Community Consulting Group, New York City

Mark B. Borg, Jr. PhD
[AUTHOR'S BIO]

Borg, Jr., M. B. (2007). Just Some Everyday Examples of Psychic Serial Killing: Psychoanalysis, Necessary Ruthlessness, and Disenfranchisement. In B. Willock, R. Curtis, & L. Bohm (Eds.) On Deaths and Endings: Psychoanalyst’s Reflections On Finality, Transformations and New Beginnings (pp. 180-195). London: Routledge.

When I was a candidate in psychoanalytic training, one of my supervisors made a passing comment that has remained with me as a faint yet reverberating echo. She said of the patient we were discussing: "She lacks an absolutely necessary ruthlessness." This necessary ruthlessness, as I understood my supervisor then and am using the term now, is the ability to inattend and dissociate extremely anxiety-provoking stimuli — stimuli that, when integrated into one's ongoing sense of self, are detrimental to one's psychological functioning. These are the stimuli which, unblocked by "necessary" dissociative defenses, cause us to experience a chaotic overflowing of unsymbolized affect — what Sullivan (1953) called "uncanny emotions." I hypothesize, therefore, that necessary ruthlessness is necessary in the maintenance of one's ongoing and continuous experience of oneself in the world. In this paper, I delineate some of the essential ingredients of a culture of ruthlessness and go on to explore the maintenance of necessary ruthlessness in three analytic patients. I approach the issue with the assumption that the ability to maintain necessary ruthlessness exists along a continuum from total ruthlessness (i.e., complete indifference to the plight of others) to the total breakdown, over time, of the ability to maintain this necessary defensive barrier. My three cases explore different points on this continuum; one will also be used to examine the possibility that we can, if we explore our own ruthlessness, find a constructive balance point.

Western societies in general seem to be breeding pools for the development and proliferation of remedies — social, personal, and cultural — for just about anything that might cause discomfort. This includes not only pain and anxiety, but also their derivatives: irritation, frustration, sadness, anger, and so on. In essence, these remedies might serve as palliatives that work to reduce our pain and suffering at the cost of losing any and all hope of recovering from whatever causes underlie the symptoms that are being alleviated (Borg, 2004a). Each of these remedies helps individual members of society to dissociate our awareness of the suffering of others around us — shores up, that is, our capacity for necessary ruthlessness. On this note, I have previously written that Human — that is, emotional — responses to everyday stimuli are increasingly pathologized, and we are increasingly promised the obliteration of all personal suffering. Yet at the core of all these human responses to suffering that need remedy is a deep sense of empathy with the struggles of existing at this time in this society, in a state of perpetual dread over the immense social problems that infect those around us, and that seem (and often are) insurmountable (Borg, 2004a, p.215, emphasis in original).

It seems that in our society it is the experience of empathy that is most feared, most defended against, and most abstained from — as if compassion is the ultimate contagion that, if experienced in full force, would lead to break down.

Some of the essential characteristics of a culture that unconsciously implements necessary ruthlessness are consistent with the sociological analyses of Bellah, Madsen, Sullivan, Swindler, and Tipton (1985), who described a general American movement toward liberal individualism. They asserted that the definitive aim of life in such a society is to promote fulfillment (in the form of increased satisfaction and decreased discomfort or pain) for individuals instead of groups or communities. By individualizing fulfillment and satisfaction, people in such a culture are perfectly set up to and supported in the practice of ignoring — dissociating — the suffering of others. That is, enacting ruthlessness as a status quo approach to living, making it seem (and often actually be) necessary. The underside of the argument presented by Bellah — and others, such as Amitai Etzioni (1991) — is that such arguments pose a kind of "new communitarianism" that defines community as prior to individual rights and a call for a return to traditional social institutions such as religion and the family (Bell, 1992; Samuels, 2001). The new communitarians largely uphold the liberal Western tradition, criticizing deviations or threats to this tradition (Ellin, 1999). Yet in this process they wind up repeating the elitist underpinning of the very system that they criticize, and becoming the watchdogs of their own version of the "good life."

