My paper for your consideration.

DIAGNOSING THE ENGLISH PATIENT:
CONTRIBUTIONS TO UNDERSTANDING THE SCHIZOID FANTASIES
OF BEING SKINLESS AND OF BEING BURIED ALIVE

December 5, 1999
Norman Doidge, M.D., F.R.C.P. (C)

Please Address correspondence to
Norman Doidge, M.D., F.R.C.P.(C),
180 Bloor Street West, # 501
Toronto, Ontario, Canada, M5S 2V6
416-925-9058
Fax: 416-783-8556
email norman.doidge@utoronto.ca

oNOT FOR CITATION OR CIRCULATION WITHOUT PERMISSION OF THE AUTHORo

ACKNOWLEDGMENTS

This essay received the American Psychoanalytic Association¹s CORST Essay Prize In Psychoanalysis and Culture, in December, 1998. I thank Drs. Vera Camden, Jonathan Lear, and Robert Paul, the judges. It received the Canadian Psychoanalytic Association¹s Miguel Prados Essay Prize, in June 1999, and I thank those judges, Drs. Gabrielle Clerk, Michel Silberfeld and François Sirois. It benefited from the comments of colleagues in New York, Toronto, Montreal and Melbourne. It was as a keynote address to the Royal Australian and New Zealand College of Psychiatrists, in Perth, and on Life Matters, in Sydney. I acknowledge the graciousness of Dr. Don Grant. Rene Cosgrove alerted me to French research on intrapsychic tombs. Submitted September 14, 1998.

Training and Supervising Analyst, Canadian Psychoanalytic Society, Toronto Branch; Head, Long Term Psychotherapy, University of Toronto, Department of Psychiatry; Faculty, Center for Psychoanalytic Training and Research, College of Physicians and Surgeons, Department of Psychiatry, Columbia University, New York.

ABSTRACT

The psychological world of The English Patient is explored to deepen the understanding of schizoid states. The protagonist is a remote desert explorer, whose triangular sadomasochistic affair with Katharine consumes and destroys both. His damaged skin is understood as a symbolic representation of his psychological condition. For the schizoid, love consumes, and leads to an obliteration of the self, represented by the loss of his identifying features, and traumatic permeability, i.e., the loss of boundaries between self and other, and the ego and repressed desires. Other schizoid themes include the animation of the inanimate, as in the depiction of the desert as a woman; hidden or buried identities; the digital and destructive experience of emotion represented by the conundrum of the bomb defuser; the sense that everything good is imaginary and could suddenly explode; and the moral unevenness of the characters. Almásy collaborates with the Nazis, so he can retrieve Katharine¹s 3-year-old-corpse, which he has necrophilic contact with, in a cave. Fantasies of the lost object buried within the self, of being buried alive, and of being skinned alive, are related to the schizoid condition. Hyperpermeability is proposed as a core schizoid state, underlying schizoid withdrawal.

ONE WOULD HAVE HAD TO HAVE LIVED IN A CAVE IN THE DESERT for many months in 1997, not to have heard of The English Patient, the novel by Canadian poet and novelist Michael Ondaatje, which won the Booker Prize, and which was the basis for director Anthony Minghella¹s film which won 9 Academy Awards including Best Picture that year. The film recalls Lawrence of Arabia, with its central character a refined and classically educated Westerner exploring and attempting to redeem the nomadic heritage of the desert; it equally recalls Casablanca in its use of a romantic North African setting on the edge of the encroaching Second World War to demonstrate how war interferes with private lives, and affects an evolving love triangle. Set in the '30s and'40s, this seductive story about an adulterous affair, with two attractive leads, unencumbered by the obligations of children, sporting Ralph Lauren-type, khaki desert wear, and a haut eco-sensitivity to the desert, has resonated with many current fashions, intellectual and otherwise.

And yet there are those for whom the characters and landscapes are merely beautiful surfaces that are hollow inside. They report leaving the theatres having felt seduced in the sense of having been tricked, because it dawns on them that the story¹s climax involves a most unbeautiful act‹ putting thousands of innocent people under Hitler¹s control, when the "hero" turns crucial British maps of North Africa over to the Nazis. These maps enable the Nazis to successfully attack Tobruk and almost win the war in North Africa. And why does the "hero" do this? To retrieve the three-year-old corpse of his dead lover. Further, he is without remorse ‹"I made a promise. The rest meant nothing to me" (Minghella, 1996, p.147)‹ and he successfully convinces the other characters of the forgivability if not nobility of his act. He seems to persuade them that both sides are equally wrong in the war. When confronted by the fact that thousands of people might have been killed because of what he did had the Nazis not been foiled, he answers, "Thousands of people did die, just different people." (Minghella, 1996; p.147). This neutralizing calculation appears to tally for the other characters, and in the end the English patient seems to compel their sympathy, pity, and admiration. Indeed it has been pointed out that the real Almásy was not an accidental collaborator, but a Nazi spy, and Ondaatje has been criticized for misrepresenting this.

I shall for the most part bypass that important controversy‹ the historical, revisionist attempt to level differences between the Axis powers and the Allies‹ and instead attempt to understand the psychological world of The English Patient. I shall make reference to both the film version and the novel (Ondaatje, 1992), using the later as the principle text, except when indicated. Minghella wrote the screenplay in close collaboration with Ondaatje, who stated the film powerfully evoked his novel and characters (Ondaatje, 1996, p. xviii). Though the film is better known, the novel more fully elaborates the internal lives of the characters. It also contains important disturbing elements that have been airbrushed from the film.

This paper has two equally important goals. One is applied analysis. I shall try to explain many apparently unrelated things, such as why the patient was a burn victim who fell from the sky, the conditions of his loving, including why he makes love to a corpse, the meaning of the Gyges story, the role of the desert expanse, and why all the characters forgive the English patient. This requires not only "diagnosing" the English patient, as though he were a real person, but, more importantly, diagnosing The English Patient, the work, as a whole, to show how it achieves its mood and power by evoking a particular set of fantasies. I argue that these fantasies are related to schizoid states. My second goal is to deepen our understanding of schizoid fantasy life by showing how the images of skinlessness and of being buried alive are clues to understanding two key schizoid states: hyperpermeability and withdrawal. These two states, though not confined to schizoid conditions, are particularly prominent in them. I will thus briefly summarize the plot of the film, review some key works on schizoid conditions, propose some new concepts, and then examine the novel¹s characters and plot in depth. Finally, having benefited from an immersion in the work, I shall explain the relationship between hyperpermeability and withdrawal, and the primary place of permeability.

THE PLOT

The film begins as follows. We see a plane flying languidly over the desert. It comes under enemy fire, and is blown out of the sky. The pilot turns into a human fireball and is found completely burned in the wreckage by the North African Bedouin. He is turned over to the British and taken to Italy for nursing. His real name is Count Almásy, but he hides his identity from the British, claiming amnesia. A nurse, Hana, originally from Toronto, leaves her colleagues to nurse him individually as he dies. She finds an abandoned Italian villa overlooking the beautiful hills of Tuscany and cares for him there. They are visited by two more figures. One is a Canadian thief turned spy, named Caravaggio. He has come, we learn, to kill the English patient. Caravaggio suspects the patient is also the man whose betrayals led to Caravaggio¹s capture, torture, and permanent disfigurement by the Nazis. We also learn that the villa has been mined by the retreating Nazis, and a Sikh sapper‹a defuser of bombs‹ joins the group, and falls in love with, but then leaves, Hana. Meanwhile, as time goes on, the English patient seems more willing to speak, partly because he is dying and wants to speak, partly because he is being drugged by Caravaggio.

