In 2007 a middle age woman came to see me. She told me that she was feeling very tense, never could relax, she said she never felt happy. She was feeling as if her head was exploding. The bright point of her life was her young daughter. She was well educated, nice and kind and compassionate towards her. She was proud of her daughter and said that she was very supportive and appreciative of her.
She was an immigrant and came to the United States at age 18 years old. Among other things she told me she said when she arrived to the United States, she was greeted by her brother and was living with her brother and brother’s wife. She did not feel welcomed there by her sister in-law. Her sister in-law was unhappy by her presence at their home and by different ways implied that she wished her to leave. Under that circumstance she was introduced to a man by a relative. She said that by the coaxing and encouragement of her relatives and pressure by different family members in spite of her reluctance and doubts she married him. Her marriage was significantly influenced by her desire to leave her brother’s home as soon as she could. She described her marriage as an unhappy one and stated that her husband was unpredictable and was demanding, harsh, rude and insulting toward her and toward her parents and relatives. She was feeling sad and angry with him and guilty because she could not make her parents happy as she wished to. She felt helpless, alone and could not invite them to their home and make them proud of her. She said she stayed in this marriage for the sake of her daughter. She said that in front of her relatives and friends she often had to find excuses to justify her husband’s behavior. Later on husband had a nervous breakdown and was unable to work. This was another burden for her. She now not only was trying to find an excuse to justify her husband’s behavior but also had to try to make up stories to pretend as if her husband was working to avoid relatives gossip. She did not want to subject herself to the gossip of family and friends. She herself, however, continued her school and progressed and found a job and eventually became an office manager and was earning a good salary. She was supporting the home both financially and in other aspects of house affairs.
After giving this information to me, she then with some hesitation and trepidation said that she in order to relieve her tension and anxiety, leaves her home and goes shopping. She said shopping gave her some relief. Later in the session I found out that she had episodes of shoplifting as well and she felt deeply embarrassed and ashamed of this behavior. She said that she picks up things that she often does not need. Later on I found out that because of these habits she also had been arrested several times. She was ordered by the Court to seek psychological treatment. She also had attended certain classes and programs, recommended by the Court for this behavior. She said that she was given fines and ordered to perform community service as punishment in lieu of detention and was ordered psychiatric treatment in the past for which she sought treatment and received suggestions and medications. She had followed all these therapeutic suggestions but now she was again in trouble. I found out that now she again was under prosecution for shop lifting for the fourth time. She was dreading the prospect of imprisonment but the possibility of imprisonment was high because of previous similar offenses. She was a respectful woman, an office manager with a responsible job supervising many financial transactions and was respected in her community and in her church. When she saw me in the first session, she already had an attorney. In subsequent sessions I learned that she changed her attorney and eventually found an attorney and later on found another attorney and she was hoping that with consultation and retaining two attorneys she would have better chances to avoid imprisonment. She was referred by the attorneys to see a psychologist who was familiar with court proceedings and necessary reports in such matters. She paid a heavy price to her lawyers and psychologist for reports.
Her mental status examination during the initial visit was unremarkable for any thought disorder. She was a middle aged woman properly and neatly dressed, age appropriately groomed and initially came across friendly and pleasant. As the interview progressed she started to show some anxiety and had episodes of crying spells. She wanted to know why in spite of her awareness of wrongness of stealing and legal consequences of it she was still unable to resist her impulse and had to face the embarrassment and dangers of such a behavior.
Before discussing the treatment and outcome of it in this particular patient, let us review some of the contemporary definitions, concepts and descriptions of this condition, which is called kleptomania.
Kleptomania in the diagnostic and statistical manual of psychiatry DSM IV is defined under the category of impulse control disorder. Under the diagnostic features, the DSM IV defines kleptomania as follows:
“The essential feature of kleptomania is the recurrent failure to resist impulses to steal items even though the items are not needed for personal use or for the monitory value. The individual experiences rising subjective sense of tension before the act and feels pleasure gratification or relief in committing the act. The stealing is not committed to express anger or vengeance, is not done in response to a delusion or hallucination and is not better accounted for by conduct disorder, manic episode, or antisocial personality disorder. The objects are stolen despite the fact that they are typically of little value to the individual who could have afforded to pay for them and often gives them away or discards them. Occasionally the individual may hold the stolen objects or surreptitiously return them. Although individuals with this disorder will generally avoid stealing when immediate arrest is probable, they usually do not preplan the act or fully take into account the chance of apprehension. The stealing is done without assistance from or collaboration with others. The individuals with kleptomania experience the impulse to steal as egodystonic and are aware that the act is wrong and senseless. The person frequently fears apprehension and often feels depressed or guilty about the theft. The disorder may cause legal, family, career and personal difficulties. The kleptomania appears to be much more common in females.”