Other authors have analyzed the pervasiveness of this liberal individualism perspective in many social and cultural institutions (including psychotherapy and the social sciences in general) in capitalist societies, particularly the United States (Richardson, Fowers, & Guignon, 1999; Taylor, 1992). However, there is a sense that some of the ways that the major critiques of liberal individualism themselves have been framed supports a kind of "America as Empire" philosophy (Clarke & Hoggett, 2004; Garrison, 2004; Johnson, 2004) that overlooks crucial issues related to race, class and gender bias (Clarke, 2004; Giroux, 2003; Schultheis, 2004). As a character defense on a societal level, the necessary ruthlessness underlying liberal individualism, allows us to avoid acknowledging the social consequences of a sanctioned perspective that supports fulfillment for some and suffering for others. As this perspective becomes rigidified, it functions as an ideology. By ideology, I mean, "those values and assumptions about the world which have implications for the control and allocation of limited resources" (Knox, 1995, p. 3). Consistent with such a notion of ideology, control and allocation processes are dissociated, problems and fulfillments become increasingly individualized, separated from their social and cultural influences and etiologies (Said, 1993; Zizek, 2004). The inability to empathize with both self and other diminishes the potential for subversive or revolutionary processes to exert any impact on societal transformations or daily functions. The phenomenon is clearly expressed in the final volume of the Dune saga, when Frank Herbert (1985, p. 78) states that "Rules are often an excuse to ignore compassion." Today there are many examples of compassion being pushed aside in favor of rules and regulations that diminish our awareness of our collective fragility.

When awareness of pain and suffering — whether on the level of individuals, communities, or groups — is reduced through the use of necessary ruthlessness, what remains is a form of chronic crisis that is so muffled that even those who suffer from it don't know how to respond. This process not only supports a "victim-blaming ideology" (Ryan, 1971), it also establishes a framework for defining social problems in terms of social conditions (e.g., poverty, racism, poor healthcare) and the groups that allegedly engender them (Seidman & Rappaport, 1986; Warren, 2001). The conditions inherent in the dynamics of necessary ruthlessness concretize the split between the subjectified self and the objectified (or "inanimate") other (Blackwell, 2004; Fanon, 1968; Freire, 1970).

I hope to show in the following case examples how certain aspects of these cultural dynamics may become internalized and enacted in our relationships with those around us (including analysts and patients), and contribute, as well, to our own sense of self.

Over the course of a three-year analysis, Deborah, a middle-class African-American woman in her late twenties, became increasingly unable to pass a suffering stranger on the street (in New York City) without experiencing acute anxiety (Deborah is the woman that my supervisor was addressing when she mentioned the lack of "necessary ruthlessness"). She ruminated incessantly about a vast and undifferentiated category of people who were homeless and mentally ill. In her ruminations, her experience of "those who suffer" had collapsed into a monolithic symbol that served to limit her needs, indict her frivolous desires, and expose her wishes as the petty complaints of a "spoiled child." Deborah "recognized" the absurdity of her own wishes and desires in the glaring contrast that confronted her gaze each time she left her apartment. She asked herself the question: "How can I live with the injustice of how much I have versus how much others need?"

Deborah's father died when she was four years old. Her family had attempted to save her from the loss by denying the impact of his death, and she had feelings of betrayal about this. Apparently her father had engaged in a similar denial right up until the moment of his death, when he called her from the hospital to say goodbye. "What," she wondered, "did my father do to suppress, for me, his unbearable emotions?" Her sense was that he had expended his very last breathes in his attempt to save her from his (or perhaps her) suffering. Was her father in extremis while she, a child, ruthlessly went on wanting and needing? Deborah lived from then on in a perpetual attempt to answer the unanswerable question: Whose needs should have been met, her father's, the man who was dying, or his four-year old daughter's? She recognized what she imagined to have been his unbearable emotions in the eyes of the homeless and mentally ill. It was not until well into her analysis that she began to recognize this process whereby she had forfeited her capacity for ruthlessness — and to assess the damage to her professional and personal life that was the result. And as it turned out, this was not a forfeiture she was willing to reverse. Upon termination, Deborah moved to Arizona where she imagined that she would be less exposed to the suffering of others, and so not have to lose her "compassion."

Another patient, Jeff, began his session in a clearly exasperated state, revealing that he had been accosted in the street by "one of those crazy homeless people." This statement was ironic, considering that this thirty-two-year-old Caucasian man was the director of an agency that worked to house such (mentally ill/homeless) people in the Bronx. "What happened?" I asked.