The patient reveals that he was an Hungarian explorer who worked in the desert during the 1930s, with men from different countries, hoping to find lost cities, lakes and caves. During their work, young Geoffrey Clifton joins them with his wife, Katharine. Geoffrey is secretly working for British Intelligence, photographing North Africa in preparation for the looming Nazi invasion. At first Almásy resents Katharine joining the all male group, claiming the desert is no place for a woman. But soon he starts to fall for her, follow her, and they begin an affair. They spend their first night together, and fall in love, while being buried alive in a jeep, in a sandstorm. They make imperfect attempts to hide their affair. At the same time, Almásy is wary of love and writes that the heart is an organ of fire, that burns. He doesn¹t feel guilty about hurting his friend Geoffrey. When Geoffrey can no longer tolerate the affair, he attempts, in a rather operatic way, to kill Almásy in a suicidal plane crash. But only Geoffrey is killed. Katharine is gravely injured, and Almásy escapes unharmed, dragging Katharine off to a cave. She tells him she wants to be buried back in the garden of her childhood home, in England, if she dies. Almásy treks through the desert to find medical help. He finds two junior British officers, and demands in a delirious way that they give him a truck to rescue Katharine, whom he calls, "my wife." (p.250) But a war is on, and he has no identification papers and is an Austro-Hungarian foreigner. He makes a scene and is incarcerated. He escapes, and to get safe passage back to the cave where Katharine is, he helps one of Rommel¹s spies cross the desert to get to Cairo. He also turns over Geoffrey¹s reconnaissance maps to the Nazis, which allows them to take Tobruk. Almásy then retrieves Katharine¹s body, puts it in his plane to take to England, and it is at this point that he is shot down over the desert, turned into a human fireball. He is burned to the point of being unrecognizable, or in Hana¹s eyes, "A man with no face. An ebony pool. All identification consumed in a fire." (p.48)

After hearing this, Caravaggio tells the patient that he was one of his victims, for when the Nazis invaded Tobruk they captured and tortured him, amputating his thumbs. He tells Almásy he had come to kill him. But now he will not. The love story has somehow justified his treachery. "It is about forgiveness, how people come out of a war," said Ondaatje (1996b).

I have, by putting the bit about the heart being an organ of fire, that burns, in the center of the plot summary, intimated my hypothesis that the English patient¹s burned physical condition, in which "All identification [is] consumed in a fire" (p. 48), is a symbolic representation of his psychological condition. He is burned because he has been consumed by love. Indeed, Almásy, Geoffrey Clifton and Katharine, all die as a consequence of their love triangle, all are consumed by it. But the image of a man without a protective skin may also describe a fear of the loss of the external boundary between the self and the other and the internal boundary between the ego and its warded off desires.

Before giving a detailed analysis of the characters, I wish to propose the general hypothesis that this novel depicts the world of schizoid object relations. Perhaps this hypothesis sounds jarring‹ for is this not a novel about a passionate, love relationship, and don¹t we think of schizoids as people who are withdrawn, and incapable of expressing feeling? I will further argue that all of the main characters‹ including even the desert which plays, in a way, the starring role‹ represent aspects of the complex schizoid world of which Almásy is the most obvious example. Each of the main characters can be seen as hypertrophocations of different aspects of Almásy, expressive foils who "qualify Almásy" (Ondaatje, 1996). I first began to see this story as a depiction of the schizoid world when I sensed that the burned, skinless state of the English patient was best understood symbolically; it reminded me of dreams of charred, skinless creatures from one of my patients, dreams upon which I had long reflected. My patient had been traumatically overstimulated in childhood and presented with schizoid states and sadomasochistic object relations. Upon making this connection, suddenly the novel began to disclose many schizoid themes: the hidden or submerged identities of the characters, 3 of them spies; the obsessive interest in the inanimate world; the longing for isolation; the experience of emotion as either turned off or explosively present in Almásy and Kip, the bomb defuser; the moral unevenness of all the characters; the inability of Katharine and Almásy to commit to each other or break it off; the romanticization of death; and the single-minded preference for the private life as opposed to the greater good. All this against the traumatic backdrop of the war.

THE SCHIZOID WORLD

I shall the use the term "schizoid" as it was first used by British Object Relations theorists, who called certain people schizoid because of "schisms" in the personality. Because the disorder often involves a skilled role play at ordinary social relations, clinicians often misdiagnose these patients as obsessional or higher level narcissistic characters. Akhtar has observed that these "schisms" are based not only upon the conscious versus unconscious oppositions, but also overt and covert descriptive features (Akhtar, 1992, p. 139). Thus the schizoid may be "Œovertly¹ detached, self-sufficient, absentminded, uninteresting, asexual, and idiosyncratically moral, while Œcovertly¹ exquisitely sensitive, emotionally needy, acutely vigilant, creative, often perverse, and vulnerable to corruption." (p. 141). Such patients display a "moral unevenness; [are] occasionally strikingly amoral and vulnerable to odd crimes, at other times altruistically self-sacrificing." (p.140). Guntrip (1969) argued that the key schizoid characteristics are introversion, withdrawness, narcissism, self-sufficiency, a sense of superiority, loss of affect, loneliness, depersonalization and regression.

Affects. Schizoids are often thought to lack affect. Yet, even though a schizoid person¹s affect is constricted, he is not without affective investments. One schizoid patient, who seemed Spock-like talking to people, had a passionate fascination with machines. His experience of emotions when dealing with people was almost digital: he was on or off, without the analogical crescendos and decrescendos of passion. The smallest surge of emotion is like a bomb going off for schizoid people. This state of affairs will find its objective correlative in the mined villa, and in Kip, the bomb defuser who must turn off all his fear.

Reasons for seeking treatment. The schizoid person tends to alternate between two painful, complex states‹ a dependent one and a detached one. On the one hand "there is a consuming need for object dependence but attachment threatens the schizoid with the loss of self" (Seinfeld, 1991, p. 1). A schizoid person can function well as long as he can successfully repress his intense dependence (Seinfeld, 1991, p. 3). To avoid losing himself in relations he protects himself by withdrawal and affective isolation (Seinfeld, 1991). Without meaningful relationships, with affect shut down, he feels enervated, futile, and lifeless (Guntrip, 1969). The chronic sense of futility, meaninglessness, and deadness are easily misdiagnosed as dysthymia, depression, or existential anxiety.

Typical Development And Dynamics. The schizoid condition was first described by Fairbairn (1940, 1952) who believed that his patients had withdrawn from parents, especially mothers, who were overtly rejecting, deserting, or unable to covince their child by spontaneous and genuine expressions of affection that they loved him or her as a person. "Both possesive mothers and indifferent mothers fall under this category." (1940, p. 13). Akhtar (1992), in an extensive review, has shown that rejection, traumatic overstimulation, and neglect in the first two years of life are common in the history of schizoids. Fairbairn noted that schizoids preferred to withdraw into, and live in, a rich imaginary world.

Core belief: Not hatred, but love is the problem. Fairbairn observed that the child with the rejecting or disappointing parent develops an internalized image of a tantalizing but rejecting parent, called the anti-libidinal object, to which he is desperately attached. The rejecting parent is often incapable of loving, or preoccupied with his or her own needs. The child is rewarded when he is not demanding, and devalued or ridiculed as needy when he expresses his dependent longings. Thus his picture of "good" behavior is distorted. The child learns never to nag or even yearn for love, because it makes the parent more distant and censorious. The child may then cover over the incredible loneliness, emptiness and ineptness he feels with a fantasy (often unconscious) that he is self-sufficient. Love and anger get hopelessly intertwined. Fairbairn argued that the tragedy of the schizoid child is that his conscience has been warped: he believes his love, and not his hatred is the destructive force within. Love consumes. Hence the schizoid child¹s chief mental operation is to repress his or her normal wish to be loved.

