To Outdo or Undo? Siblings and Hysteria

Suzanne Haas-Lyon. Studies in Gender and Sexuality. Volume 8, Issue 1. Winter 2007.

Oedipal Sibling Triangles

Siblings frequently serve as oedipal rivals or prizes for one another. Like relationships with parents, and often as influential or more so, sibling oedipal relationships affect identifications and strivings, whether positively or negatively. Taking the form of oedipal sibling triangles (Sharpe and Rosenblatt, 1994), they comprise two siblings and a parent (or three siblings) and occur in parallel with parental triangles. In a pathogenic version of oedipal sibling triangles, a favored child is recruited by a parent into a spousal position and becomes a primary oedipal rival for the other parent and a sibling (or siblings). The nonfavored sibling may also compete with the parent for the chosen child as oedipal prize.

In my clinical experience, many patients, whether nonfavored or favored children, suffer profoundly from this structure. Their suffering takes hysterical form: their strivings are inhibited, guarded, and fraught, and they often regress from or undo progress toward what they desire in work and in relationships, feeling painfully held back from experiencing themselves as truly adult. Indeed, as I will show, families with oedipal sibling triangles that feature a chosen child tend to cultivate hysteria. First, I have found that parents who suffer from hysteria or hysterical conflicts of their own (regarding sexuality, dependency, and intimacy) often stimulate such triangles. Second, above and beyond the effects of the parents’ internal conflicts, the intensely ambivalent, threatening, and guilt-ridden sibling relationships fostered by these triangles result in hysterical suffering that centrally blocks developmental progress.

To the great disadvantage of such patients, clinicians frequently overlook the sibling relationship and the hysterical nature of the entrenched conflicts. For some time, hysteria has been diminished as a diagnosis, and oedipal sibling triangles, as well as siblings in general, have long been underrecognized in psychoanalytic theory and practice. In treatment, sibling relationships, often central in the patient’s manifest content, must be addressed as a central focus in the transference for the patient to move forward.

My purpose in this paper is to bring attention to and elaborate on oedipal sibling triangles and how they are related to hysteria, in both theory and treatment. I primarily emphasize the role of parental favoritism because, as Bieber (1977) and Sharpe and Rosenblatt (1994) have found, aggressive and libidinal strivings are fraught for both favored and nonfavored children, primarily, because it appears that the only possible positions available are “in” or “out” (see Safer, 2002). However, neither Beiber nor Sharpe and Rosenblatt referred to hysteria. In contrast, J. Mitchell (2000b, 2003) proposed a close connection between siblings and hysteria. In doing so, she essentially clarified that the inhibitions and guardedness associated with sibling trauma are manifestations of hysterical regressions to wished-for maternal care in response to sibling threat. She included having a favored sibling among the factors that engender such trauma.

In this essay, I wish to bring traditional formulations of hysteria into conversation with J. Mitchell’s linking (2000b, 2003) of hysteria and sibling relationships, by adding a focus on oedipal sibling triangles, particularly, those with a chosen child. Taken together, traditional psychoanalytic understandings of the etiology of hysteria, and the profound influence of siblings in respect to hysteria, can powerfully illuminate these triangles.

I focus on the case of a patient who suffered from hysteria and whose sibling was a primary oedipal rival and prize and became the basis of her choice of intimate partner. This patient’s plight resembles that of many others with whom I have worked. I pay particular attention to sibling transference, which was characterized by intense envy, guilt, and competitiveness and which involved negative therapeutic reaction. As so often happens when treacherous waters are ventured on, addressing the sibling transference and countertransference was vitalizing, difficult, and essential to the patient’s progress.

Siblings and Strivings in Psychoanalytic Literature

Freud’s remarks (1900) about siblings focused primarily on the intensity of rivalrous wishes: “Children are completely egoistic; they feel their needs intensely and strive ruthlessly to satisfy them-especially as against the rivals, other children, and first and foremost as against their brothers and sisters” (p. 250). In addition to characterizing children’s mental states, he observed their unconscious productions: “In none of my woman patients … have I failed to come upon the dream of the death of a brother or sister” (p. 253). Further, Freud noticed similarities between his own formative fraternal relationships and his fraught collegial relationships. He suggested that sibling transference was possible. Yet, despite these observations and his recognition of infantile murderousness, Freud did not theorize that the murderous wishes toward siblings might in themselves significantly affect psychic structure. Although he alluded to wishes for and fantasies of sibling incest in his self-analysis, he did not suggest that they could have such effects either. Rather, Freud’s conception of the Oedipus complex as the shibboleth of psychoanalytic theory largely excluded siblings as significant contributors to psychic development. In his view (Freud, 1916-1917), the Oedipus complex simply becomes extended to siblings as a family complex.

In retrospect, Freud underrecognized siblings in psychoanalytic theory, perhaps at least in part because his own sibling experience was complicated, confusing, and traumatic. Indeed, that he mentioned none of his seven siblings in his autobiography is telling. Agger (1988), Breger (2000), and J. Mitchell (2000b) have spoken to aspects of Freud’s experience that, they suggested, could have been so threatening as to cause a blind spot about siblings that affected his theory and collegial relationships. Regarding the latter, Freud favored followers who remained loyal, admiring “sons.” He severed relationships with those who expressed differences and who appeared to seek lateral, brotherly collegiality (e.g., J. Mitchell, 2000b). Freud’s sibling experiences included an intensely close and competitive relationship with his nephew, a sibling surrogate, who was one year older than Freud was; the death of his first brother, Julius, when Freud was about 18 months old; and, at two years old, losing his nursemaid, who had been his most consistent maternal object, when his next sibling, Anna, was born.

