Mary Cappello

by Swallow: Foreign Bodies

  Four months after the removal of the tacks, as reported in the foregoing, the patient came to Dr. Cole’s office at the suggestion of Dr. Geo. W. Bogart, stating that she had the same old symptoms, and she thought there must be more tacks there. She further said that the tacks Dr. Jackson took out were corroded, yet the last just coughed up was bright and new. A radiograph showed one tack on each side of the thorax . . . not so near the periphery as the previous tacks. The question then arose how could the patient get the tacks into the bronchi voluntarily, as it was clear that she was a hysteric, if not demented. Dr. John W. Boyce, in consultation on this point, said that by throwing a number of tacks into the pharynx and taking a deep inspiration, she might get one or two down, but in so doing she would swallow many more than she could aspirate, so that, if not too late, a radiograph would show tacks in the alimentary canal in progress of passing through.

  Jackson concludes that the “sympathy” the patient received combined with her case’s “sensational features . . . evidently appealed to [her] neurotic temperament . . . and developed the hysteria which now is most troublesomely manifest in ways unnecessary to enumerate here.” Jackson’s attitude toward human psychology is what it always is here—impatient, incurious, and dismissive. The human psyche is an annoyance he’d rather dispense with when it interrupts his work on the body, but is it possible that the hysteric in this case doesn’t want necessarily to be treated by him but to baffle him? In presenting a case of presumably voluntary aspiration, she outwits the doctor and even projects a certain mastery of physiology without the trouble of book learning.

  Hysteria includes acts of purposeful swallowing of things and is also the category for which is reserved, in psychoanalytic parlance, the utterly menacing “phantom foreign body”—a sort of false foreign body or felt foreign body that is and is not real. We have to love Jackson’s seemingly oblivious misuse of the phrase to designate phantoms produced by errors, which are therefore correctible—when the X-ray machine is dirty, for example, or when patients have faulty memories of the Thing, which an X-ray machine then corrects. In his 1934 work Annals of Roentgenology: A Series of Monographic Atlases, phantom fbdies of this kind are in these ways easily explained and easily eliminated. The examples are plain and simple:

  Phantom foreign bodies may be the result of dirt or extraneous objects in the cassette or elsewhere about the equipment. The cassette and all other pieces of apparatus should be kept scrupulously clean. We have seen a number of errors result from failure to insist upon this rule. In one instance error was due to accidental partial exposure of the film before it went into the cassette. Usually phantom foreign body is eliminated by its failure to appear in all of the films made.

  Never take it for granted that the foreign body of which the patient gives a history is necessarily the one that is lodged in the patient. For example, a supposed bone in food was a pin that fell from the cook’s clothing. Conversely a supposed pin was a radioparent bone. We have had a number of such cases. All examinations should be complete for radioparent as well as radiopaque foreign bodies regardless of the history. In one instance a supposed oyster shell turned out to be a cap off a catsup bottle.

  In Jackson’s world, phantom foreign bodies can only be signs of failure to remember or to carefully observe. Reliability is his bottom line; he needs to know exactly what he is dealing with to exact a cure. The psychoanalyst, however, needs to be open to ambiguity and an inexpressible center, to the possibility of “phantoms” that are reliably there, on one level, and entirely illegible on another.

  Practically concurrent with Jackson’s discussion of phantom fbdies in the early twentieth century, psychoanalyst Sándor Ferenczi, an original thinker who was also a reluctant detractor of Sigmund Freud, was writing about two kinds of hysterically induced phantom fbdies: aerophagy (the hysterical swallowing of air to simulate a pregnant belly) and globus hystericus (the production of a lump in the throat often accompanied by severe dysphagia). When we are children, we might believe that pregnancy is a result of something going into the mouth, that kissing is where babies come from. So the aerophagic hysteric reverts to this earlier assumption and, for any number of reasons, makes herself pregnant. When we consider that the contraction of the upper esophageal sphincter during inspiration probably serves to prevent inhalation of air into the esophagus, the purposeful ingestion of air must be quite a feat: in hysteria, the involuntary nature of the swallow mechanism is overcome, rerouted, perverted, and undone.

  Globus hystericus, a quite common occurrence among Ferenczi’s early-twentieth-century patients, introduces even more complicated implications. The conundrum that Ferenczi observes is that the lump in the throat is a phantasm produced by the hysteric at the same time that “a kind of foreign body, a lump, really is brought about.” In the early pages of his essay “The Phenomena of Hysterical Materialization” (1919), Ferenczi interprets such symptoms almost always genitally. So, in the case of globus hystericus, “on analysis, the lump certainly appears as a quite peculiar and not harmless foreign body, but one with an erotic significance. In not a few cases this ‘lump’ moves rhythmically up and down and this movement corresponds to unconscious representations of genital processes.” Ferenczi’s theorizing doesn’t end there, however; he doesn’t rest easy with the “mysterious leap from mental to bodily” processes featured in hysteria but admits to vast lacunae in our knowledge of these matters and remains determined to find a language for the hysteric’s ability not just to manifest a feeling (I feel like I have a lump in my throat) or fantasize a bodily state, but actually to bring the physiological state about. In a separate fragment titled “Materialization in Globus Hystericus” (1923), he offers further proof of this strange mental process “by which an idea actually becomes true in the flesh” by citing a story told by another psychoanalyst in which a doctor feels the tumor or lump about which the patient complains, his fingers inside the patient’s throat, only to discover no “malformation” upon further surgical inspection.