Being smitten. In my experience, should the adult schizoid fall in love with someone who reminds him of his rejecting parent, he will often describe himself as "being smitten" or some such equivalent; "smitten" is the past participle of to smite, and to be smitten is to be disastrously and deeply affected as one falls in love, as though one has sustained a severe blow.

Pickinesss and Prickliness. On the other hand, when more nurturing people come along, the schizoid will often dream, guiltily, that he or she is being disloyal to the parent imago, betraying a pact. This intense, internal backlash derives from a pathological superego, which unlike that in a loved child, is anti-libidinal, because it is based on an internalization of the anti-libidinal parent image. The schizoid child has a conscience that has made self sufficiency an ideal and love a crime. Conscience always incites us to scrupulously pour over events and see them in a moral light; the schizoid¹s conscience demands he focus on the new love interest in an active, picky, prosecutorial, fault-finding way. Love becomes about as pleasant as litigation, for both parties. To avoid feeling picky, he may try to withdraw or simply enter a defensive, turned off state, finding the potential lover "boring" or "a turn off". He has gone into total affect shut-down. Or he may become prickly, and chronically irritable so that others know not to approach.

Under the skin, the wish for merger or fusion. Should the love object "get under the skin", the schizoid person feels taken over. This is pleasant, insofar as it undoes his isolation and terror of separateness. But being smitten also releases his own pent-up wish to merge and cling that was appropriate in early childhood, but never satisfied at that time; his own longing gives rise to the fear that he will lose the external boundary that exists between himself and the exciting love object. He feels as if the love object is possessing him, in the sense of spirit possession.

Reversal of the values of life and death; preoccupation with the living dead, and the dead in the living. While schizoid patients may have quite conventional attitudes on the surface towards life as being something good, the fantasy life, so suffused with antilibidinal themes, often displays a reversal of values of life and death, and an emphasis on the futility of life that one sees so frequently expressed in Beckett, for example. For instance, many of us fear that death is futile, and goes on for an unrelieved eternity; Beckett depicts not death but life as futile and going on and on without meaning. Thus there is a strong tendency towards nihilism and withdrawal that must be struggled against.

Buried alive. Schizoid withdrawal is not only interpersonal, i.e., away from real people; there is a kind of intrapsychic withdrawal, based upon fantasy. As treatment progresses, it is not uncommon for the schizoid to reveal fantasies of having buried his self within him‹ where it lies waiting until it is safe to be exposed (Guntrip, 1969, p. 22, 40). This fantasy may represent an archaic wish to return to the safety of the womb, or a fantasy about entering a pregnant mother¹s body. The fantasy that the self is buried also explains a dread of many schizoids, the fear of being buried alive. A patient dreamed, "There was a baby, it was buried alive. It was horrible and no one knew." Images of being frozen, put in suspended animation, paralyzed and unable to communicate, forced hibernation, and solitary confinement can be versions of being buried alive. The fantasy of being buried alive is probably related to the notion of encapsulation as a defense against annihilation (Hopper, 1991), and related imagery includes that of tortoises, crustaceans, encased insects, foxes in holes, armor, safety deposit boxes, laminated objects, and those related to latex and leather perversions. Related to the fantasy of being buried alive, is imagery which fuses living states and dead ones. Imagery of the "living dead" and the "dead come back to life" are especially common in Gothic horror stories).

DEFENSIVE TECHNIQUE AGAINST FALLING IN LOVE.
1. Ascetic ideals ‹the fantasy that the object is a temptress, and desires are insatiable. To squelch this hunger for love the schizoid may idealize asceticism. But like the ascetic who retreats to the desert to avoid human contact and temptation, he soon begins to see the temptress in his wet dreams, sanctuary drawings, and religious stories, in a tantalizing return of the repressed. He concludes, mistakenly, that desire is a bottomless pit; promiscuity and celibacy may alternate, both as attempts to deal with this perceived insatiability. Related to this is the wish to be inanimate. Such patients may describe a wish to be passionless, and become bone, rock, an ice queen, or sphinx-like. One, who cycled through periods of celibacy and promiscuity was so tortured by his peremptory desires that he dreamed of a dead person, all bone and no flesh. In his associations he said, "this is how I wish to be, this would be happiness, to be dry as bone, with no desire, or need, or longing.

2. Role playing. Another antilibidinal technique used by schizoids to preserve the pact with the bad parent is to appear to be involved with others by role playing, and being involved in a limited way. Fairbairn (1940, p.16) showed that the schizoid can unconsciously disown the social role while he is playing it. A patient of mine who appeared cooperative and involved in sessions, disclosed, only well into treatment, that he always had the omnipotent fantasy he was controlling everything I said.

3. The in and out program. A related distancing technique has been described by Guntrip as the in and out program, and involves "always breaking away from what one is at the same time holding on to." (1969, p. 36) This may involve "rushing in and out of one marriage after another," or always emphasizing to one¹s partner that one could get along without him or her, or always fantasizing about taking a job away from the partner while staying with the partner. Such patients are "unable to commit themselves to any one relationship in a stable and permanent way." (p. 37) They are always negotiating the optimal distance between themselves and others, saying things like "I need my space." But not infinite space, for the repressed hungry self is rarely completely obliterated, and it draws them back into the optimal orbit of others (Akhtar, 1992). Often, they prefer that much of the relationship takes place "in their head."

4. Sadomasochistic object relations. The belief that love consumes or destroys one¹s identity, makes sadomasochistic object relations with a rejecting parent substitute highly likely. Sadomasochistic hurts help keep the object at a distance, which suits the schizoid¹s in and out program. Given the history of rejection or desertion, the schizoid, when smitten, is drawn to depriving, attached, or unavailable mates like a moth to a flame. Untreated schizoid states preclude resolution of the Oedipus complex; repetitive and self-injurious sexual triangles are extremely common. Schizoid people may be drawn to philosophies, sensibilities, ideologies that ridicule tender love as vain illusion. Yet such "liberated" thoughts actually appease the anti-libidinal conscience.

5. Attitudes towards children. There are no children in The English Patient. In my experience, the classic schizoid is ambivalent about the "idea" of having children‹ though, may be surprised at how attached he or she may become towards them, should children come along. In sicker schizoids the parental instincts seem turned to pets, collecting things, or the environment which becomes animated.

HYPERSENSITIVITY AND HYPERPERMEABILITY‹ PSYCHOGENIC AND BIOLOGICAL CAUSES
I suggest that hypersensitivity and hyperpermeability, are primary schizoid states, and that detachment and withdrawal defend against them. The schizoid type I am describing is hyersensitive to rejection, or emotionally "thin skinned" for several reasons: he is always being deserted in his internal fantasy world (Guntrip, 1969); he always projects a rejecting, exciting object on to others; and he experiences his infantile neediness for a real object as threatening him with a perceived loss of self and boundaries (Seinfeld, 1991), so if the other leaves he will lose his self along with them.