In my view, Freud’s family contained oedipal sibling triangles, the most significant of which being Freud as his mother’s chosen son. In another triangle, Freud’s sister Anna, whom he particularly disliked, was apparently their father’s favorite (Heller, 1956). Freud’s assumption that parental favoritism was an undamaging given-he saw it as being natural for the mother to favor the son and for the father to favor the daughter-derived at least partly from his family experience. He theorized that this “seduction” stimulates the child’s wish to possess the parent for himself or herself, thus ushering in the oedipal phase.

In this essay, I consider sibling relationships in psychic as well as external reality. For the most part, psychoanalytic theory and practice have viewed sibling relationships as displacement from what is usually considered the more threatening parental transference. They have not been regarded as significant internal objects. In her summary of the sibling literature, Colonna and Newman (1983) remarked that siblings are so absent that there is not a single reference to them in the index of the Standard Edition (Freud, 1871-1940). This is not to suggest by any means that Freud and his followers were solely responsible for the marginalization of siblings in psychoanalytic theory. Other major theorists who did address aspects of sibling relations, such as Kohut (1971), Klein (1961, 1975), Sullivan (1953), and Winnicott (1964), considered them much less influential than parental relationships (see also Lesser, 1978; Colonna and Newman, 1983; Rosner, 1985). In a paper entitled “Les complexes familiaux dans la formation de l’individu” (The family complexes in the formation of the individual), Lacan (1938) identified an intrusion complex, in which the child realizes that he or she has siblings, who also have the parents’ attention. However, this complex almost entirely disappeared in Lacan’s work in which the Oedipus complex was fundamental (Evans, 1996).

In a 20-year period from the late 1970s onward, somewhat more attention was trained on the effects of pathogenic sibling relationships and the importance of addressing sibling transference and countertransference (Bieber, 1977; Lesser, 1978; Bank and Kahn, 1982; Rosner, 1985; Agger, 1988; Graham, 1988; Des Rosiers, 1993; Sharpe and Rosenblatt, 1994; Volkan and Ast, 1997; Shechter, 1999). Out of this work came the vital understanding that sibling relationships are significant internal objects: the feelings associated with them can be excruciatingly intense and ambivalent. On the one hand, the sibling is a longed-for mirror/soul-mate (such as the imaginary twin), whom one wants to be loved as one wants the self to be loved. Extending from this mirroring, siblings become powerful objects of identification and can be vital attachment figures. On the other hand, the sibling is the object of the most murderous wishes possible. Moreover, the destructive and loving, aggressive and libidinal, feelings that siblings arouse are all the more frightening and guilt inducing because they are actually or potentially less contained than they are in relation to a parental authority (e.g., Bank and Kahn, 1982; Sharpe and Rosenblatt, 1994). That children usually spend more time with each other than they do with their parents intensifies these passionate affects (Graham, 1988). One reason that sibling relationships have been overlooked may be that the feelings associated with them can be so threatening.

The intense guilt about murderous and incestuous wishes toward siblings may result in guardedness or profound inhibitions in strivings. As shown by Agger (1988) and others (Bieber, 1977; Lesser, 1978; Bank and Kahn, 1982; Rosner, 1985; Graham, 1988; Des Rosiers, 1993; Sharpe and Rosenblatt, 1994; Shechter, 1999), pathological sibling relationships often affect oedipal resolution, strivings and intimacy, separation and individuation, and Erikson’s stage of initiative versus guilt. Achievement aversion and negative therapeutic reaction are frequently associated with siblings. The above authors observed that sibling transference and countertransference are commonly characterized by intense envy, jealousy, rivalry, and guilt.

The degree to which sibling relationships are influential, either positively or negatively, depends on many variables, including age and gender; circumstances of sibling births, sibling deaths, and disability; parental projections and availability; family circumstances; culture; and so on. According to Bank and Kahn’s comprehensive overview (1982), the two factors that are most consistently associated with influential sibling relationships are high access during the formative years (identical twins are highest access, being of the same age and gender) and parental influence on the sibling relationship. Graham (1988) suggested that when sibling relationships are pathogenic, the parental effect is probably large.

Bieber (1977) paid special attention to the pathogenic effects of parental preference on sibling relationships. He described how children, both favored and nonfavored, experience difficulties with guilt, envy, competition, strivings, and intimacy. Each child develops the belief that the only possible positions available are “in” or “out.” This splitting is exacerbated if the parent also splits and projects idealized aspects of himself or herself (or his or her sibling objects) onto one child and devalued aspects onto another child (see Safer, 2002). Both children feel pressure to perform, because being chosen seems to depend on it. As I discuss later, to the degree that this parental splitting is associated with hysteria, to that degree is this sibling-related hysteria likely.

The sibling who is “in” feels superior and suffers from primary grandiosity, almost like royalty. However, guilt about doing better than her or his sibling and fears of her or his sibling’s envy can make the “in” sibling hold herself or himself back. On the other hand, she or he guards this position, because, if displaced, the only other position is “out” (Bieber, 1977). The nonpreferred child, feeling inferior, uses omnipotence as a defense. She or he is hostile, envious, and intensely competitive, usually unconsciously. Yet she or he may well admire the favorite. The nonfavored child is overly compliant and badly needs to be accepted by the parent and sibling. She or he may manifest this dilemma by helping the favored sibling shine while holding herself or himself back as a way to allay anxiety about hostile wishes and to protect herself or himself from personal guilt that, if successful, she or he will displace the favored sibling into her or his own second-class position.