Jeff said that as he approached my office an apparently homeless man had asked, "Do you have a quarter?" In an act that my patient recognized as being somewhat "strategic" (his euphemism for aggressive) he did not answer. The man then shouted, "Don't you speak English?" Jeff then turned to him and, "uncharacteristically, but calmly" said, "Fuck you."

The homeless man, now a few paces away, dropped his bag and began to approach Jeff. Jeff, dropping his briefcase, also began to move toward what he was imaging would be physical contact (another euphemism — a fight). "What entitles you to my money?" he hissed.

At that point, the homeless man stopped, looked into Jeff's eyes and said, "You mean you want to fight?" My patient also stopped and was silent. The man went back to his bag and picked it up. "But that would be illegal," he said, and began to move on, leaving Jeff stupefied and trembling.

Jeff and I explored this interaction, which we came to refer to as a "border crossing." Although humiliated by his increased awareness of his own capacity for ruthlessness, Jeff also began to experience a sense of paradox: in order to be able to be compassionate in his day-to-day work, he had to be able to dissociate his ongoing experience of the very pain that those with whom he worked lived with constantly. Jeff was willing to explore what this interaction said about him and about his relationship to his work, as well as about our interaction (why did he feel so ashamed? why did he experience my questions about the interaction as being so judgmental? etc.).

So this interaction was a crossing wherein, from Jeff's point of view, a generally unseen Other (who had been, in an instant, summed up as homeless and, perhaps via projection, deemed mentally ill), became a real obstacle to the well-honed image that he used to navigate his way through his life. The man had somehow invaded the boundaries of Jeff's generally integrated, continuous, and well-defended sense of self. After all, Jeff had been in analysis for three years and had attained some sense of what existed beyond those (conscious) boundaries, and even of how he himself had been historically forbidden to see, let alone exhibit, those contents. Did the homeless man suddenly manifest what lay beyond those seemingly impenetrable socially-constructed walls? Had an aspect of himself that Jeff thought had been securely put to rest (i.e., killed) suddenly been resurrected?

Or inversely, Jeff wondered, had he somehow inadvertently stumbled into the position of denying existence to the homeless man? Was he one of those who deprive and withhold? One of those who withhold, most essentially, the acknowledgement of existence? In an act of defiance and protest, that man had pushed his own subjectivity across a threshold of regulated spatial and emotional distance to enforce a near-violent moment of co-participation that refused suppression. Perhaps this was a (or another) last-ditch effort for this man to, if not reclaim his humanity, at least turn the tables on an archaic, and generally condoned and enacted murder.

Jeff and I began exploring this "experience in the borderlands." He had been forcibly yanked out of his position of necessary ruthlessness. He had a sense that the area that he inhabited without it existed at the boundary of his own defensive system, and that the emotions that ignited within him in his engagement with the homeless man were not actually alien to his experience. It was as if the interaction suddenly outlined the perimeter (perhaps uncomfortably close) of his own sense of marginality; as if it brought him too close to some implicit and standardized measuring stick against which he could never measure up. Fuery and Mansfield (2000), considering the violence inherent in identity formation and maintenance, suggest that "the identifying group consolidates its sense of collective selfhood by nominating and defining what is other to it. The identity thus created inscribes two kinds of possible selfhood, therefore: the identifying self, and the counter-identified other" (p. 145). This process is the reduction of the other to the same (or self). The other loses his/her/its independence, and becomes merely an inferior (or otherwise outwardly projected) version of the dominant self. And, of course, a version of self that, in comparison, offsets one's own feeling of lack. The other, therefore, is represented as a sort of blind spot in the standard economy of representation — a blind spot sustained by necessary ruthlessness.

The function of identity is to stabilize our experiences in the world, to make ourselves something that will not only be secure, but will also be continually validated by the world around us. The something that we appear to be must be something that has meaning to (is valid to) others, and to the massive, impenetrable social forces that others represent. We do not so much express our inner natures in our identities as we perform identities in order to give the impression that we have a recognizable, orthodox, acceptable inner nature (Butler, 1993, 2003). In this performance, guilt, over-identification, and a usually warded-off aggression offset the standard collusion that generally plays out along the surface where multi-faceted, internally-sustained identity conflicts become an environmentally (externally-) focused category.

