How is madness embodied in psychoanalysis?

17 May 2025

These remarks are extracted from a much longer piece entitled:  “My Body, My Psyche, My Self: An Empath’s Reflections in Being and Becoming in the World,” that is part of a special issue on Madness of the journal Psychoanalytic Inquiry.

From the analysand’s perspective, when sensory perceptions, heightened by bodily and psychic memory, overwhelm our minds and take us to a place that has no context in our present lives, we can find ourselves in the throes of what seems like madness. The support of a caring psychoanalyst can allow us to begin a process of recall and discernment to discover the past traumas and deeply buried memories that are the sources of those unbidden, seemingly anomalous feelings, which are often accompanied by somatic manifestations. Contextualizing and placing these embodied memories within our personal histories weakens their toxic grip, so that what had felt like an invasive, bodily presence of madness is identified, disempowered, and gradually disembodied, allowing us to recapture a sense of agency and autonomy over our psyches and our selves.

I was born in Hong Kong in 1951 to a refugee family that had fled from Shanghai to Hong Kong in May 1949, just weeks before Mao’s troops marched into the city. My sister Elaine, then ten, remembers seeing people being taken away to be shot. As a result, I hold trauma-based understandings of the sensitivities and vulnerabilities that led to my hearing voices, and familial, cultural, and spiritual understandings of the factors that fostered my resilience, helping to guide me through my most difficult voice-hearing experiences.

My own primary traumas were familial and historical, born of war, colonization; refugee flight within and from China, maternal distress during gestation, immigration before age four, maternal depression, racism, and a retreat into silence at age 14, when a family conflict arose between my parents, especially my mother, and my middle sister. In an effort not to think or feel too much about the family conflict, I hid my true thoughts and feelings and ceased to form or articulate opinions about almost everything.

I believe that the sensitivity and accompanying vulnerabilities within my own physiological makeup, a sensitivity not shared by my two older sisters, is born of the particular combination of traumas I experienced beginning in my mother’s womb. I believe also that my several breaks from shared experience were my mind’s way of shaking off the bonds I’d placed on it in order not to think thoughts that might risk betraying my family – and also possibly myself.

In 1951, with me in utero, my mother returned to China to tell her family that she and my father had placed the family names on the immigration list to the United States. Mother then said her goodbyes and returned to Hong Kong wondering, as she prepared to leave family, homeland, and heritage for an uncertain future, whether she would ever see them again. She would not know for the next 27 years if anyone in her family had survived Communism or the Cultural Revolution. The family immigrated to the United States when I was three and a half years old. By the time I was born, the then-14 years of my parents’ marriage had been filled with refugee flight—first from the Japanese, and then from the Communists.

By the time I graduated from college in 1972, I was profoundly depressed. That fall I moved to Boston and began therapy with a third-year psychiatric resident at Harvard, trained in psychoanalysis, whose warm and gentle guidance helped me begin to consider who I was and who I wished to be and become in the context of family, friends, and the world. But it was not a natural path for one who had learned to favor silent stoicism over expressing emotions. I walked out of therapy the week “Dr. M.” asked about my relationship with my mother. I stayed away for three weeks. After making peace with Dr. M. for having “forced” me to betray my mother, I finally went back, and Dr. M and I began exploring more deeply the ways in which I experienced, understood, and made sense of the world. This process served me well when I began actively hearing voices. Just as I had learned to negotiate the terms of therapy, and through it to consider the nature and sources of my unhappiness, so did I learn to stand up to the voices. I learned to consider whether or not their presence and requests were useful, and whether I should allow them to have a lasting impact on my life.

As the youngest of three daughters in a Chinese immigrant family, I often felt suppressed, and sometimes oppressed, by birth position and the difference in ages between my sisters and me: I was frequently denied privileges that they, almost five and thirteen years older, were granted. And because there were differences of opinion as to what was age- and position-appropriate, I sometimes threw violent temper tantrums when I didn’t get my way. Over time, I learned that privilege was contextual: based upon age, birth position, family resources, and appropriateness within family and culture. My ability to find equanimity always depended upon my ability to consider and place my desires within this framework.