It is helpful to think about these dynamics in terms of oedipal sibling triangles, which Sharpe and Rosenblatt (1994) defined as the following:

triangular relationships among two siblings and a parent, or among three siblings, that are sufficiently similar to the standard oedipal triangle …to warrant their being described as “oedipal-like.” …Such relationships may exist parallel to and relatively independent of the oedipal “parental” triangle. Moreover, they often exert definitive influence on the individual’s later identifications, choice of adult love object, and patterns of object-relating. (p. 492; italics added)

According to Sharpe and Rosenblatt, “sibling relationships are autonomously generated and often normally culminate in oedipal-like constellations” (p. 515). Thus, the authors proposed a developmental line of sibling object relations involving a separation/individuation process that progresses from the dyadic to the triadic, such as that which occurs in regard to parents.

Sharpe and Rosenblatt (1994) contended that oedipal sibling conflicts can be more entrenched and difficult to resolve than parental oedipal struggles. In particular, the child is more motivated to give up parental oedipal wishes because he or she depends on the parent. Further, sexual wishes toward siblings are more realistically attainable, and aggressive wishes are better tolerated in relation to siblings than to parents. At the same time, defeat by a sibling peer can be more crushing and narcissistically wounding than that found in a relationship to a mature and powerful parent, whom the child can view as being “out of [his or her] league” (p. 506).

Echoing Bieber’s arguments (1977) about the effects of parental favoritism, Sharpe and Rosenblatt (1994) identified a particularly pathogenic form of oedipal sibling triangle, which is the focus of the clinical account related here. In it, a child is recruited into a spousal position and becomes a primary oedipal rival and prize for the rival parent and a nonfavored sibling. The favored child bears the burden of being the victor in regard to a parent and a sibling, and the nonpreferred child may feel without a place. Each feels strongly that she or he can be only “in” or “out” relative to others, overvalued or devalued in ways that determine closeness or distance. Because there may be more than one oedipal sibling triangle in a family, a child may be preferred in one triangle and nonpreferred in another and may have characteristics of children in both positions.

In Mad Men and Medusas: Reclaiming Hysteria (2009b) and Siblings: Sex and Violence (2003), Juliet Mitchell linked sibling relations to hysteria. She deemed the twin absences of these two phenomena from the past half century of psychoanalytic theory and practice to be related: neither sibship nor hysteria, she argued, can be fully understood apart from each other, for when experienced as being traumatic, the threat of being displaced by a sibling results in hysteria. Recognizing the conflicts produced by pathogenic sibling relationships as hysterical allows for an integrated understanding of why and how sibling relationships affect psychic development and structure.

In hysteria, the child is caught between the maternal dyad and the world of the third, or the father. Unresolved sexual conflicts and unmet dependency needs reverse progress made toward oedipal resolution and generate regression to the comforting mother. In J. Mitchell’s view (2000b, 2003), hysteria is characterized by repeated alternations between overassertion or dramatization of the self and regression from, inhibitions in, or undoing of strivings. Regression may involve substance use, eating disorders, or somatization. J. Mitchell’s contribution is to argue that the regressed desire for the mother, which characterizes hysteria, is motivated by the threat of being displaced by a sibling. The presence of the sibling produces “the catastrophic awareness that one is not unique,” and this devastating recognition “triggers the onset of hysteria” (2000b, p. 20). What makes sibship a psychic crisis is that the sibling is a desirable and dangerous replica-a soul mate and, horrifyingly, a potential replacement. J. Mitchell argued that the threat of being displaced by a sibling is always a catastrophe but, beyond that, can be experienced as a trauma. If so, hysterical suffering persists. The child continues to protest the law of the father, which prohibits incest, and cannot give up the wish to possess the mother for himself.

According to J. Mitchell (2000b, 2003), the crux of the child’s experience is that someone else not only seems to be the same as him or her but has a place that he or she cannot occupy. For the older child, the catastrophe is the birth of a sibling; for the younger, the realization that he or she cannot be the older sibling. If there are no siblings in the family, the threat of annihilation by siblings is experienced through fantasies about siblings or through relation to peers (Arlow, 1972; J. Mitchell, 2000b, 2003). The perceived absence of place or position excites annihilation anxiety, to which humans are vulnerable because of the terror of infancy’s helpless dependence on the maternal object for survival. The threat to one’s sense of existence makes for the most intense states of mind: “To miss out on the importance of siblings is to miss out on the place of death. …The wish to kill siblings or the sense of being annihilated as a unique subject by [the presence of siblings] is a crucial aspect of the human condition” (J. Mitchell, 2000b, p. 76; italics added).

In the face of the sibling catastrophe, the child feels desperate to be the only one in the mother’s eyes (or the eyes of the parent representing the mothering function) and, in the hope of achieving this place, regresses to being smaller or younger. Underlying the child’s wishes to possess the mother and displace the sibling is the longing to be seen as a unique subject, which is at the heart of hysteria.

In J. Mitchell’s view (2000a, b, 2003), the law of the mother can help the child overcome the threat of displacement and thereby move forward securely and realistically. The law of the mother has two aspects. First is the enforcement of boundaries between children and the mothering function itself: the mother prohibits parthenogenetic fantasies, or the fantasy of having babies of one’s own by oneself. These fantasies of identification with the mother, on the part of boys as well as girls, defend against the threat of displacement by a sibling. The law of the mother deflates the child’s fantasies per se and, I would add, prohibits the grandiose pseudoindependence that flows from them. The second aspect of the law of the mother is the assignment and enforcement of appropriate lateral boundaries between siblings in regard to gender, age, place, and position.