A number of patients that I have treated, who presented with schizoid states, also had an acute nervous hypersensitivity to stimuli, including smells, sounds, light, temperature, and motion, as though they lacked a filter, or stimulus barrier, and were "thin-skinned" as it were. They described this sensitivity going back to childhood. Such hypersensitivies are also seen in autism (Tustin, 1981; Ratey and Johnson, 1997) or in some right-brained individuals, who are visual learners, and in some children with Attention Deficit Disorder (Freed and Parsons, 1997). Edgar Allan Poe¹s description of Roderick Usher in The Fall of the House of Usher captures this nervous hypersensitivity: "He suffered much from a morbid acuteness of the senses; the most insipid food was alone endurable; he could wear only garments of certain texture; the odours of all flowers were oppressive; he eyes were tortured by even a faint light...." (Poe, p.143). Incidentally, in that story, which takes place in a Gothic setting, hypersensitive Usher accidentally kills his twin sister, burying her alive, a connection I will explore below.

Injured skin imagery and hypersensitivity to stimuli. In some patients, hypsensitivity seems to be an almost constitutional given, and schizoid withdrawal an attempt to turn off sensory stimuli; but in others, hypsensitivity seems like a post-traumatic hypersensitivity (in the form of nervousness, jumpiness, agitation) that decreases as trauma is worked through. Hyperpermeable states may be represented by images of skin envelopes which have been penetrated. Anzieu (1980) has systematically shown how Freud¹s statement that the ego is first and foremost a body ego applies to the skin, or skin ego. The skin is the first border, and the first place of contact between baby and mother. Torn animal skins or envelopes, open mouths, orifices, doors, liquids escaping, decomposing bodies, skin diseases, invasive germs, porous bodies, and flaying imagery all can represent insults to the skin ego. Often these injuries are symbolically healed by skin contact (e.g. the laying on of hands).

Second skins: rhythmic sensations to counter fears of unboundedness, falling, spilling, dissolving. As schizoids turn away from people, they often turn to things, animating them. This parallels something that happens in some autistic children, who seem unable to turn towards people, because of an extreme of hypersensitivity. Tustin (1981, 1986), basing her work both on accounts of children who emerged from autistic states and work with neurotic patients with autistic barriers, showed that autistic individuals are often terrified of dissolving and falling into dreaded bottomless pits, black holes, or chasms. This seemed based upon pre-symbolic, pre-verbal terrors, of a loss of contiguity with the caregiver, occurring in an immature state of psychic organization. To block the terrifying, unbuffered awareness of bodily separateness, they took to moving objects rhythmically to create a protective envelope of contiguous sensations. But when these rhythmic sensations were interfered with, they experienced their skin as a sieve, and themselves falling into unbounded space or terrifying black holes. The film The English Patient begins with an unforgettable, buffering sequence of sensations: sonorous rhythms of the whirring airplane motor passing over the highly regular, almost stroboscopic shadows, created by the rib-like waves of desert dunes. Then beautiful, yet menacing music rises, the English Patient is shot, dissolved by fire, loses his skin, becomes permeable, (i.e. hypersensitive) and falls out of the sky, in one fell swoop.

Hyperpermeability and petrification fears. The schizoid person is often aware that his sense of self is a fragile fortress, and built upon a fantasy. Several of my schizoid patients had the ongoing fear that this imaginary fantasy world, in which they were withdrawn and protected, could all blow up at a moment¹s notice. Thus while the schizoid person¹s surface may be nondescript, decorous, emotionless, he is terrified ‹because he experiences himself as permeable‹ of being "seen through" or revealed, as human, and full of hunger. Seinfeld (1991) has noted that he fears being petrified and turning into rock, if another person catches him in his glance, as was Medusa when she saw herself as others saw her, i.e. in all her fantastic, composite ugliness, filled with unruly sexual and aggressive desires and defects. Being exposed is psychologically akin to being too permeable, or too easily seen through. Medusa is not only frozen, but she is, by being turned into stone, buried alive in her own statue. The fear may cover the powerful wish to be inanimate.

THE INTRAPSYCHIC TOMB
The phenomenon of intrapsychic tombs, described by the French psychoanalysts Abraham and Torok (1994), though not originally based on schizoid patients, will be particularly important when we analyze the cave scene, and Almásy¹s grief in response to Katharine¹s death. Torok (1968, pp. 107-124), began formulating this concept following a lead by Karl Abraham. Abraham wrote to Freud of patients who seemed to show manic denial and an upsurge of libido, as opposed to melancholia, after the death of their loved ones. Torok noticed that a number of her patients related stories of sexual acts and needs right after a death. She saw this as a desperate and final attempt to sustain the relationship by enacting the fantasy of incorporation (concretely taking a person¹s body inside them) with a substitute object. In these cases grief could not proceed because of a shameful secret in relation to the lost object (e.g. an incestuous link). She described these patients as having a fantasy of the lost object as "an Œexquisite corpse¹ entombed somewhere inside them, which they hoped to revive. The sense of exquisiteness also attached to the exquisite pain of the outburst and was also a cover for the exquisite pleasure involved. One dreamed, "I committed a terrible crime. I ate someone and then buried them... For this reason I have to spend the rest of my life in prison." (p. 122). Abraham and Torok brilliantly observed that in many cases of complicated grief, the anguished pining that the living bereaved feel is not their own longing for their love object, but rather, the fantasized pining of the deceased love object for them. Insofar as we deny our beloved has died, our fantasy of our beloved as alive, and seeking us, persists. This crucial fantasy is overlooked because it is unconscious, and because we are preoccupied with our conscious longing for the lost object. Fantasized incorporation of the deceased ‹eating the object (which parallels, in ways, the Christian imagery of consuming the host)‹ stifles mourning. "When, in the form of imaginary or real nourishment, we ingest the love object we miss... we refuse to mourn.... ." (1972, p. 127) Children can also form a "dead mother" identification with a mother who is not literally dead, but who feels it, because depressed, distant and lifeless (Green, 1972).

THE CHARACTERS IN THE ENGLISH PATIENT
Hana; Hidden, Traumatized Selves and Identities. The theme of hidden traumatized selves and hidden identities is most apparent in the book which begins with pages and pages of description of an unnamed character. We finally learn, on page 32, that her name is Hana, the 20-year-old nurse. As is common in the schizoid world, there is a loving description of inanimate detail. The nameless Hana seems selfless, just a series of devoted actions. Indeed, there is something strangely evocative in watching this woman without a name, without an explained past, performing her nursing tasks on this dying man without an apparent physical or historical identity. These hidden or buried identities evoke the fact that in the schizoid world, the self is deeply buried beneath a nondescript surface.
We learn that her beloved father has been killed recently in the war, and her single-minded devotion to her patient helps her deal with his death. She is in shell shock (p.28). Her lover has also just been killed in the war, but not before he impregnated her, and so she has recently had an abortion (p.83) and now feels she destroyed the child. Everyone she loves dies‹her love consumes. She longs to perform acts of reparation by nursing the English patient, who is described as the ghost she is caring for (p.28). In the villa she cuts off all her hair, and discards her femininity, in grief.

The Allies are moving up the ankle of Italy and the Germans are in retreat. She has found a beautiful Italian villa, Villa San Gorilamo, in which she can take care of the skinless man, where he needn¹t suffer by being jostled about. Through charred lips her nameless patient begins to speak. He tells first of his accident, which arouses our sympathy for him as a victim, and next that he was an idealistic explorer seeking to document the desert, and find a lost ancient city, near where there had been a lake in the midst of what is now desert.