These are essential elements of intersubjectivity and metacognition. Wikipedia defines Intersubjectivity as the shared understanding that emerges from interpersonal interactions. And Metacognition is an awareness of one’s thought processes along with an understanding of the patterns behind them. 

In his 2003 article The Roots of Empathy: the shared manifold hypothesis and the neural basis of intersubjectivity, Italian neuroscientist Vittorio Gallese states that the ability to understand certain individuals “vulnerability to major psychoses such as schizophrenia” can be enhanced through a deeper understanding of the act of intersubjectivity – the ways in which humans enhance their ability to understand others by ‘placing ourselves into them.’ Gallese writes, “It is commonly held that Einfühlung, or empathy, was originally introduced by Theodore Lipps into the vocabulary of the psychology of aesthetic experience to denote the relationship between an artwork and the observer who imaginatively projects himself/herself into the contemplated object” I understand Lipps and Gallese to be communicating that they interpret this process from the perspective of actors with considerable agency, who are consciously engaging their imaginations to internalize within their own beings the perceived movements of others. Or, as Lipps writes, “When I am watching an acrobat walking on a suspended wire, I feel myself so inside of him.

I certainly resonate with this description of empathic understanding of another’s experience and perspective and often engage it.

But for me, this feeling is sometimes reversed – I sometimes feel others inside of me, and that feeling, often with accompanying thoughts, is entirely unbidden, outside of conscious desire and, until I am the grip of those unbidden thoughts and feelings, often outside of conscious awareness.

In 2017 I was told by a psychiatrist that I am an empath, a phenomenon where people actually feel other people’s emotions—without accompanying intentionality. Google led me to Dr. Judith Orloff, a California-based psychiatrist whose book, The Empath’s Survival Guide, was a revelation. I finally had a context—and a reason—for many of the unexplained, seemingly unexplainable, and extremely unsettling sensations, feelings, and experiences I have had throughout my life. Having a label with a defined context outside of the medical model was immensely reassuring. Apart from Orloff’s work, there is little “hard science” based evidence of the existence of the empath, as opposed to the highly empathetic individual, whose gifts of insight, compassion, and understanding are celebrated.

When I was a child, I frequently felt as if I had no personality of my own. Oftentimes when I was playing with another child with a stronger personality, I would find myself behaving just like them—not by choice, but simply by virtue of being in their presence. It was fine when I liked the person, but when I didn’t like them and yet found myself talking and acting just like them, it was upsetting, and I would have to work very hard to stop the behavior.

These recollections are affirmed by my father’s observations on several occasions that I am a “natural born mimic.” I believe his remark was based upon increasingly keen observation—watching me act in various situations, contexts, and with different people. I don’t know what sense he made of that phenomenon, but I do know that over time, and after some trial and error, he understood that the best way to instill within his youngest daughter a combined sense of decorum, respect for elders and betters, personal agency, and independence, was not through reprimand, but by setting a beautiful example. Thus, by the time I was a pre-teen, his reprimands were always well considered and expressed without anger lest his felt anger or frustration manifest in my behavior.

The factor of Choice

We are, throughout our lives, confronted with multiple possible realities and innumerable choices. Our ability to make our own informed decisions about who we are, who we wish to become, and how we wish to engage with the world, provides us with the independence, self-confidence, and self-respect we need to live full and productive lives. But when we have little or no personal agency and our lives are constrained by the prejudices, desires, and expectations of others, and quite frequently of ourselves, it is difficult to make the choices that will allow us to find even a measure of equanimity, much less fulfillment or happiness. At those times, many of us choose – or wish to choose – to live outside of the world as we know it. And sometimes those choices can create pathways for a journey into madness.

One of the choices we make is when and how to listen to our voices, especially when they first arise, speaking either to our deeply buried fears or our greatest desires.

It can be very difficult to resist listening to the voices when they are new and talking to and about us. Later, when they begin speaking to our self-acknowledged, as well as sometimes deeply buried fears, it becomes virtually impossible. Thatis important. Our voices represent our deeply suppressed emotions, buried because we would not allow ourselves to remember and certainly not feel, the most terrifying or shameful things that happened to us. Allowing the voices to speak, and working to discern what they are really trying to tell us, offers the opportunity to gain insight and understanding – and over time freedom from their terror.