The hysteric, however, is unable to relinquish protests against the law of the mother, as well as those against the law of the father. He or she cannot give up the wish to have the parent to himself or herself, which entails wishes to displace both the sibling and the parental rival.

Turning now to oedipal sibling triangles in which a favored child has been recruited into a spousal position, we can see how traditional psychoanalytic understandings of hysteria’s etiology interface with J. Mitchell’s linkage (2000b, 2003) of hysteria and sibship. Hysteria may arise when generational boundaries are weak and when, in the parent, sexuality is conflicted and dependency needs are left unmet. Under these circumstances, the relationship with one parent, often the one representing the mothering function, becomes too close, whereas the other parent is distant or excluded from the dyad (e.g., Bollas, 2000). To put this another way, a parent who is incapable of genuine sexual intimacy may emotionally seduce a child into a spousal role as a safer and more dependable object than the actual spouse.

At the same time, however, unclear intergenerational boundaries place the child in an overvalued position relative to siblings as well as the spouse. Whereas in classical formulations of hysteria, the law of the father is compromised, in such oedipal sibling triangles, neither the law of the father nor the law of the mother is enforced. Although displacement from the parental oedipal relationship may play a part, the sibling becomes in large part the primary oedipal rival or prize.

Encountering the Sibling Monster: Clinical Considerations

Ruth, a patient who suffered with hysteria, had as her primary oedipal rival and prize her older brother, who was their mother’s chosen son. Although that oedipal triangle was the principal focus of treatment, Ruth was also involved in sibling triangles in which she was favored. As manifested in treatment, being unfavored in one triangle and being favored in another contributed powerfully but differently ‘ to her inhibitions.

I saw Ruth in psychoanalytic psychotherapy over several years. Because of anxiety about her progress, Ruth interrupted her treatment for a year and then ended it prematurely. Sibling trauma is often associated with negative therapeutic reaction; however, the work with Ruth was more difficult than it might have been otherwise because it was during her treatment that I became deeply aware of the significance of sibling relationships. I came to my understanding primarily through psychoanalysis that I entered into one year after I began working with Ruth, in which I focused on my own sibling relationship. As I address, there are things that I would do differently if I were working with Ruth now. I use this case because it vividly illustrates the necessity, pitfalls, and vitality of addressing sibling transferences and counter-transferences.

An attractive woman in her early 40s, Ruth sought psychotherapy because her husband had an affair. The betrayal was particularly devastating because Ruth had emotionally and financially supported her husband in his creative work, at great cost to herself. In Ruth’s work as well as her relationships, she eagerly tried to please and attend to the creativity of others in the hope of receiving recognition, but she eventually resented the inevitable lack of reciprocal attention to her needs and strivings. Ruth said that she was attracted to men like her husband for “their energy, focus. They knew what they wanted. I was more like that myself when I met them; then I’d have a sense I was feeding on them.” While yearning for pursuits of her own, Ruth felt powerless to acknowledge or act on her desires. She had not experienced sexual desire for some time.

From the beginning of treatment, Ruth connected her narcissistic husband to her self-centered older brother, Tom. As a child, Ruth idolized Tom and yearned for his admiration. However, when she sought Tom’s attention, he would tease her, in Ruth’s words, pooh-poohing her as being stupid for everything that she said. To add injury to insult, he would hurt her by twisting his finger into her back. Ruth described their mother as having a classic first-son relationship with Tom, in which he could do no wrong. Tom’s aggression toward Ruth was dismissed as harmless, whereas Ruth found her mother intolerant and threatened if Ruth expressed anger and rivalry. Ruth became paralyzed by anger, whereas her husband and brother personified it.

As eldest daughter with two younger sisters, Ruth identified with her caretaker, self-effacing mother, who was always in the wings. Her mother contributed to this identification in various ways. Ruth felt that, in addition to her mother’s allowing Tom to put down Ruth’s strivings, her mother neglected Ruth’s wishes for help with or attention to her creative endeavors. And when Ruth was absorbed in such endeavors, her mother interrupted her with demands to help with household tasks. However, perhaps due to the identifications between the mother and Ruth (which, burdensome as they were, also provided gratification), an angry, needy, and less attractive younger sister regarded Ruth as mother’s favorite, creating another sibling triangle. Moreover, Ruth was an object of sibling envy because her mother promoted the idea that Ruth was the father’s favorite among the children.

Ruth regarded her father with disgust and pity. His profession suggested strong character, yet he was infantile, weak, and distant, and he had numerous affairs. Ruth’s attitude toward her father was also intertwined with her identification with her mother, who was disgusted by sex and spousal demands for it.

Overall, Ruth felt invisible in her family, whereas others stormed around and made demands. Yet, Ruth felt guilty because her life was more successful than that of anyone else in her family. Her brother and her jealous sister developed addictions, became overweight, and fared poorly in relationships and work.

In her relationships, Ruth fervently focused attention on others, imparting a degree of availability and intimacy both unexpected and flattering. For example, she found herself gushingly engaged with strangers who asked for directions. This false self eagerness to please would be followed by relieved and guilty retreat from the other. When she began treatment, Ruth’s anger and her longing for attention were somatized, denied, undone, or otherwise obliterated, as occurs in hysteria. For example, Ruth would be notably solicitous and accommodating regarding vacations or other manifestations of my needs and strivings, even experiencing them as exciting. Her excitement would then be followed by report of a sore throat or flare-up of pain in her leg (the latter was a physical condition for which she was receiving essential medical attention, but it was exacerbated by repressing emotion). This bodily suffering, which could eventually be verbalized, represented Ruth’s experience of feeling painfully and infuriatingly held down, held in, and held back when she wished for vital attention to her needs and strivings.