In the psychiatric text book 8th edition of Kaplan and Sandok, kleptomania is defined and described as; “The essential feature of kleptomania is a recurrent failure to resist impulses to steal objects not needed for personal use or for monitory value. The objects taken are often given away and returned surreptitiously or kept hidden. People with kleptomania usually have the money to pay for the objects they impulsively steal. Like other impulse control disorders, kleptomania is characterized by mounting tension before the act, followed by gratification and easing of tension with or without guilt, remorse, or depression during the act. The stealing is not planned and does not involve others. Although the thefts do not occur when immediate arrest is probable, people with kleptomania do not always consider their chances of being apprehended, even though repeated arrest leads to pain and humiliation. Those people may feel guilt and anxiety after the theft, but they do not feel anger or vengeance. Furthermore, when the object stolen is the goal, the diagnosis is not kleptomania, in kleptomania the act of stealing is itself the goal.”
In psychiatry text books, the etiology of kleptomania, like many other psychiatric illnesses is described in a vague manner. In the textbook of psychiatry it states: “The symptoms of kleptomania tends to appear in times of significant stress, for example losses, separation and ending of important relationships. Some psychoanalytic writers have stressed the expression of aggressive impulses in kleptomania, others have discerned libidinal aspects. Those who focus on symbolism see meaning in the act itself, the objects stolen and the victim of the theft. Kleptomania is often associated with other disturbances, such as mood disorder, obsessive compulsive disorder, and eating disorder. It is frequently associated with bulimia nervosa, in some reports nearly 1/4 of patients with bulimia nervosa met the diagnostic criteria of kleptomania.” Under the biological factors, the book states that brain disease and mental retardation have been associated with kleptomania, as they have with other disorders of impulse control. Focal neurological aspects, cortical atrophy and enlarged lateral vesicles have been found in some patients. Disturbances in monamine metabolism, particularly of seratonin have been postulated.
As one can see there is no meaningful description of the etiology of this illness in the textbooks of psychiatry and this is not only specific for kleptomania but many other psychiatric disorders. This disorder is attributed to a wide variety of postulations. However, this is not the case in Orgonomy and Reichian approach – We will discuss theories and treatment approach in Orgonomy later – for now I will return to describing the client who was suffering from kleptomania and inconsistencies in contemporary psychiatric theories.
The description of kleptomania in the DSM IV, as well as its description in psychiatric text books as the reader may recognize is vague. In the DSM IV as well as in text books of psychiatry kleptomania is described as a recurrent failure to resist the impulse to steal items, even though the items are not needed for personal use or for monetary value. The text book definition and description of it is also similar. However, neither DSM IV nor psychiatric text books describe the origin of the impulse. The text books and DSM IV descriptions do not say where and why this impulse appears in a person. Science and scientific thinking dictates that every impulse must have an origin and must have energy attached to it. Neither of these characteristics of an impulse has been dealt with in contemporary medicine, psychiatry or psychology. The impulse is vaguely defined without description of its characteristics, qualities and its origin. This shortcoming is not limited to the description of impulses in kleptomania, but it exists in all other psychiatric illnesses as well. Medicine, psychiatry and psychology have avoided dealing with energetic aspects of such impulses and source of its emergence. From our point of view that is the reason why the pathologic process, the development of these illnesses are poorly understood and treatment of psychiatric illnesses has been hindered. A recent article in the March 1st issue of New Yorker Magazine titled, “Head Case” by Lewis Menand pointed to disappointing results in psychiatric treatments, is an example of this hinderance. A similar article titled, “The Assault on Freud” was also published in Time magazine November 29th, 1993 regarding disappointing results in psychoanalysis. On the contrary, Orgonomy deals head on with the matters of impulse and energy. Orgonomy considers these impulses, i.e.: impulse to steal as a secondary impulse or drive, the distortions of primary healthy impulses which is distorted because of armoring of the organism. The theory which has been developed in Orgonomy is based on the experimental work of Dr. Reich and also based on clinical observations and treatment trials, which proves itself applicable in clinical work. Our theoretical approach to these impulses is that the impulses originate from the core of the organism, which we regard to be autonomic ganglions in the center of the organism and propagates toward the periphery in a pulsetory manner. As a consequence of persistent outer and environmental inhibitions against expression of natural primary impulses, sexual and aggressive impulses, mechanism of armoring sets in, which permanently prevents expressions of anger, rage, and sexual emotions. The original healthy impulses then split and get distorted and manifest themselves with different neurotic and anti-social manifestations. Schematically in Orgonomy this process is explained as the following schema (courtesy of the Wilhelm Reich Infant Trust):
Our treatment approach is based on these schemas. Ideally the clinician who is conducting the treatment, will need to acquire the knowledge experience and skills of psychoanalytically oriented psychotherapy as well as psychiatric orgone therapy. In restoring the orderly flow of the energy in the organism, to loosening up and removing the armoring and establishing the organismic capacity to express primary and undistorted drives, the clinician finds himself working as an electrical engineer restoring the proper energy flow in the human organism. The ideal psychiatric orgone therapy treatment is considered complete when the armoring is resolved and orderly flow of energy is restored in the body. In such a case patients become capable of expressing primary unadulterated and undistorted impulses as he or she wishes to. Parallel with it, the patient develops sexual potency, potency to love and have genital embrace, be affectionate and in the final stages of treatment develop full orgastic potency. The patients who achieve such a level of health as Dr. Reich has described, attains qualities of Jesus Christ, incapable of lying and incapable of harming.