  Ferenczi’s cases are beyond intriguing: in them, people make of themselves a foreign body, they introduce foreign bodies into themselves from inside themselves. This is especially apparent in patients’ manipulations of their digestive tracts. Exerting great control over their intestines, “our neurotics, especially the hysterics,” Ferenczi remarks, make “it possible to retain a faecal mass or gas-bubble at some place or other, and compress, so to say shape it.” One of Ferenczi’s male patients offered the analyst the opportunity to “study the hysterogenic role of the rectum and anus for months on end” until together they concluded that, “with the help of the contractile rectal walls,” the patient “was compelled to mould for himself a male organ—the member of a consciously hated opponent—from the plastic material of the ever-present rectal contents that could not remove itself from the rectum till the conflict was solved.” Ferenczi understands these internalizations as substitutes for withholding of information, or retention of desires, and he refers to the creation of fbdies inside oneself as “auto-plastic tricks” that are the precursors of art (the difference between the hysteric and the artist being that the former manipulates her own body, whereas the latter manipulates material from the external world).

  Ferenczi doesn’t settle for one interpretation of globus hystericus or autoplasticity. Are we witnessing the bodily expression of something psychological? Is what’s going on the result of internal stimulus taking precedence over stimuli from the outside world? And how is it that “in hysterical symptoms . . . organs of vital significance subordinate themselves entirely to the pleasure principle, regardless of their own particular function in utility”? Ferenczi is convinced that something instructively unusual is occurring in globus hystericus, neither a hallucination nor an illusion but, in his coinage, a “materialization.” The word carries connotations of spiritualism, ghosts, and the occult; in fact, the word “magic” enters into Ferenczi’s exploration of the problem.

  Contemporary feminist soci
al scientist Elizabeth Wilson mines Ferenczi’s speculations toward a radical understanding not of spirit but of biology and the body—not the body understood as that which opposes the spirit and is flatly concrete, but the biological as a realm of dynamic thinking all its own. In a startling essay, “Gut Feminism,” Wilson reopens the lacunae that had necessitated Ferenczi’s writing in the first place by proposing that we suspend our investment in hysteria as a form of psychosomatic projection. Hysteria’s body isn’t a passive recipient of psychological conflict, she argues, but a reversion to an earlier body. In such instances as globus hystericus—those Ferenczian materializations—or bulimia, in which the person appears to have gained unusual control over the gag and retch reflexes to such an extent that she can will food back out of the stomach, Wilson wants us to consider that a profound and particular kind of regression is taking place. A primitive form of thinking vested in the organs themselves takes over where the psyche fails. I cannot begin to do justice to the subtleties of Wilson’s proposal, via Ferenczi, of a “biological unconscious,” but can only reiterate what distinguishes the mouth, the throat, and the human swallow as the place in the body where the most is going on.

  In Wilson’s words, the “back of the throat is a local switch point between different organic capacities (ingestion, breathing, vocalizing, hearing, smelling)” and “the fauces is a site where the communication between organs may readily become manifest.” Our organs communicate with one another, but in the transformations engendered by psychopathology, one organ can also take on the function of another. In Wilson’s example of the bulimic, “ingestion has become a technique for expulsion rather than digestion.”

  Phantom fbdies, autoplasticity, aerophagy, globus hystericus: these are not conditions that can be bronchoscopically treated or even glimpsed, though it might be significant that the introduction of hardware into the gullet and the onset of these biopsychological states were contemporaneous.

  The Notion Department contains merchandise assembled according to its uses and made of the most varied materials. To most people it looks like a mixture of small articles which have no relation to each other. It sometimes seems to be the place for all the things that cannot be classified under any other name. . . . Arrangement of one’s stock is not very different from the arrangement of one’s ideas. Every time we put a thing where it belongs we see more clearly its use and its relation to other things around it.