Ruth’s repression of such wishes and feelings were inextricably intertwined with guilt, envy, jealousy, and rivalry related to siblings. For example, the first time that I commented on Ruth’s solicitousness about an upcoming vacation, she said that no other response was justified because she was lucky to have me, relative to others in her family. Guilt and fear of envy extended to sibling patients. When early in therapy Ruth got a more lucrative job that allowed me to increase her fee, she immediately expressed relief that she would no longer be getting “more than her share,” which she associated with guilt in relationship to her envious sister.

Although fear of being favored constricted Ruth, her inhibitions were primarily intertwined with her position in relation to her favored brother. After Ruth expressed excitement about leaving her job and seeking the aforementioned, more satisfying and rewarding job, she dreamt of a monster that looked like a pig, hairy and fat, associated with Tom. But the face was of a lion. Ruth said that although she is a Leo, she did not feel comfortable with her strength or authority. She identified as a crab, Cancer, humble and in hiding. Chronic fear that she had throat cancer expressed her conflict about asserting her voice and authority. Ruth then recalled how years previously, a male boss, threatened by her competence and initiative in undertaking a significant project, had “shot her down” and how she felt “killed” inside. Traumatized by this reexperiencing of her masochistic relationship with Tom, Ruth held herself back in her work ever since. Ruth dreaded being punished or annihilated if she asserted her authority, creativity, or sexuality. She feared being greedy and destructive like Tom, as well as wanting to be so.

Excitement about going forward, followed by anxiety and attempts to undo her progress-which so painfully characterizes hysteria-recurred often in the therapy. For instance, although Ruth initially related to me as an idealized maternal figure, she most frequently replayed in the transference the triangle of her brother, who wished to crush her strivings, and her mother, who discouraged or failed to support them. We came to know well another version of this repetition, in which Ruth would attempt to undermine her own insights. Her great excitement upon discovering her initiative, creativity, and authority would be quickly followed by internal pressure to do more, which in turn led to a feeling of complication and overwhelm rather than to a sense of progress or mastery. Ruth would then turn to me for help in sorting things out. In so doing, Ruth attempted to put herself down, as Tom had done to her (e.g., “Who do you think you are? “That’s just your stupid opinion”) and to place me in the position of dominance that Tom required. At the same time, asking for help represented a regression to helplessness, like that of the baby, to stay attached to me as the maternal figure, whom she imagined needed to be in the role of helping and tidying up to feel valued and remain available (and who needed Ruth to be in such a role as well).

For a time, I found myself in an enactment, caught up in Ruth’s confusion, working hard with her to try to unravel it. My part in this enactment was related to my own sibling experience, which mirrored Ruth’s. My father had favored my younger sister. I attempted to receive his attention through helping and supporting her while unconsciously yearning to displace her and be the star. I accepted the role of expert from Ruth partly unaware because I wished to shine and to lord it over her, as had Tom. And I felt I could do so through being an eager helper, like Ruth.

When I instead addressed how Ruth’s confusion represented retreat from her insights and initiative, she disclosed that she envied me the role of therapist, a profession that she had wished to pursue but felt she could not aspire to. Although Ruth was intensely anxious about her competitive feelings, her revelation was followed by a burst of creativity such as that she had not experienced for 20 years. She recounted how, as a child, she had been set up not to pursue her own desires. Rather, she lived them through others.

Interestingly, Ruth began therapy when I was in postdoctoral training, which, I see now, could have re-created the experience of living her aspirations through a sibling object. Her underlying envy and rage about being in her sibling’s shadow had arisen vividly in a dream that she reported when I began my practice and moved into a new office. Although outwardly excited about the move, Ruth dreamt of being with her ex-husband, who was seated, and with two kneeling women, who were stroking his foot. She was angry and wanted to leave but was powerless. Ruth felt as though she was supposed to stroke me as I moved forward, as she was meant to join her mother in supporting Tom’s initiative. She feared that her position was “out,” defeated and unable to pursue her own ambitions.

Ruth also reexperienced the sibling triangle in couple therapy, to which I referred her and her husband. Predictably, Ruth found the woman therapist and her husband engaged with each other, whereas she felt invisible. I served as a maternal presence who gave Ruth permission to make a place for herself in the triangle. As we explored why Ruth held herself back from doing so, she became anxious that she would interrupt a special connection between two others. Subsequently, she acknowledged her wishes to break the connection and to have the attention herself, which she experienced as relieving and freeing. However, profound shame accompanied these wishes, because Ruth feared that her husband would feel as forgotten as she had been forgotten.

Five years into the treatment, Ruth’s underlying dread and fury about feeling forgotten, unrecognized, and displaced in relation to siblings erupted in pivotal dreams, which precipitated a one-year interruption in the therapy itself. For several months, Ruth had been making progress, and she was pleased and excited. She was seeking a competitive job commensurate with her worth and was beginning to desire a sexual relationship with her husband for the first time in years. I had an upcoming vacation. Ruth had also planned a vacation, to begin shortly after I returned. Subsequently, I informed her that I would be away again later in the summer.