Hana too has something to hide: herself. "There was something about him she wanted to learn, grow into, and hide in, where she could turn away from being an adult." (p.52) The Villa seems at first to be a respite from the war. Hana is nomadic in it, half-adult and half-child (p. 14). She is there not only to nurse, but because she is fed up with war. "She would not be ordered again or carry out duties for the greater good." But the Nazis are not yet defeated, and one cannot but think that this wish to close her eyes and make the war go away is child-like. The only catch is that she is not safe in the Villa, for it, like the English patient¹s story, is mined. Shorn Hana will need a complementary helpmate, someone who is her opposite, who will keep his eyes open and turn off his emotions, to defuse the villa‹ the long-haired Kip. She is someone who is terrified of her destructiveness; he is someone who spends his life defusing it.

The breakdown of psychological boundaries between self and other. A real, largely non-verbal intimacy builds up between Hana and her patient. Imagine how isolated he must feel! In this private place her nursing is not bound by stifling convention. When he is cold at night, she lies in bed beside the man with injured skin (p.5). Next we hear descriptions of his almost ceremonial treatment at the hands of the Bedouin who provide layers of salves to cover him. Like many of his descriptions, though, it is numb. The terror of losing one¹s skin, of losing the natural boundary or barrier between oneself and the world, is never described. But it is evoked everywhere in images of permeability that permeate the novel. Images of water deepen our sense of a state without boundaries. As the English patient listens to Hana, he is "swallowing her words like water." (p. 5) There are numerous beautiful metaphors of the breakdown of boundaries, or the passing of fluid between boundaries. When he is in the desert, one of the Bedouin feeds him by chewing and softening a date, which he passes from his mouth to the English patient¹s mouth. He remembers "the taste of saliva that enters him along with the date." (p.6) Hana deskins plums which grow in the garden, and passes them into his mouth. What Almásy says he likes about the desert is a lack of any kind of physical boundary‹it is more like a sea. "In the desert it is easy to lose a sense of demarcation. When I came out of the air and crashed into the desert, into those troughs of yellow, all I kept thinking was, I must build a raft... And here, though I was in the dry sand, I know I was among water people." (p.18) The Cave of Swimmers‹the most important of Almásy¹s discoveries‹ was a cave in the midst of the desert with prehistoric drawings of figures swimming. This proved to Almásy that in Tassali, 6000 years ago, there had been a lake where now there is dryness. The desert is turned by him, in his imagination, into a plentiful sea. This is what a schizoid child does in the midst of deprivation.

The desert becomes a woman. When Katharine Clifton first arrives with her husband, Almásy is noticeably standoffish, picky and prickly, because he feels women don¹t belong in the desert. Yet he often describes the desert as though it, she, were a woman. In the film, the desert is adoringly photographed , as though it were a lover¹s body, with lean ribs, thickening plateaus, spread dunes, hidden recesses and caves that hide water. In the book we hear that it is "raped by war." (p. 257) To find the remnant of the famous lost lake that he seeks, Almásy is told to find the place where the mountains form the shape of a woman¹s back. When Almásy describes "the deserts of Libya" he says, "Remove politics, and it is the loveliest phrase I know. Libya. A sexual, drawn out word, a coaxed well."

The English patient. Our first impression of the English patient is of course that he is a patient, in the very dependent position that is the danger position for any schizoid person. But he seems to be impressively stoical, almost inhumanely so, never feeling sorry for himself. This is because he is detached, with the schizoid gift for living in his own internal world. We are told of his life before his accident and he seems, at first glance, to represent reason, refinement, knowledge, and universality. Indeed, he seems to know about everything, from jazz to Plato. As a learned explorer he takes one book with him, his precious Herodotus, and attached to its pages are all his collected drawings, notes, discoveries and letters. But, though he knows so much, we hear absolutely nothing about his family history. His past is a blank. Katharine and Almásy are opposites in this respect: "For her there was a line back to her ancestors that was tactile, whereas he had erased the path he had emerged from. He was amazed she had loved him in spite of such [a] quality of anonymity...."(p. 170) This anonymity suggests a reluctance to be revealed. Though Hungarian, he lacks a "parochial" national identity. About the war he takes a superior attitude‹ both sides are wrong. He thinks of himself as an idealist, who has gone beyond the love of one¹s own that is the heart of familial and political ties, and which gives rise to feelings of loyalty. Yet, for all his declared openness to others, he has few friends and no loves. This openness to others is more of an openness to people who have erased themselves as he has. In the desert, where there are no boundaries he says:

There were rivers of desert tribes, the most beautiful humans I¹ve met in my life. We were German, English, Hungarian, African‹all of us insignificant to them [the tribes]. Gradually we became nationless. I came to hate nations. We are deformed by nation-states.... The desert could not be claimed or owned.... All of us wished to remove the clothing of our countries.... Erase the family name! Erase nations! I was taught such things by the desert.... By the time the war arrived, after ten years in the desert, it was easy for me to slip across borders, not to belong to anyone, any nation. (p. 138)

A great leveling operation is performed by Almásy: all nations are blurred together; the regimes of these nations- be they Nazi, totalitarian, monarchic, democratic, all become morally equivalent. So what can he pledge himself to? If he sees no good in nations, he see no bad in tribes; but to do so he must depict tribes without tribalism. He praises the "openness" the desert teaches; but such openness is a desire for people who have no identity based on family or historical roots. Is this really openness?

Katharine Clifton. Katharine Clifton arrives. It seems Almásy has never fallen in love before. Airbrushed from the movie is that Katharine is a generation younger than Almásy. Seeing the Cliftons for the first time he says, "They were youth, felt like our children." Almásy, emphasizes: "She was a willow... an innocent.... I was forgetting she was younger than I." Later he says that her "openness is like a wound, whose youth is not mortal yet." (157) Her youth is a remedy for Almásy¹s sense of his own mortality. Katherine begins a very 1960s-bohemian piece of dialogue just before the two make love:
"If you make love to me I won¹t lie about it. If I make love to you I won¹t lie about it." She moves the cushion against her heart, as if she would suffocate that part of herself which has broken free.
"What do you hate most?" he asks.
"A lie. And you?"
"Ownership," he says. "When you leave me, forget me."
Her fist swings towards him and hits hard in the bone just below his eye. She dresses and leaves." (p. 52)

Katherine has just had the first of what are to be many encounters with Almásy¹s tendency to blot her out, to erect a cold wall between them (p. 155). Katharine notes he never reveals his real self to her, and tells him that he acts "as if the greatest betrayal of yourself would be to reveal one more inch of your character." (p. 174) She is describing what it is like to be with a schizoid person who is terrified that he will be consumed in closeness, and who retreats; someone who fears that in revealing himself he will lose himself, will be engulfed, petrified, overexposed. She says of his tendency to disappear, "you have become inhuman.... I don¹t think you care.... You slide past everything with your fear and hate of ownership, of owning, of being owned, of being named. You think this is a virtue." (p. 238) But Almásy is experiencing "my old desire for self-sufficiency." (p. 238)

Love Consumes. Yet, he falls in love, and his "in and out program" is no longer working, "Nothing can keep him from her." (p. 153) The man who never felt alone in the desert is desperately lonely, and begins to stalk her. (p. 155) "The minute she turns away from him... after he greets her, he is insane." (p 156) In the diary entry of July 1936, Almásy writes that to love is to be consumed, to lose the inner self, and that the heart is an organ of fire:
There are betrayals in war that are childlike compared with our human betrayals during peace. The new lover enters the habits of the other. Things are smashed, revealed in new light. This is done with nervous or tender sentences, although the heart is an organ of fire. A love story is not about those who lose their heart but about those who find that sullen inhabitant.... It is a consuming of oneself and the past. (p. 97 )

In other words, when a schizoid person falls in love, a sullen hidden aspect of the self, not previously seen, emerges and consumes one or threatens one¹s existing identity. This passage anticipates and rationalizes his turning over the maps to the Nazis: it is not as bad as the betrayals of peacetime, which Almásy doesn¹t fret about too much in the case of Geoffrey. He will betray thousands so that he can tell himself he did not betray his lover¹s dying wish. Yet this absolute preference for the private sphere of love over the public sphere is articulated by a man who is no unambivalent champion of love. This passage demonstrates his moral unevenness, and anticipates the combination of hypersensitive, idiosyncratic sacrifice and hyposensitive, depravity that we shall see in his rescue of Katharine¹s corpse. In truth, the English patient is at home neither in the public world of nations nor the private sphere of love.