An exclusive focus on category provides distance from both the subjective individuality of the Other and the more general culture in which he or she lives; this wards off anxiety-provoking experiences of Self and Other that may give rise to impenetrable self-protective biases. Yet what sort of interactions do such defenses perpetrate across the Self/Other border? Historically, murder. The Selfs who colonize "new" territories have historically licensed genocidal treatment of Others (e.g., indigenous ethnic groups) based upon whether or not they measure up to the standards of a self-defined "human enough-ness."

Perhaps in the borderlands these things of memory, things unconsciously silenced, things that were thought to have been transcended, appear in our vision, pulling us back into our breakable bodies. After all, the threat of death is constantly, if implicitly, evoked in our perpetual struggle for presence.

Hegeman (1995) has said about the process of enculturation and the anxiety that it can evoke that "security operations arising from interaction in the interpersonal field can bring about a fear of Ôotherness': a stranger who does not know or follow the cultural conventions we are familiar with can behave unexpectedly and induce a great deal of anxiety" (p. 831).

This being the case, what would it mean to have empathy for such a person? To relinquish the ruthlessness? Would empathy and compassion require that Jeff relinquish the well-established "self-system" (that is, self-experience in the context of anxiety-reducing security operations [Sullivan, 1953]) that allowed him to do his job, not to mention his other routinized daily activities such as leaving his apartment, entering the subway, and so on? Would he lose the ruthlessness that allowed him not to see? And if he were to see, would he then see how close he himself was to not measuring up to what he believed were the requirements of his own cherished image of a functioning and successful individual in this society? Perhaps, then, the silent presence of the suffering Other(s) would explode into the absent space that inhabits Jeff's gaze when he looks through men such as the one he had just encountered, a man who refused to be left for dead by the silence of the unseeing.

Jeff's necessary ruthlessness collapsed in his interaction with the man who asked him for money, and Deborah lost it over time as she walked the New York City streets. Both of these examples suggest that there is a message revealed in the ruthlessness. It was spoken to the cold and unconsciously calculating machinations of a ruthless narcissistic cynicism, a cynicism adopted by those of us inner-city dwellers who believe that we live within the margins, a cynicism that perhaps has as its motto: You do not exist if you are inconvenient.

One of my patients, Joyce, is mentally ill and homeless. She told me that this allowed her to experience (chronically) the "killer" in others. She felt "murdered," she said, by every act of cold, cruel indifference that was perpetrated upon her when she met the hopefully averted eyes of others as they passed her on the street. She described feeling a kind of death each and every time this happened to her — and it happened often. But what is it like for the killer who finds himself in the cross-hairs of the one who was supposed to have been killed? Jeff knew. I found out too, as I dodged a half-full cup of coffee that flew toward my head as Joyce terminated her two-year, three-times/week psychoanalytic treatment with me. In that moment, and in the transference, I was the incarnation of every cold-blooded or apathetic killing that Joyce had suffered in her years of homelessness.

Joyce began treatment at age thirty-nine, after a year in a New York City homeless shelter between repeated psychiatric hospitalizations. Throughout our work, as I shifted, in the transference, from typical (not-to-be-too-enticed-by) object to needed (and fairly exciting) subject, Joyce's experience of being humiliated and chronically objectified and ignored became increasingly clear to her and to me. It also became clear, after about a year of treatment, that every practitioner she had dealt with (and, with her history, there were literally hundreds) had ultimately disappointed her. When that happened, her pattern was to stage rather severe attacks in her attempts to destroy the disappointer. She enacted destruction through litigation cases, reports to licensing boards, claims of fraud, and so on made against those, such as myself, who represented the apathy of the system toward her conditions.

Interestingly, both of her parents had been physicians, and they had expected her to be one as well. But they both died unexpectedly within a month of each other when she was seventeen — as she puts it, she was "orphaned." Soon after that she was placed against her will in her first psychiatric hospital. She was released after about a year, deemed incompetent to handle her own affairs (including her inheritance), and given the status of "mentally disabled" (complete with Medicaid and Medicare benefits). So prepared, she began a life-long pattern of chronic hospitalization and homelessness.