In the session preceding my first vacation, Ruth said she felt “stressed and depressed, like a sob is caught inside.” She related these feelings to her husband’s interrupting the emotional intimacy that they had been experiencing, by turning his attention to work. I asked whether her feelings could also be related to the upcoming interruptions in our intimacy. Ruth replied that, on the contrary, it would be a relief to have time alone. I wondered if my inquiry felt as though I was asking for attention. Ruth suddenly became intensely anxious that she could have hurt me. Upon my return, Ruth reported having had one of the most disturbing dreams of her life. She reported this dream with considerable anxiety yet with a sense of underlying satisfaction:

A little boy is in intolerable pain, and I feel I must end his misery. He wants to die. I jump up and down on him but don’t succeed in killing him. I feel mortified that, instead, I hurt him more, in this terrible way. Then I have a wonderful meal in a restaurant and get my hair done.

Ruth associated first to her brother and father, who stomped like children when angry or frustrated, unable to verbalize feelings; she was crushing her own feelings. When I inquired whether she might be crushing responses to my vacation, Ruth said that she felt mortified that she might have hurt me in our previous session by not caring whether or not I was available. When I wondered if she might have experienced my absence as not caring about her, Ruth denied this possibility. She feared that if she felt hurt or angry, I, like her mother, would be harmed and she would need to take care of me. However, with the words “I want to live!” Ruth left with excitement for her vacation, in which (as the dream predicted) she enjoyed and nurtured herself to an extent not previously possible, culminating in intercourse with her husband.

This next dream preceded my second vacation: “Little boys are being taken away and eaten. I am the only one who’s concerned and ready to act.”

Ruth felt that the little boys represented her “little boy parts”-anger, authority, competence, initiative, strivings-being eaten up at her job. With some vehemence, Ruth then associated little boys with “being able to do anything you want (be the boss) and get away with it.” She went on to express envy of a woman who can set limits, preserve time for her family and personal growth, and be aggressive and still have people like her. She lamented, “I may never achieve that focus in my lifetime.” I challenged Ruth’s polarized view. But rather than take up the probable reference to myself, I wondered about Ruth’s squashing angry and competitive feelings toward boys and her brother, as represented in the dreams. Ruth was quite struck and ended the session with intensely charged anger about a demand Tom had made.

When we resumed, Ruth disclosed that she missed therapy because she felt that she was making progress. She also felt anxious; her leg hurt more; and she suddenly announced needing to take a break from treatment due to finances. I inquired about anger and hurt in regard to the break. I wondered if she was punishing herself for making progress or if she experienced my leaving as abandoning or punishing her for her progress and her needs. I also confronted Ruth’s plea of helplessness, given her contemplation of a more lucrative job. Despite such interpretive efforts, Ruth’s defenses against anxiety won out, and she disappeared tearfully from treatment.

This therapeutic crisis, not surprisingly, represented an intersection of primary vulnerability (Elkind, 1992), for me as well as Ruth. Like Ruth, I had lived in my favored sibling’s shadow and held myself back, and I was in the midst of making hard-won progress. Through recognizing my murderous wishes and fears about outdoing my “sibling” analyst in my own work, I had begun to make a place for myself professionally through teaching and presenting on sibling relationships. I thus experienced Ruth’s rage, envy, and dismissal as a crushing attack on my strivings, as she had felt attacked by me. Fear of my own anger inhibited me from fully recognizing and normalizing Ruth’s murderous wishes.

Thus, I could not suggest that Ruth wished to hurt me, to kill me off, to triumph. For why would she not wish to displace me, if it felt to her like only one of us could assert a “little boy self”? Why would such wishes in themselves be so destructive? Why can we not each have a place? Ruth may well have been too anxious to take in such potential interpretations. But because of my own anxiety, I could not provide them. Instead, I had in effect retaliated as Ruth had.

Ruth resumed therapy a year later, when her body worker (with whom she had perhaps replaced me) advised her to do so because the pain in her leg had intensified and represented a blockage. An opportunity to revisit the anxieties that precipitated the interruption soon arose when I had an upcoming vacation. I reminded Ruth of the dream of stomping on her feelings and leaving treatment at just such a time. When I returned, Ruth said that she had thought about my absence and reported big changes. She saw her brother and spontaneously expressed intense anger toward him in response to his disregarding her-in Ruth’s words, “making me feel like I don’t exist. It made me feel better. I jumped all over him.” Shortly after this breakthrough, Ruth became aware of not feeling present in her body around her brother and husband when she felt left out and invisible. Subsequently, we were able to relate the exacerbations of Ruth’s somatic symptoms with her dissociated anger and her wishes to be seen.

Ruth was responsive when I suggested that my absences might make her feel invisible and that perhaps she experienced interruptions as punishment and rejection of her strivings, competitive feelings, anger, and needs. Ruth recognized that she was envious and angry because she felt she could not take a vacation or pursue work that she was interested in, as could others, such as myself. She recalled always being interrupted in pursuits such as dancing lessons. In Ruth’s words, “my parents would say they would help me with anything but then would balk at the money.” As Ruth became animated about expressing her hurt, anger, and wishes in regard to me, she became anxious that she would be unfair, ugly, and demanding like her siblings-an archetypal demon, twisted and warty-whereas she was supposed to be pretty.

Nonetheless, in the midst of this vital period, Ruth told me with excitement and joy that she had a creative idea for a project. In her words, such “wanting to want” (see Elise, 2000) had been missing in her life. She related this change to having expressed her anger to Tom, who was taken aback but responsive. Ruth said that “it felt awful” for her anger to emerge unforeseen but yet also “like triumph!” Ruth expressed feeling spontaneous as a result of confronting Tom. She felt that he had less power over her, and she recognized his vulnerability. She spoke with compassion about how she and Tom were alike in many respects but that he had not been able to be social and Ruth had not been able to express aggression. She wished to talk to Tom about the effect that the family had on them. Ruth recognized that because Tom had been put on a pedestal, like royalty, he felt vulnerable when not idealized.