The sadomasochistic relationship with Katharine. When love, by definition, burns, sadomasochistic object relations cannot be far behind. Shortly after meeting Almásy, Katharine has a sadomasochistic sexual dream about the two of them, set in her marital bedroom: "They [Katharine and Almásy] had been bent over like animals, and he had yoked her neck back so she had been unable to breathe within her arousal." (149) This sadomasochistic theme is not only expressed in dreams. "She had always had the desire to slap him, and she realized even that was sexual." In a section beginning, "A list of wounds": we learn Katharine stuck a fork into his back, has thrown countless objects at him, and he frequently appears in public "with bruises or a bandaged head" (154) or welts. Katharine suffers with "a terrible conscience" and asks, "How can I be your lover? ... he [Geoffrey] will go mad." (153) Yet she betrays Geoffrey many times. Almásy suffers no remorse on behalf of his cuckolded rival. Why should he? If love never means possession, then love triangles are nothing to be fussed over; if no one belongs to anyone, adultery is no sin; rather, it is fidelity, the keeping what does not belong to you, which is to be disapproved of.

Jealousy. Yet things change. Once love has broken down his defenses, Almásy begins to feel out of control. "He has been disassembled by her." (p. 155) The possessiveness which he scorned now comes back with a vengeance: jealousy. "He [Almásy ] slides his open palm along the sweat of her shoulder. This is my shoulder, he thinks, not her husband¹s, this is my shoulder." (p. 156) In a jealous fit he follows a man she has innocently touched for two days. We can understand this jealousy from the point of view of the schizoid state: Katharine made him feel alive with love; how can he, now alive, imagine living without her? This jealousy is one of the first signs that Almásy might really be able to attach to a person, and his possessiveness signals an almost infantile terror of separation from her. But there is more to it. As Freud has pointed out, pathological jealousy has many roots; in some cases this includes a warded off homosexual attraction to one¹s same sex rival. Indeed there are hints of homoerotic longings in Almásy, which come up in the book in a powerfully sensual homoerotic description of a dancing, teasing, desert boy, who climaxes and reveals himself in front of the men; and possibly in Almásy¹s wishing to keep women out of the desert. (Apparently the real Count was homosexual.) Then, half way into the novel, it stated, explicitly, that Almásy had loved Geoffrey Clifton. Just before the death scene, Geoffrey Clifton is described as "The husband they had both loved until they began to love each other."(p. 174) Is this "love" in a mere Platonic sense? Or is it erotic in some way?

The Relationship of Almásy, Geoffrey and Katharine. To understand this love, we must enlarge our view of it, into the full-blown Oedipal love triangle it is. It touches the most elemental passions, and leads to the death of all three. It begins strangely. Almost immediately upon arriving at the campsite, Geoffrey Clifton, acting as though he is not aware that others might take a sexual interest in his wife, "shared his adoration of her constantly" (p. 229) "Clifton celebrated the beauty of her arms, the thin lines of her ankles, he described witnessing her swim." Initially, Almásy thinks "The words of her husband in praise of her meant nothing." (p.231) But Clifton behaves as though he were on a campaign to interest Almásy in his wife. He leaves Katharine for long periods with other men and with Almásy, alone in the desert. One begins to wonder if Geoffrey extols Katharine to support his own vanity. It is at this point that Katharine reads the famous story of Gyges from Herodotus, aloud to her husband, Almásy and friends. It is a story of a love triangle that Almásy says he always skims past (p.223). The story within the story, like a dream within a dream, contains important warded off elements. Indeed, it is right after hearing this story, that Almásy says, "I fell in love" (p. 234). In the eerie scene, with an embarrassing directness that makes the observer want to turn away in that strange shame one feels when one sees too much, Katharine tells Geoffrey, by allusion, that he is setting up a triangle in which Almásy will sleep with her. "Are you listening Geoffrey?" she says emphatically, as she begins to read the story, out of Almásy¹s Herodotus:

This Candaules [the king] had become so passionately in love with his own wife [that] he deemed [her] fairer by far than all other women. To Gyges...for he of all his spearmen was the most pleasing to him... He said... "Gyges, I think that you do not believe me when I tell you of the beauty of my wife... Contrive therefore means by which you may look upon her naked." (p.232)

Gyges, like Almásy, puts up some initial resistance, entreating the king not to ask him to look, but the king insists, and hides Gyges in the bedroom, saying "there is a seat near the entrance of the room and on this she lays her garments as she takes them off one by one; and so you will be able to gaze at her at full leisure."(p. 232-233) The queen discovers Gyges, and realizing it was set up by her husband, feels ashamed. The next day she summons him, and says, "Either you must slay Candaules and possess both me and the Kingdom of Lydia, or you must yourself here on the spot be slain... so that you mayest not in future... see that which you should not." (p.234) Thus the queen who has been looked upon has her king killed. Apparently she is a very modest woman.
Why is she outraged to the point of murder? The virtue of modesty protects the private self by keeping it sufficiently hidden or impermeable; its violation leads to humiliation, but such a violation is not generally a capital crime. But in the schizoid world, in petrification fantasies, looks do kill, because the schizoid person fears that he will lose his very identity if exposed.

Consistent with this theme of homosexual love, though barely hinted at in the movie, is the extent to which Almásy is smitten by Katharine¹s boyishness and youth. "Was it desire for her youth, for her thin adept boyishness?" (p.236) he asks himself. Bony-kneed Katharine is not the most feminine of women; Clifton, sings her femininity, but Almásy loves her boyishness. Thus the Herodotean, or negative Oedipal version of the story, makes up some of the latent content of the narrative, whereas the main, or manifest story has a positive Oedipal cast, insofar as it is about about being caught in an illicit, heterosexual triangle. This is enacted in the film in the steamy, furtive sex scene, which we see through a window, while their friends are partying at Christmas. Then Geoffrey finds the sweaty couple, clothing all askew, fulminating with each other¹s scents.

The Cave Scene. The climactic Cave of Swimmer scene in the film leaves out a detail from the book, that many readers seem not to notice; indeed it is remarkable how many readers pass over this passage without taking in that Almásy makes love to Katharine¹s corpse. The film¹s editing does not make clear that Katharine had been left in the cave not some few days, but three years. Almásy left her immobile and dying in September 1939, and returned only in 1942. When he turned the maps over to the Nazis, there was no prospect of rescuing her alive. By glossing over this fact, we are left with the impression that Almásy¹s made a noble and desperate attempt to save the life of the woman he loved. If he so wanted her remains, why could he not wait until the war was over to get them ‹ then he would not have had to turn the maps over to the Nazis. Or did he have Nazi sympathies?