In the period I am reporting, we had been discussing some alternatives to Joyce's pattern of attacking the very practitioners to whom she turned for help. A month or so earlier, she had begun to write "hate" letters to the White House, complaining about her poor treatment by her numerous practitioners. This was immediately after 9/11 (Joyce's treatment is covered more thoroughly, specifically her reaction to 9/11, in Borg, 2003). The letters were perceived by the White House staff as being quite threatening and Joyce was hospitalized for three weeks. Thus she had brought with her to the session I am describing a large shopping bag full of a new onslaught of threatening letters; instead of sending them, she planned to give them to me for "safe-keeping." It was in the act of handing me the bag of attack letters that Joyce suddenly shifted her sights to me, and began blasting away. Could it be that in that act, the bag became the symbol of her necessary ruthlessness? In the moment of relinquishing it did she become impossibly vulnerable, too overwhelmed by her experience of what it would be like to exist without it?

With her coffee-cup missile, Joyce took back her own ruthlessness and her capacity to categorize me as "practitioner," objectifying me and leaving me with a powerful and ongoing countertransference dread of an (actual) counter-attack (that is, that she would report me to state boards, etc.). Oddly enough, aside from the termination of her treatment, no counter-attack ever came. In fact, the endless calls that I, as her analyst, had received from her caseworkers, her doctors, and the staff at local psychiatric hospitals throughout her treatment ceased completely after that. In the moment when she threw the coffee, I learned what it's like to be absolutely taken out — I no longer exist in her world.

Deborah and Jeff seemed, at times, to be able to make use of the silent and death-like surface of the homeless/mentally ill category as a highly functional (albeit defensive) blank screen. This surface served as a "convenient" repository for submerged needs, desires, and generally dissociated self-states. Joyce, on the other hand, lived to ensure that the necessary ruthlessness of others would be anything but convenient — although she certainly had repositories of ruthlessness of her own. The fact of categorized difference is probably as powerful a trigger (and container) for the projection of unacceptable impulses with resulting prejudices toward the object of the projection as we have in our culture (Holmes, 1992). Consistent with this statement, Fuery and Mansfield (2000), comment that

Each identity requires an inferior other that can be measured against it. The other is not something outside and alien. It is a necessary part of the identity that thinks it is using the other as something to define itself against. The outside is truly inside. The difference is truly part of the same (p. 62).

To assure my three patients' own continuous and fluid sense of existence (and to ward off the anxiety of non-existence), it appeared, the individual subjectivities of numerous others had to be compressed into the static presentation of a stereotyped Other. In exploring such processes, Sullivan (1964) states that "anxiety and its complex derivatives prevent the progressive discrimination of significant differences between given persons and inadequateÉstereotyped personifications" (p. 311). In one broad stroke of necessary ruthlessness, these two specific (anxiety-provoking) conditions (homelessness and mental illness) become crystallized and solidified into one vast category, a semiotic warehouse for all those who exist in society-sanctioned silence in the borderland world of the disenfranchised: "homelessmentallyill."

In this objectification, therefore, the homelessmentallyill category embraces those perceived as a threat to those inside the margins, those who fall outside our implicit bioeconomic pact to behave, to conform, to produce, to consume, to buy, to sell. Inhabitants of this category are disqualified as citizens, and emerge as a symbol of the wild fragment of nature that must be systematically disavowed.

This is not a new kind of thinking. In 1764, Le Tronse, who was a judge at the presidial court of Orleans published a treatise on vagabondage. In his evaluation, vagabonds are those who "live in the midst of society without being members of it, who wage war on all citizens, and who are in the midst of us in that state that one supposes existed before the establishment of a civil society" (Le Tronse, 1764, quoted in Foucault, 1977, p. 88). Le Tronse went on to suggest that such people should be hunted down and killed "like wolves," as they are far more threatening. The idea of the homelessmentallyill as a crude reminder of our own primitive potentialities, and the threat that this poses to "civil society," has a long history.