I focus on the sibling triangle involving Tom because it was the most powerful in Ruth’s psyche and in the therapy. However, crucial material related to Ruth’s envious sister emerged in the tumultuous period surrounding absences. In essence, Ruth became aware that, rather than be excited about my vacations, she resented feeling guilty about being the lucky child. On the contrary, her fantasies had been that I was going away with my husband and child, leaving her behind and burdened with the care of needy siblings. Her wish was to have me to herself.

As a result of the pivotal reworking related to siblings, Ruth went on to a more competitive job and immediately initiated paying me my full fee. Shortly thereafter, Ruth had a dream about frightening alien beings that possessed people. Once possessed, one became like these creatures, which meant that one could do whatever one wanted. In the dream, Ruth felt less frightened as she interacted with them, but she worried that if she were to do what she liked, she would be seen as an outsider, as they were. She associated the aliens to her siblings and expressed fear that if she took initiative at work, she would be fired.

Following the session in which she related the dream, Ruth phoned to say that she needed to take a brief break from therapy due to finances, that money had gotten out of control. At my suggestion, she came in nonetheless. I wondered if Ruth was interrupting therapy again partly because she anticipated being interrupted, punished, and alone at a time when she was moving forward. Ruth realized that she was depriving herself of therapy partly in defense against anxiety and anger that her husband was not doing as well as she was, financially and otherwise. She became excited about allowing herself to continue, attending to her own needs and aspirations, rather than holding herself back to protect her husband. However, she was anxious that she would be out of control like the other-worldly creatures in the dream and that, if she were strong and powerful, she would be put down or used.

Ruth’s anxiety was manifested in backpedaling on the fee increase. She would forget to include it in her check, or she would fail to pay me on time. When we addressed these lapses, Ruth felt that she had probably jumped the gun in proposing the increase just as she began the new job. If I were working with Ruth now, I would suggest that, although concerned about scarcity, she might be more anxious about being successful and powerful in relationship to me, as represented by the full fee-and I would not have allowed her to backpedal. Instead, I agreed to decelerate the timetable for the increase (which was being implemented in steps, at Ruth’s request), in effect colluding with her experience of scarcity. Material followed about Ruth’s feeling controlled and infantilized at work. My announcement of a vacation was apparently the last straw. Immediately thereafter, Ruth phoned to say that finances were an insurmountable obstacle and that she had to take a break. She did not respond to my following up, nor did she resume treatment.

In retrospect, accommodating the fee constituted a putdown of Ruth’s initiative. It communicated that I did not wish to view her as being powerful and creative and that I was threatened by her competitive, aggressive, and libidinal wishes toward me. In the sibling countertransference, I was again anxious about my anger at being devalued and dismissed. Moreover, I feared becoming successful in my work, as represented by Ruth’s progress and earning my full fee, because of competitive wishes to displace my own analyst. Fears and wishes about being a sibling monster on my part, as well as Ruth’s, derailed important progress.

Integrating the Sibling Shadow

It is wrenching for us as psychotherapists to have a treatment end as Ruth’s did. However, Ruth’s therapy does profoundly illuminate the intense ambivalence and annihilation anxiety that are often evoked in sibling transference and counter-transference. I elaborate on treatment issues as illustrated by the case and then turn to theoretical considerations concerning the etiology of hysteria.

To know and act on her feelings, aspirations, and desires, Ruth needed to integrate the aggression and all that it was associated with-initiative, authority, creativity-that had been split off and projected onto her siblings, particularly, her brother. The process of change in regard to such sibling relationships always involves reclaiming aspects of the self that had been presumed to be the territory of siblings (Bank and Kahn, 1982; Rosner, 1985; Agger, 1988; Graham, 1988; Des Rosiers, 1993; Sharpe and Rosenblatt, 1994) and that had appeared to be available only by living through or shadowing sibling objects (Agger, 1988). Becoming separate required Ruth to de-idealize and de-demonize her brother, husband, and me and begin to ask more for herself. When Ruth expressed anger at Tom and he was responsive, she recognized that she was not the destructive monster that her siblings had represented. She also recognized that Tom was vulnerable as well. He feared that if he was not royalty, he would not have a place, contributing to his difficulties in the social arena in which Ruth excelled. In other words, Ruth was able to recognize that she was not unique, nor were she and her siblings replicas (J. Mitchell, 2000b, 2003). Rather, self and sibling were alike and different (Bank and Kahn, 1982; J. Mitchell, 2000b, 2003).

Because of the intense ambivalence of the sibling relationship and transference, negative therapeutic reaction is common. Ruth feared that, to have a place, she needed to annihilate and displace her siblings and sibling objects in the way that she had felt displaced and interrupted in her strivings by her siblings. And she was intensely anxious about her wishes to do so. As often occurs in relation to siblings, Ruth fantasized that her aggression was monstrous, consuming, and overpowering. Ruth could go forward when she experienced that she and I (I as sibling and maternal figure) could survive and go forward in mutual recognition.

When oedipal sibling triangles are repeated in the transference, the therapist or analyst may shift rapidly between standing in for the sibling and standing in for the parental figure, or the therapist or analyst may be both at once. For example, when Ruth undid her excitement about her insights because of competitive wishes to be the therapist, I was the brother who needed to be on top in the transference; simultaneously, I was the mother who was threatened by Ruth’s competitive strivings and who needed Ruth to be dependent on her and identify with her as a caretaker. Further, the parent and the favored sibling can each be oedipal rival and prize (Sharpe and Rosenblatt, 1994). Ruth competed with her brother for her mother’s attention (negative oedipal) and with her mother for her brother’s attention (positive oedipal).

