Is every person truly capable of love?
The ability to love may appear innate and natural, yet psychopathology can significantly distort this capacity. Love is not merely a biological function; it is the outcome of emotional development, childhood experiences, and mental health.
Dr. Otto Kernberg, M.D., Honorary President of the International Psychoanalytical Association, concluded in his clinical work that
when personality organization has undergone severe distortions, the capacity for love may take on pathological forms or even become entirely blocked.
Such impairments create profound challenges for psychotherapy. The therapist must address not only symptoms but also the underlying mechanisms that determine a patient’s capacity for intimacy. One of the most striking examples of such difficulties arises in cases of borderline personality organization, where psychopathology manifests with particular intensity.
In some of the most severe cases of borderline personality organization, particularly patients with significant self-destructive and self-mutilating tendencies, or with narcissistic pathology, antisocial tendencies, and ego-syntonic aggression, a remarkable absence of the capacity for sensual pleasure and skin eroticism may prevail. Both male and female patients may experience an absence of any sexual outlet, no pleasure in masturbation, no sexual desire linked to any object, and an incapacity to achieve excitement, let alone orgasm, in sexual intercourse. These are patients who manifest no sense of having established the repressive mechanisms seen in healthier patients (usually neurotic) who might present a repression-based, secondary inhibition of sexual excitement.
These patients are unable to achieve sexual excitement, although they are clearly equipped with a perfectly normal biological apparatus.
Their history of early development conveys the impression that pleasurable activation of skin eroticism was not achieved or was interfered with from earliest infancy. Severely traumatic experiences, physical or sexual abuse, and the remarkable absence of any loving, concerned parental object dominate their history. Often self-mutilation—they pull their skin, hair, or mucosal surfaces—gives them sensual gratification of a kind, but pain by far overrides any evidence of erotic pleasure. Psychoanalytic exploration reveals a world of primitive fantasies dominated by sadomasochistic interactions, and a search for power is the only assurance of security as an alternative to total submission to a sadistic object. These patients have great difficulties achieving the capacity for sensual enjoyment. Paradoxically, psychoanalytic psychotherapy may enormously improve their personality difficulties but may contribute to further consolidating their sexual inhibition by introducing repressive mechanisms. Sex therapists rightly regard these patients as presenting extremely guarded prognoses for treatment.
At the same time, psychotherapy creates the conditions for the gradual integration of the inner world. Through the therapeutic process, patients may develop the capacity for genuine emotional engagement and involvement in relationships.
As Dr. Otto Kernberg emphasized, the integration of primitive, split-off, idealized, and persecutory internalized object relations as part and consequence of psychotherapeutic treatment may make it possible for these patients to develop the capacity for idealization, to long for an idealized relation that may facilitate improvement in their capacity for emotional investment and commitment. They may finally be able to establish a committed love relation, but they typically show no capacity for passionate love.
Clinical Vignette:
A woman in her late twenties was hospitalized because of severe self-mutilating tendencies, with life-threatening implications.
In the past, she had deeply cut her arms, presented multiple disfiguring scars, had burned herself with cigarettes, and seemed to be alive only miraculously after several suicide attempts.
She had interrupted her university studies in the first semester to enter a drifting lifestyle in which she lived with men who provided her with illegal drugs, and she did not experience any sexual desire or sexual pleasure in her intimate relations with them.
On the contrary, extremely suspicious of being exploited by men and, at the same time, tending herself to exploit men financially and emotionally, she obtained sensual gratification only from being held physically while sleeping with them at night or from feeling that they were providing her with drugs without asking questions or making any demands on her other than for her sexual favors.She presented, however, the capacity of loyalty to a man she lived with as long as her demands were met and she felt in control of the relationship; she reacted with sudden devaluation and abandonment of him only when she feared that she was being exploited or treated unfairly.
Her history included physical abuse by her mother and sexual abuse by a stepfather.
Early success in elementary school related to her high intelligence was followed by a gradual deterioration of her functioning because of lack of investment in her work during the later years of high school. She had been part of a marginal, somewhat antisocial group, but had not engaged in antisocial activities other than shoplifting during her early adolescence, which she stopped when she decided it was too dangerous.
This case once again emphasizes that love is a complex psychological phenomenon, shaped by multiple levels of personality development. For psychotherapists, it is essential to recognize not only the patient’s symptoms but also the developmental trajectory through which the individual may gradually move toward integration, intimacy, and the capacity to love.
Less severely ill borderline patients may present the capacity for sexual excitement and erotic desire but suffer from the consequences of their pathology of internalized object relations. The splitting mechanisms of borderline personality organization divide the world of internal and external object relations into idealized and persecutory figures. They are capable, therefore, of idealizing relationships with “part objects.” These relationships, however, are fragile and forever at risk of being contaminated by “all-bad” aspects that may shift an ideal into a persecutory relationship.
The love relations of these patients may present erotic desire along with primitive idealization of the love object. What we find here is the development of intense love attachments, with primitive idealization and a somewhat more enduring nature than the transitory involvements of narcissistic patients. The counterpart of these idealizations is a tendency to abrupt, radical disappointment reactions, the transformation of the idealized object into a persecutory one, and disastrous relations with previously idealized objects. These cases typically show the most dramatic aggressive features in divorce proceedings.
Perhaps the most frequent type of this pathological relationship is displayed by women with infantile personalities and borderline personality organization, who cling desperately to men idealized so unrealistically that it is usually very difficult to get any accurate picture of these men from the patients’ descriptions. On the surface, such involvements resemble those of much better-integrated masochistic women who submit to idealized, sadistic men, but unrealistic, childlike idealization is much more marked in these cases.
(c) Yuliia Holopiorova,
Ukrainian Association of Transference-Focused Psychotherapy