Not tonight dear, I¹m dead. The following scene omitted from the film, shows the extent to which Almásy is living an imaginary schizoid existence which reverses the values of life and death. Returning with the help of the Nazis to the cave where he left her, Almásy chooses first to take his clothes off, and enters the cave naked:

I approached her naked as I would have done in our South Cairo room wanting to undress her, still wanting to love her. What is terrible in what I did? Don¹t we forgive everything of a lover? We forgive selfishness, desire, guile. As long as we are the motive for it. You can make love to a woman with a broken arm, or a woman with fever. She once sucked blood from a cut on my hand as I had tasted and swallowed her menstrual blood. There are some European words you can never translate properly into another language. Félhomály. The dusk of graves. With the connotation of intimacy there between the dead and the living. (p. 170)

After he did whatever he did to her corpse, the text states that he lifted her out of the cave, and got dressed. When we juxtapose Almásy¹s naked approach to her corpse, his disrobing, his justification for making love to the injured or ill, the emphasis on physical sexual acts, the reference to swallowing blood, the allusion to doing the unforgivable, the phrase that emphasizes the intimacy between the dead and the living, followed by his dressing, we have intimations of necrophilia; the writing so strongly affirms necrophilia that whoever doubts it must come up with a better hypothesis. Yet Ondaatje does not use the word. Still, it is worth trying to understand why or even how Almásy could involve himself in this way with a corpse. Here are some reflections.

There is something familiarly vampiric about this scene. But to understand the cave scene ‹ the unreality of it, in the midst of what otherwise appears to be historical fiction ‹ it is helpful to "diagnose" The English Patient in a second way, by classifying it according to its literary genre. Manifestly, it is a realist novel. But latently, it is a Gothic Romance, complete with "picturesque ruins, ghosts, moonlight, demon lovers and a dashing hero with a mysterious background... antiquarianisms, blood, horror, highly erotized emotion and sentimentality... and its ... de-emphasis on verisimilitude and characterization" (Marchand, 1997, p. 56). The Gothic novel uses " medieval locale, properties, local color, etc. especially to produce an effect of horror and mystery."(Webster, 1966) Love and death, which are fused in many romances (De Rougemont, 1983) are fused concretely in the Gothic romance. Literary forms that descend from the Gothic romance‹ the thriller, the horror story and the vampire stories, have various concrete representations of this fusion of sexuality and aggression in the "love bite" which either kills, or renders the victim the identificant with the aggressor.

Thus understood we are suddenly reminded how closely The English Patient¹s corpseplay echoes with the famous corpse embrace scene in Bronte¹s Gothic novel Wuthering Heights. The disturbed Heathcliff has a quasi-incestuous, triangular affair with his step-sister, Catherine who spurned Heathcliff to marry a more respectable man. Yet her love for Heathcliff persists. Like the affair of Almásy and Katharine, it is full of cruelty and ends in Catherine¹s death. Both lovers declare themselves to be aspects of the other; Catherine says "He¹s more myself than I am.... I am Heathcliff." Both lovers state that the other¹s love murders them. On her death day, Heathcliff and Catherine have very violent embraces. Then years after Catherine¹s death, Heathcliff enters her dug up grave, opens her coffin to see her face again, and expresses his wish to dissolve with her. Heathcliff¹s words betray that he seeks re-union with the buried part of himself.

A social realist novel could not bring off this macabre necrophilic enactment; but the unreality of the Gothic prose romance promotes it. The classic prose romance does not create real people, but represents a self and its warded off aspects, which contributes to the "glow of subjective intensity" of this form (Frye, 1957). Thus one can see each of the minor characters as aspects of a main character, an approach used by Freud (1900). Katharine represents the warded off feminine, earthy, chthontic, chaotic Dionysian aspect, tied into the fertility goddesses who create and destroy life. That is why he invokes her sexuality, menstrual blood, illness, her corpse. The orderly, Apollonian Almásy is the opposite of all this. Shortly after he does what he does to her buried, cold corpse, Almásy undergoes his awful metamorphoses, and is burned, and becomes skinless. Now he is described as "a corpse" and a ghost himself. She, a corpse, has transformed him into one as well, with her love-bite. No finer place for the vampiric climax could be chosen than a cave, a subterranean nether world of darkness; the lair of the chthontic goddess and bat alike. Like Heathcliff, who anticipates becoming a corpse, Almásy does not seem displeased at his transformation.

The relation of skinlessness and being buried alive. I suggest that the damaged, skinless condition of Almásy symbolically represents the vulnerability and overexposure that the buried self of the schizoid person experiences on real human contact. This terror of contact, felt to obliterate the self, gives rise to the wish to be buried alive. (It is no accident, that Almásy and Katharine first unite and express their love while buried alive in their jeep beneath the sandstorm, or that they unite in a transformative and final way buried beneath ground in the cave.) Being buried alive is ultimately driven by a fantasy of being safe and united with a good mother in her body. Yet, to be buried alive creates its own problems. The fantasy of uniting with the other gives way to the reality of isolation. A fear of being alone in a black hole, understimulated for eternity is itself so horrifying that the self periodically attempts a premature birth. The emphasis on disrobing and re-robing at the mouth of the cave calls our attention to the hunger for contact and touch that is part of this level of fantasy. The person cycles through fantasies of being buried alive, and of being skinned alive (or being alive, but then skinned).

One can think of other levels of explanation of the cave scene. Katharine is now literally an object, buried, and cold; she has achieved the schizoid ideal of moving beyond desire becoming bone. As a corpse she cannot reject his touch, and fear of rejection is perhaps the deepest schizoid fear of all. Here we may call upon the above mentioned ideas of Abraham and Torok. Almásy, unable to bear the loss of Katharine must deny it; he makes love to her as though she were alive. At still another level, we may note that this necrophilia seems also to hint at necrophagia, or eating of the dead, as seen in Almásy¹s reference to tasting and swallowing Katharine¹s menstrual blood in the scene. In his refusal to mourn he incorporates her, and buries her within him, as it were. He, the Hungarian, becomes possessed by the mortally wounded English woman he incorporates giving psychological truth to his being "the English patient". And, as he is dying, he incorporates all life, in a stunning reversal of life and death values. "We die containing a richness of lovers and tribes, tastes we have swallowed, bodies we have plunged into and swum up as if rivers of wisdom, characters we have climbed into as if trees, fears we have hidden in as if caves. I wish for all this to be marked on my body when I am dead." (p. 261)

None of these possibilities undermines our sense that something sexual is alluded to in the cave scene. It is a dramatic representation of the stubborn upsurge of libido described by Torok that denies the loss; and Katharine is truly an exquisite corpse‹particularly in the opening scenes of the film, when "seems to be asleep"(Minghella, 1996, p.3) her flesh flawless, not three years decomposed. She is lovely in death, while Almásy¹s flesh is corrupting in life. This is another reversal of life and death. Nor should Almásy¹s destructive aggression be minimized. Like a vampire, our Hungarian Count Almásy seemed like a bat to come passionately alive in the darkness of the cave. Like a vampire, when given the opportunity to choose between good and evil, he risks the lives of countless innocents, and by the end of the novel, his actions lead to the death not only of Geoffrey, Katharine, but the suicide of his best friend Madox. In the end, all the main characters mimic Almásy¹s condemnation of the Allies, his insistence they were not much better than the Nazis, and long to withdraw. Moral Kip, in his rage that the atom bomb was dropped on the Japanese, insists the Allies did so out of Western racism against the purer East, and that the Allies are not any better than the Nazis. He, without much struggle, abandons Hana, as a Westerner. His outrage calls attention to the fact that that not a single character ultimately expresses outrage about Nazi racism or atrocities, or "eastern" Japanese racism or atrocities in Nanking. When told that her patient worked with the Nazis, Hana says feebly, "It doesn¹t matter what side he was on...." (165). Hana writes, "From now on I believe the personal will forever be at war with the public. " (p.292) But if that is so, there can be no "common" good. Each of us is locked in the prison of our privacy. This is the schizoid condition. Her isolation leads directly to the isolationist position, and she imagines sitting out the next war, and being purer for having done so. But if World War II showed anything it showed, by being a world war, that living far from the initial conflagration offers limited protection. In fact, isn¹t the point of setting the novel in North Africa, a way of showing that if one tries, at this point in history, to flee from society and its ills to the most deserted realms, there is still no escape. Nor does the dropping of the atomic bomb at the end of the novel, point the characters towards the obvious conclusion that there are few bunkers beyond the reach of such weapons. But Hana and the others opt for withdrawal into an imaginary, idealized psychic retreat, and endorse a moral relativism, which, by declaring a plague on both the houses of the Allies and the Axis powers, frees them from guilt about leaving others behind. One might compare their high-minded lack of empathy for the European victims of the war, to the attitude of the characters in Casablanca.