However, achieving such a level of health is not always possible. In fact psychiatrists and clinicians conducting psychiatric orgone therapy rarely are able to resolve the armor of a patient which is heavily ingrained throughout their lives to achieve full orgastic potency. We often have to content ourselves with resolution of armor to a certain extent. By some resolution of armoring, the patient senses relief and some normality is brought to their lives.
The treatment of this patient started and progressed based on principles of psychiatric orgone therapy, with recognition that stealing impulse was a distortion of patient’s ability to express her primary impulse of anger, rage and sexual drives. The treatment of this patient lasted one year with an average of one session every week. In this vignette I do not intend to explain step by step the treatment process, which has been described in this journal by Dr. Reich with annotation and in other Orgonomy literature by Dr. Reich as well as by Dr. Herskowitz. I only will mention some cardinal points and developments that happened during this treatment process.
I began the treatment of this patient from the most superficial and conspicuous feature of the patient, her facial expression as is customary in psychiatric orgone therapy. Her excessive politeness and apologetic and pleasant appearance was the surface manifestation. This was a feature that had been with her since childhood, she all her life was trying to please others, trying to avoid any confrontation, but at the same time this apologetic and agreeable mask was the mask that was hiding her anger, rage and sadness. As treatment progressed the patient recognized this attitude, events in her life that caused this attitude were expressed by the patient. She recognized her fear of expressing anger, which started from the relation with her own parents and later on with her brother’s wife and then with her husband. She gained insight on her inability to express anger. By the techniques specific to psychiatric orgone therapy her excessive pleasantness, politeness and appeasing attitude was uncovered from her facial expression. She became able to express her anger and frustration toward different people including her husband that she all along was fearful of. Attaining this ability and insight surprisingly translated itself to actions in her life and at her home. She became capable of speaking up against her husband, she even threatened her husband to throw him out and divorce him and to her own surprise, the husband complied and suddenly changed his attitude. She gained power that she all along longed for. She also dared to talk about the oppressive environment that she grew up in since her teenage years. By her ability to express her anger and speaking up against her husband a significant change happened in her life. She became more relaxed and more expressive. During this time with the help of her attorneys she completed her legal obligations properly and became free of legal threats. She also lost the impulse to steal or commit other transgressions, such as frequent traffic violations that she used to do. Several months later she was invited by her relatives to return to her country of origin. She accepted the invitation and went to visit her relative. For a while she kept contact with me and as of the last I knew about her, her condition was stable and she did not have impulses to steal. She, while in treatment, told me with horror that she was assigned to attend programs and saw many people who were attendees of those programs for numerous times without improvement, becoming revolving doors in institutions.
This is one example of thousands, who suffer from such illnesses but because of a poor understanding of the illness by present day psychiatry and psychology, they remain poorly treated, constantly struggling with their impulse, which continues to seek reappearance and ruins their potential to live, work and love. Dr. Herskowitz, in a speech he gave in commemoration of the 50th year of Dr. Wilhelm Reich’s death in Rangely Maine said: “I lived long enough to know that life is too short to be wasted with sickness.”
As described earlier we consider the psychiatric orgone therapy complete when armoring is widely resolved and the patient develops orgastic potency. In the case, which was described, although some resolution of armoring took place, but because of the patient’s departure to her country of origin and interruption of the treatment process , armoring was not adequately resolved. In such cases there is always the danger of reemergence of unhealthy and pathologic impulses as a consequence of redevelopment of the armor. Therefore, we cannot in confidence claim a successful completion of treatment in this case. Nevertheless, considering the educational value and theoretical discussion of it, its presentation was judged to be worthy.