding the feelings of women. Paradoxically, while women often use their bodies to express hidden feelings, the secrets of the body, itself, have been drawn into this conspiracy.

While psychoanalysis was invented when Freud invited his female patients to speak, the conspiracy of silence has permeated the psychoanalytic literature too. Balsam catalogs the many reasons for this, including Freud’s well-known phallocentric bias, which led him to construct theories about women emphasizing deficiency (and ultimately masochism, envy, and passivity); Freud’s focus on the genitals and on erotism; the embarrassment and backlash against Freud’s theories, which led to new theories deemphasizing the body altogether; the influence of attachment theory, object relations theory, and self-psychology, which emphasize the mother-baby relationship; the fall of ego psychology with its drives (which offer a link to the body); the demedicalization of psychoanalysis; and the influence of postmodernism (with its attack on biological essentialism). Balsam jokes that the force of these combined influences led psychoanalysis to “throw out the body with the bathwater!” (p. 19).

By contrast, for Balsam, “the bulging belly of a pregnant woman is one of the biological wonders of our human world” (p. 189). Her many clinical examples are replete with talk of the body qua body (especially the female pregnant body), described with its “vast belly,” “bounteous breasts with their arresting outline,” and “convexities and concavities” (p. 55). Balsam’s female patients describe the “physical intensity” of the experience and fantasy of inhabiting this body and of being exposed to the mother’s body during childhood (p. 57). They talk of the importance of female-to-female interaction (and competition) around bodies. Haven’t we always known that women dress for other women? Balsam’s female patients talk of the anxieties but also of the pleasure and power they feel in relation to the body and its marvelous capacities.

In her exploration, she points the way to a psychology that includes the impact of psyche, culture, politics, and the body, without marginalizing any of these points of view. In her view, while the body is always mentalized and elaborated on in fantasy, it has a fixed and stable aspect. Balsam delinks the concepts of sexuality, femininity/masculinity, motherhood, eroticism, and female/male. She also demands that we separate value system from fantasy. If psychoanalysis can shake off its denial, it will be well-positioned to imagine a hybrid body that is both physical and mental.

Balsam’s book also includes a delightful trip through history and culture, touching on such disparate topics as 16th-century art depicting the female body, Elizabeth Blackwell’s refusal to engage in “un-lady-like parading” at her own medical school graduation, and 21st-century mannequin marketing (p. 21). It also includes a review of the psychoanalytic literature relevant to the topic of women’s bodies, including many writers who are well-known (Sigmund Freud, Melanie Klein, Helene Deutsch, Hans Loewald, Robert Stoller, Michel Foucault, and Karen Horney), many who are less well-known (Patrick Mahoney, Dianne Elise, Judith Kestenberg, Nancy Kulish, Deanna Holtzman, Edmund Bergler, Denora Pines, Elisabeth Young-Bruehl, Paula Bernstein, Joan Raphael-Leff, Virginia Goldner, Nancy Chodorow, Adrienne Harris, Jessica Benjamin, and Arlene Kramer Richards), and some who are mostly unknown (Margaret Hilerding, Marie Langerand, and Caroline Hall). Throughout, Balsam’s tone is refreshingly unfancy, and even irreverent, as she speaks directly to the reader, saying things like, “God (that show-off male who created the earth!)” (p. 22). Finally, as noted earlier, this book is wonderfully personal. For example, we are treated to glimpses of Rosemary growing up in Ireland in a glorious matriarchy or, more recently, trudging through the snow of New Haven in an old coat, looking a bit disheveled and thinking about her patient. As I read this book, it was impossible not to reminisce in detail about growing up in and surrounded by female bodies and of the many important interactions with other women and girls who shape inner life. My guess is that I am not alone in this kind of dream-like reading/reverie.

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