As an example of such objectifying practices, psychiatric epidemiological studies since the 1960s have shown that the prevalence of psychiatric disorders is extremely high among American homeless people, with a broad consensus emerging that of the homeless people residing in shelters, about one third have significant mental illnesses (Breakey & Thompson, 1995). Yet there is some discrepancy of opinion as to whether these illnesses are a cause or a result of homelessness (Cohen, 1993). Experience and research findings suggest that homeless people are a heterogeneous lot. Although, a steely and impervious homogeneity is attributed to homelessness, and it serves as a trigger for the stimulus-response nature of the transferential reactions explored within this paper, homeless people do not constitute a distinct class of individuals (Smith, North & Spitznagel, 1993). In fact, the National Institute of Mental Health has identified eight major subgroups among the homeless: 1) street people; 2) chronic alcoholics; 3) situationally homeless; 4) chronically mentally ill; 5) dually diagnosed (substance abuse and psychiatric disorder); 6) homeless families; 7) homeless children and adolescents; and 8) HIV infection (Breakey & Thompson, 1997). But how much heuristic penetration can we expect from an epidemiological study? Does not that research methodology in and of itself provide a repetition of the very circumstance that I am discussing, in that it must compress the vast diversity and the many unique subjectivities and individualities of actual people into objectifiable categories and almost equally anonymous subcategories?

In one such study of the "epidemic" of homeless mentally ill persons, the authors state that the "outrage" of the American public has little to do with concern for the people in this condition, and more to do with "visible signs of failures of our social and health care policies" (Breakey & Thompson, 1997, p. ix). This system breakdown, evidently, is the cause of a massive form of collective defense, characterized (in a general way) by a generally hopeless attitude about the epidemic proportions of homelessness among the whole of U.S. society in general. Thus, society-level security operations are created against the anxiety that were we (that is, I) to fall into this status, I, like those who are there now, would be stuck there.

To think about the workings of such a societal system conjures up the notion of Erich Fromm's (1941) "social character." Invoking this specter, and Fromm's explicit forebodings regarding it, Hegeman (1995) suggests that, within such a character formation, "successful adjustment to society could produce psychopathology" (p. 830). This being a society where the some (the homelessmentallyill) suffer from an inability to adapt while others (my three patients, myself, etc.) suffer from the compromises they have made in order to adapt (Fromm, 1968). Directed specifically against homelessness and mental illness, perhaps as a screen for the displacement of other concerns about a system-wide failures, this adaptation allows us to maintain a blind spot around the notion that were we to fall (into that death-like silence) there would be nothing to catch us.

In the clinical cases mentioned above, the surface of "homelessmentallyill" became a reflector of transference and countertransference reactions: that is, the patients' reactions to the homelessmentallyill, and my dread of being targeted by Joyce's rage the way that so many other practitioners had. The surface became that which my patients used to organize (project) warded-off emotions, feelings of` inferiority, and self-states that could extort silence in the context of murderous threats to well-established and long-held images that my patients (and their analyst) used to navigate their way through the outer world.

In many conquered civilizations throughout history, the language, rituals and cultural styles of the conquered were forbidden and subsumed under and incorporated (via bastardization) into the spoken and written word of the conqueror (Sardar, 1997). Any so-called minority group is defined as such not through some kind of numerical weighting, but rather through the possession or dispossession of a voice (hooks, 1994). Once access to the system of languages/discourse is denied, then subjectivity is lost and people become like objects (Kristeva, 1982).

From the psychoanalytic perspective, the question becomes: what lies beneath the surface — the surface of writing, speaking, and even of existence itself? Generally speaking, what we usually come up with is meaning. This being so, the search for meaning reflects a cult of authority that encodes social interaction into the lexicon of meanings surrounding the experience of agency and authenticity. Whose existence is authentic? Whose way of being manifests agency? Official, or dominant, culture attempts to impose unitary models of interactive legitimacy on an otherwise dynamic social field, educating us in "correct" models of being. Meaning from this perspective becomes a sort of tyranny; it imposes a widespread social system that both narrows and distorts the possibilities of human existence.

Jeff's interaction with the homeless man became increasingly complex as we found different ways to re-engage with it together. Perhaps more understanding of the need for ruthlessness and the use we make of it would allow us to handle it better than exhortations against it; perhaps we could make better choices about how we see, hear, and think about, as well as what we want to do with, the crisis of serious social problems that confront us (e.g., homelessness, mental illness). In a sort of counterpoint to Sullivan's (1954) clinical approach of "participant-observation," we generally manifest a type of non-participant/non-observation with regard to such problems. Whether consciously or not, we do experience and respond (even if through inaction) to such chronic crises, or at least to the voices of those who whisper (or scream) at the peripheries of our existence.