When my voices first began, I was filled with shame and guilt over the role I had played in helping my mother bring my first cousin Jean to the United States, and my subsequent neglect, which I felt had precipitated her suicide less than one year after she arrived in the U.S. Because I was constantly asking myself, “What am I doing?” my early voices often asked, “what is shedoing?” and came across as both curious and judgmental. As I started listening more, they turned mean and gossipy, clearly a reflection of my own negative self-judgments.

When the voices came back on April 12, 1989, as the student protests in China were mounting, culminating in the Tiananmen Square Massacre of June 3-4, and their insistent and sometimes assaultive physical manifestations began, I felt an odd combination of tormented and intrigued. Why were they back? Who was doing this to me? And why? The most important question being, WHY? What did they want? What did I want? Who would win in the end? And what would victory look like? The last two questions were not particularly top-of-mind at the time, but they are questions that most, if not all of us, must consider periodically as we move through life.

Continuing Contemplations
Some of the following was shared during the Q&A.

There is so much about the most extreme of my lived experiences that continues to mystify me because, to my knowledge, they have no discernable context in my own life. No such violence has ever been inflicted directly on my body by any living, breathing human. I am confident this is true because I have never placed myself in a situation that would have rendered me unable to recall what had happened the night before.

French psychoanalyst Françoise Davoine suggested, after reading an earlier draft of this paper, that perhaps some of those particularly puzzling extreme experiences were the result of a “transmission” from my cousin Jean, whose suicide was determined to be the precipitating factor for onset of my negative voices. Françoise suggested that this transmission forced me “to be a witness to what Jean and millions of others went through during China’s Cultural Revolution, not through the abstractions contained in books, but by living through it in order to show how it is possible not to surrender.

This is a beautiful analysis. I especially like the suggestion that my experiences help show how it is possible not to surrender. I believe that if a transmission did take place, it is quite possible that my voices and presences inflicted on me some of the harms that were inflicted on my cousin Jean, when she was sent to the countryside at age 14. Young, innocent, and powerless, Jean would certainly have been vulnerable. The eight weeks I spent in China in 1981, and my role in bringing Jean to the U.S. which resulted in her suicide “on my watch,” had primed me for this transmission.

I have also wondered whether some of the abuse I endured was the result of epigenetic trauma, a manifestation—or transmission—of things my mother may have experienced, or deeply feared experiencing, during the Japanese occupation of China in the 1930s. Or perhaps the source was the sexual harassment she experienced at the university where she and my father, who had been neighbors growing up in Tianjin, met again—she as a librarian, and he as a chemistry professor. Desperate for a sympathetic ear and perhaps some guidance, Mother reached out to Father as “an older brother” (by seven years) for advice. They fell in love and were married. And the threat was removed.

The idea of transmission, combined with my reading the opening chapter of Michael Eigen’s most recent book, Bits of Psyche (Eigen, M., 2024), about his work with his patient “Arnie” who grew up with a depressed mother, prompted me to wonder whether my withdrawal from full engagement with life after that ninth-grade Christmas break fight had more to do with my relationship with my mother and mirror neurons than with my considerable distress about the family fights. When Mother realized she could not force Daphne to do what she wanted, and not wanting to drive Daphne (or me) away, Mother shut herself down further—again—as she had done when she left her family behind in China. I imagine she wanted to remain as good a mother to Daphne and me as she could be. And I, unconsciously, unwittingly, mirrored her emotional void, moving from being the headstrong and often naughty child I had been, to being “good.” And so, we both ceased to form or articulate thoughts or opinions about almost everything.

These are mere conjectures, theories that cannot be proved or disproved. But I do believe they contain some large elements of truth. I greatly look forward to continuing to examine my lived and embodied experiences, encouraged, inspired, and supported by many of the wonderful people I have met through ISPS and the HVN. The benefit of engaging in this process of rumination, conjecture, and discernment, is that we develop a greater sense of self-agency, understanding, of capacity for love and forgiveness—for ourselves as well as others. Many, and perhaps most of us do not have to be dominated by known or unknown voices, known or unknown energies if we choose not to be. We can be greatly aided in this task through the guidance and compassionate support of the people, and in the communities where we feel safest, and most greatly understood.