At the end of a war there are all kinds of exhaustions; physical, economic, mental and above all moral exhaustion. These characters are morally exhausted, and they wish to retreat now into forgetfulness‹ including a forgetfulness of the fact that it is often private ambitions and aggression that lead to public catastrophes. All of this is called by the noble sounding name of forgiveness. And, lest you think I am being hard on Almásy, let me add that he himself was not too fainthearted to question whether his love caused all this destruction: "Had I been her demon lover? Had I been Madox¹s demon friend? This country‹had I charted it and turned it into a place of war?" Or is he asking a question at all? For maybe he was asserting what the schizoid person seems always driven to assert: love consumes.

REFERENCES

Abraham, N & Torok, M. (1994) The Shell and the Kernel, Volume 1, edited and trans. Nicholas T. Rand. Chicago: University of Chicago Press.

Abraham, N and Torok, M. (1972) Mourning or melancholia: introjection versus incorporation. In The Shell and the Kernel, Volume 1, Nicolas Abraham and Maria Torok, edited and trans. Nicholas T. Rand. Chicago: University of Chicago Press, 1994 pp. 125-138.

Akhtar, S. (1992) Broken Structures: Severe Personality Disorders and Their Treatment. Northvale, New Jersey: Jason Aronson, Inc.

Anzieu, D. (1989) The Skin Ego, trans. Chris Turner. New Haven: Yale University Press

Anzieu, D. (1980) Skin Ego. In Psychoanalysis in France, edited by Serge Lebovici and Daniel Widlöcher. New York: International Universities Press, pp. 17-32.

De Rougemont, D. (1983) Love in the Western World. New York: Schocken Books.

Dietrich, D. R. (1989). Early childhood parent death, psychic trauma and organization, and object relations. In The Problem of Loss and Mourning, ed. D. Dietrich and P. Shabad. New York: International Universities Press, pp. 227-335.

Fairbairn, W. R.D. (1940) Schizoid factors in the personality. In Psychoanalytic Studies of the Personality. London: Routledge & Kegan Paul, pp. 3-27.

Fairbairn, W. R.D. (1952) Psychoanalytic Studies of the Personality. London: Routledge & Kegan Paul.

Freed, J., and Parsons, L. (1997) Right-brained Children in a Left-brained World. New York: Simon & Schuster.

Freud, S. (1900) The interpretation of dreams. Standard Edition 4/5.

Freud, S. (1913) Totem and taboo: some points of agreement between the mental lives of savages and neurotics. Standard Edition 13:1-162.

Frye, N. (1957) Anatomy of Criticism: Four Essays. Princeton: Princeton University Press.

Gabbard, G. (1994) Psychodynamic Psychiatry in Clinical Practice: the DSM-IV Edition. Washington DC: American Psychiatric Press, Inc.

Giovacchini, P. (1986) Developmental Disorders. Northvale, NJ: Jason Aronson, Inc.

Gottlieb, R. (1994) The legend of the European vampire: object loss and corporeal preservation. The Psychoanalytic Study of the Child, Vol. 49, pp. 465-480.

Green, A. (1972) The dead mother. In On Private Madness. New York: International Universities Press, pp. 142-173.

Guntrip, H. (1969). Schizoid Phenomena, Object Relations and the Self. New York: International Universities Press, Inc.

Hanly, C.M.T. (1992) Unconscious irony in Plato¹s Republic. In The Problem of Truth in Applied Psychoanalysis, New York: The Guilford Press, pp. 135-154.

Hopper, E. (1991) Encapsulation as a defense against the fear of annihilation. International Journal of Psycho-Analysis 72: 607-624.

Hurka, T. (1997) The moral superiority of Casablanca over The English Patient. Globe and Mail, Toronto, Jan. 25, p. D 5.

Jones, E. (1951) On the Nightmare. New York: Liveright.

Kernberg, O. (1984) Severe Personality Disorders: Psychotherapeutic Strategies, New Haven: Yale University Press.

Knowlson, J. (1996) Damned to Fame: The Life of Samuel Beckett. New York:Simon and Schuster.

Marchand, P. (1997) Saturday Night Magazine, October 1997, pp. 52-59.

Minghella, A. (1996). The English Patient: A Screenplay. New York: Hyperion-Miramax Books.

Ogden, T. H. (1989) The Primitive Edge of Experience. Northvale: Aronson.

Ondaatje, M. (1992) The English Patient. Toronto: McClelland and Stewart, Inc.

Ondaatje, M. (1996a). Introduction, in The English Patient: A screenplay, by Anthony Minghella, New York: Hyperion-Miramax Books, pp. xv-xviii.

Ondaatje, M. (1996b) Michael Ondaatje responds. The Globe and Mail, Saturday, December 7, 1996, Toronto.

Poe, E. A. (1986) The Fall of the House of Usher and Other Writings. Penguin: New York.

Ratey, J., and Johnson, C. (1997) Shadow Syndromes. New York: Pantheon Books.

Salett, E. P. (1996) A queasy feeling about The English Patient. The Washington Post, December 4, 1996. Reprinted in The Globe and Mail December 6, 1996.

Seinfeld, J. (1991). The Empty Core : An Object Relations Approach to Psychotherapy of the Schizoid Personality. Northvale, NJ: Jason Aronson.

Simon, B. (1988) Beckett¹s Endgame and the Abortion of Desire. In Tragic Drama and the Family: Psychoanalytic Studies from Aeschylus to Beckett. Yale University Press: New Haven. pp. 212-265.

Steiner, J. (1993) Psychic Retreats: Pathological Organizations in Psychotic, Neurotic and Borderline Patients. The New Library of Psychoanalysis, #19, General editor, Elizabeth Bott Spillius. London: Routledge.

Torok, M. (1968) The Illness of Mourning and the Exquisite Corpse. In The Shell and the Kernel, Volume 1, Nicolas Abraham and Maria Torok, edited and trans. Nicholas T. Rand. Chicago: University of Chicago Press, 1994, pp. 107-124.

Tustin, F. (1981) Autistic States in Children. London: Routledge & Kegan Paul.

Tustin, F. (1986) Autistic Barriers in Neurotic Patients. New Haven: Yale University Press.

Webster¹s New Twentieth Century Dictionary of the English Language, Unabridged Second Edition, (1966). Cleveland: The World Publishing Company.

180 Bloor Street West, Suite 501, Toronto, Ontario, M5S 2V6
fax 416-783-8556
E-mail: norman.doidge@utoronto.ca