In 1980, in responding to the terrifying possibility of a weapon of mass destruction that would kill humans while leaving the fruits of their labor intact (buildings, property, etc.), Jello Biafra of the punk band the Dead Kennedys offered his more contemporary version of Swift's satirical "modest proposal." In the song Kill the Poor, he states sarcastically:

This song, in many ways, captures the sentiment of this paper. I read it less as a nihilistic "proposal" about what (in actuality) should or could be done (to the poor, the homeless, the mentally ill), but as what, at the psychic level, is done each and every day — and perhaps with necessity.

"Speak that I may see you" suggests Bromberg (1994, p. 517). The image of the Other, however, remains unseen (and, hence, unheard) as disturbing images (and muffled voices), such as the whole vast category of homelessmentallyill, become dissociated from meaning and from their task of representing the world. After all, how can I see you, feel you, hear you, touch you when, to maintain the integrity of my own sense of self, I must dissociate your existence with a precise and "necessary" ruthlessness? In opposition to the idea of a complete and whole subject (person), both Freud (1930) and Sullivan (1953, 1964), long before the current multiplicity of self theories, postulated that the subject was infinitely fragmented, spilt, and often at odds with him- or herself and the social environment. This fragmentation is, of course, endlessly anxiety-provoking. Therefore, the stimuli (people) that reminds us of it must, if at all possible, be neutralized, if not obliterated completely — killed repeatedly as they arise, serially, as if each potentially disturbing image must be shot down before it enters our awareness in a kind of unconscious skeet-shoot.

It is my impression that we have in our culture a significant investment in maintaining categories of Otherness that reinforce our collective tendency to use them as focal points for the projections and dissociated self-states that we find most unacceptable. Freud (1917) referred to a similar process as "the narcissism of minor differences." The "narcissism of minor differences" formula goes something like: a) although two groups may seem alike, they have minor differences, b) rituals are developed to maintain these minor differences and keep a psychological barrier between the opposing groups that absorbs the flow of aggression and, at least in times of peace, keeps the groups from killing each other (Volkan, 1988).

Our actual opportunity to work on problems such as homelessness and mental illness is limited by our own institutionalization of these categories. This limitation is upheld by our limited professional appearance in the outside world, in community contexts, where such a vantage point might be actually challenged and opened up to new possibilities (Borg, 2004b; Borg, Garrod & Dalla, 2001). Winnicott (1958) spoke of the developmental process as one wherein "ruthlessness gives way to ruth, unconcern to concern" (pp. 23-24). Although Winnicott was referring to early developmental problems between parents and children, he was also speaking about the facilitating environment and its role in development and personhood, much as I have been discussing at a broader societal level.

We cannot simply impose "ruth" on our patients or on our world. Moments of true ruth often come as a shock, even a severe blow, to the defensive system — or perhaps as a result of such a shock. All three of the cases presented here reveal this — the shock that comes when indifference gives way to compassion, when our (necessary) defenses break down and reveal the (suffering) other as subject, when the other becomes the serially-killed self resurrected.

Of my three patients, only Jeff was willing to explore both the need for ruthlessness and the potential to survive unprepared moments of compassion. In the slow expansion of Deborah's ruth, she lost her capacity to defend against the suffering of others to such a degree that she had to regress to an "ideal" world where suffering no longer existed. As we saw in the case of Joyce, the unprepared or shocking compassion that one might feel toward others also has the capacity to induce a panic state, when the necessary categorization of Other breaks down and leaves one vulnerable to one's own fragile state.

This shift from ruthlessness to ruth, from indifference to compassion, was, in each case, painful; it did not come without a price. Living in a city like New York, where the suffering of others is rampant and efforts to intervene in it feel daunting, if not futile, ruthlessness may be a necessary defense if one is going to survive. I think that awareness of the pain of another's condition is what this shift is all about. However, we cannot naively assume that this will be possible at all times, especially if we consider that we have all, most likely, had to make adaptations that allow us to exist and function (at a level of maintaining "efficiency and progress") in "civil society." And, in many ways, our necessary ruthlessness brands us as, in cyberpunk author Neal Stephenson's (1995) terminology, "veterans of that elongated state of low-intensity warfare known as society" (p. 286). And so the question remains: How can we close the gap between necessary ruthlessness and the generally dissociated empathic connections that, perhaps at times necessarily, remain unlinked between those inside and those outside of the borderlands? If we do not address this gap, then perhaps we might assume that the reason why we never used the neutron bomb was because we did not need to.

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