The parental transference in regard to such oedipal sibling triangles involves fears that the therapist could be seductive or rejecting, favoring or nonfavoring. The analyst or therapist must recognize, normalize, and accept the patient’s wishes to annihilate the sibling and be the only one, while disillusioning the omnipotent, frightening, and suffocating fantasy that she could actually do so.

The intersubjective turn in psychoanalysis allows the therapist or analyst to feel freer to recognize the lateral sibling transference and countertransference than was possible when the ideal of analyst as neutral authority held sway. However, doing so involves coming to terms with one’s own sibling ghosts. Otherwise, the therapist retreats from sibling transference into the power and authority of the parental role (Schecter, 1999), perhaps tinged with hostility arising from sibling rivalry (Lesser, 1978), when a more lateral position is called for. This occurred when I accepted the role of expert that Ruth evoked when she was anxious about her competitive wishes to be a therapist. On the other side of the coin, unconscious hostility and guilt related to siblings inhibit the psychotherapist from asserting authority when it is required. As stated by S. Mitchell (1997), influence and authority are inherent and necessary in the position of analyst; grappling with the frame or the limits of the analytic relationship allows the patient to develop autonomy and confront the painful awareness that he or she shares the analyst with others. Anxiety about my own murderous wishes prevented me from fully embodying my authority when Ruth’s anxiety precipitated her flights from therapy.

In turning from treatment to theoretical considerations, the case illustrates how the catastrophic threat of being displaced by a sibling is exacerbated for both chosen and nonfavored children and for both older and younger children in oedipal sibling triangles. A nonfavored younger child, such as that represented by Ruth’s position in respect to her brother, is in for a shock if the waning of attention that she or he received as the baby is accompanied by the realization that an older sibling is favored. This is particularly the case if the sibling is prized for attributes, real or projected-in Ruth’s case, gender-that the child cannot compete with.

Ruth’s brother, Tom, serves as an example of how chosen children, whom one might imagine would feel secure in their positions, actually need to guard them, often fiercely (see Safer, 2002). Tom was so dismissive of Ruth’s wishes to be recognized that she felt invisible in his presence. As mentioned, the chosen child feels threatened because he or she perceives that, if dethroned, the only other position is “out.” On the other hand, Tom was presumably held back in his strivings because of guilt about triumphing over his sibling and his father in competition for the mother.

In my view, the plight of the chosen child offers an opportunity to see how traditional psychoanalytic understandings of the etiology of hysteria and the linking of hysteria with siblings (J. Mitchell, 2000b, 2003) work together to illuminate pathogenic oedipal sibling triangles. When a child is chosen, conceptualizations of the order of events in the oedipal situation appear highly likely and interrelated (Freud, 1910; J. Mitchell, 2000b). The mother’s preference for the son and the father’s for the daughter engender the wish in the child to displace the rival parent, thus ushering in the Oedipus complex. It certainly makes sense that parental favoritism and overvaluation of a child-which formed Freud’s own experience-tantalize, seduce, and feed the child’s fantasies and wishes in respect to possessing the parent, regardless of whether or not a sibling is on the scene. But it is an expectable universal experience that a child threatened with displacement by a sibling wants to possess the mother solely. It makes sense then to think that a child who is seduced into feeling chosen is especially vulnerable to feeling betrayed or abandoned by the parent when a sibling arrives and that such feelings of abandonment exacerbate the threat of displacement and the defenses against it. (Chosen sons whom I have seen in treatment experienced later sibling births as traumatic betrayals and became hysteric, reenacting the seductions and betrayals in some form of Don Juanism; see J. Mitchell, 2000b.)

Freud did not have the opportunity to confront his sibling ghosts in his self-analysis, and they affected his collegial relationships. However, as psychoanalysts and psychotherapists, we have the opportunity to address ours in treatment. When we do so, collegiality and competition in the therapeutic dyad become real. Both analyst and analysand have claims to more or less the same professional territory. Excruciating as this may be at times, it is hard to imagine a riper or more rewarding arena in which to experience that we are not replicas nor “in” or “out.” Rather, we each have a place.

The necessity and value of addressing oedipal sibling triangles was poignantly expressed by a patient who had hysterically and painfully undone her strivings at several critical points in her life. This bright and energetic woman, who had been treated as a black sheep in relationship to a chosen older brother and a favored younger sister, had been in previous psychotherapies. Yet, she was unable to get at why she undid her creative efforts, until we focused on her sibling relationships. In her words,

I’ve realized through this therapy how much I’ve felt guilty and held myself back, crushed myself, because of being afraid I’ll hurt my brother and sister. [With intense feeling] I was shocked by how much I felt about my brother last week. [The previous week she began a creative endeavor but was suddenly engulfed with profound anxiety and empathy in respect to her brother’s depression and failures.] I had no idea. I had never thought about any of this, and it’s opened up so much. These feelings are so powerful. Now I’m understanding why I’ve held myself back all my life. What you said about how it’s felt like only one of us can succeed. It doesn’t really make sense, but it is the way it’s always felt.

We need to recognize the significance of oedipal sibling triangles, in which a child is recruited into a spousal position, and their relationships with hysteria. Previous psychoanalytic understandings of hysteria and the contemporary understanding of the profound effect of sibling threat in engendering hysteria join with powerful effect to illuminate these triangles. To be of help to our patients, we must be ready to address the painful consequences of the sibling relationships as they show up in the transference.