  —M. ATTIE SOUDA, Notions (1922)

  Sometime in the early 1930s, according to an article for a then widely circulating newsweekly, the Literary Digest, a display of fbdies had been assembled at Brooklyn’s Kings County Hospital as “mute testimony to the resilience of the human stomach.” The astonishing collection, described under the heading “museum” in the article, is no longer extant; all that remains is its media trace in “Iron Rations: Fakirs Swallow Swords, but Amateurs Take Cake Lunching on Hardware,” a jaunty piece of journalism that presents the patient, Miss Mabel Wolf, as an amateur when compared to a knife-swallowing Indian magician, but one whose staggering feat far outstrips his. Each sentence is accompanied by a wink and a nudge as if to admit the extremity of her act while keeping all that is disturbing about it at bay. Mabel Wolf had swallowed a staggering 1,203 pieces of assorted hardware. “When she felt depressed,” the journalist jokes, “she cheered herself up by indulging in a little nut-and-bolt snack.” Wolf, who worked in a notions department in a New York store, arrived at the hospital in March 1934 and deposited (delivered? gave over or gave up? relinquished? manifested?) the following collection of fbdy Things:

  588 fine upholstery-tacks

  144 carpet-tacks

  2 chair-tacks

  1 round-headed thumb tack

  3 ordinary thumb tacks

  46 small screws

  6 medium screws

  80 large screws

  1 hook-shaped coat-hanger

  30 small bolts

  47 larger bolts

  3 nuts

  3 picture-frame hooks

  2 large, bent safety-pins

  1 small safety pin

  1 head of a nail

  3 brass nails

  83 pins

  1 matted mass of hair containing screws and pins

  59 assorted beads

  4 pieces of wire

  89 pieces of glass

  1 teacup handle

  A close second to Wolf’s mosaic glass and metal assortment was the collection retrieved from the insides of Mrs. Paul Pappas of Nyack, New York, who, “in February 1935 had 234 pieces of assorted hardware removed,” including a “meat-skewer, teaspoons, pins, links of automobile chains and fragments of bed-springs” as well as “rounded and curved bits of glass in assorted sizes.”

  “Aim-inhibited eating.” “Eating in the absence of nourishment.” The “mouth’s extraordinary virtuosity.” These are phrases that appear in British psychoanalyst Adam Phillips’s essay on a banal, peculiar, deeply pleasurable human habit—kissing—but they could just as easily serve as grounds for understanding such scarily self-penetrating acts as swallowing hardware. Miss Wolf and Mrs. Pappas aren’t eating, per se. Theirs is a form of swallowing without chewing (there should be a word for it) since it’s not “mastication,” and it’s not about nourishment, though it may indeed be about appetite. It points up the vitality of the mouth-hungry versus stomach-hungry distinction, and yet the stomach still plays a role—in this case, perhaps becoming a cabinet or drawer, an endlessly expansive tool chest, a place for stowing or hoarding and for keeping a collection, the self transformed into a warehouse complete with inventory.

  Hysteria’s stomach is like those one finds in myths and fairytales where human beings are swallowed whole, in which the stomach is not a place of digestion but of capture. In “Little Red Riding Hood,” the stomach is a place from which you wait to be rescued; in Jonah and the Whale, it’s a darkly separated interior where you hang out for an age, contemplating the nature of God. In these fantasies, the stomach functions more like a womb; or maybe the tales express a wish to enter another and not be changed in the process—to be held rather than digested, to be churned out rather than to be born. When a tack or nail or bolt goes in, the body (the self) becomes a place where things end rather than begin. And yet a world does emerge, even if you don’t want it to, even if the upholstery-tack snack was only ever about getting the impossible to go down. If you swallow enough items, you can create a world, or someone else will do so for you, re-creating it according to his own taxonomy. Man and the creation of the human is necessitated by a woman’s inability to resist putting something into her mouth. This is where the world begins—according to at least one famous account, it issues from the ingestion of a forbidden object.

  The hysterical swallow relieves but does not satisfy. It seems to require a fixation, and it delivers much like a fix. It’s a form of self-soothing, and a form of self-harm. When does it begin? Because there must be a first time, a moment when the first nonnutritive item goes in, but you might say, no, it’s just a repetition of what one has always done, there’s nothing new here. But, then again, yes, there is a difference here, the breaking of one habit by the establishment of a new one. Or maybe it’s a mix: it’s the continuation of something old, and the establishment of something new. The first time a bolt goes down is the culmination of a process that has been ongoing. After which nothing is the same.

  We speak of an inner psychic reality, and I wonder where in the body we locate that entity if not in the head, and if it is commensurate with the place we reserve for the idea of the soul. For swallowers of hardware, the stomach seems to be the seat, center, inner sanctum, and nexus of significance, as though the mind has shrunk to the size of a pouch at the center of the self, and a one and only question of expansion and accommodation and contain-ability.

  Tempting tolerance or elasticity, when people expect too much from us, we can experience our inability to meet their demands as a lack of capacity. “I’ve had it up to here!”
we exclaim, hand held just beneath the chin as if to keep down a rising gorge. “I’m fed up!” we say, in place of “I’m angry” or “I’m frustrated,” where anger and frustration are understood as having too much of something, of having something alien inside oneself. “I haven’t yet taken it in” tells me that to face, accept, acknowledge, or realize demands incorporation. To make sense of something is to find a place for it in me, but the hysterical swallower challenges this model by redrawing the lines between what is supposed to be kept out and what is acceptable to let in, rendering what should remain outside and what must enter in ambiguous—or, for that matter, what should be confessed and what must be kept secret. Whether one “confesses” to what one has swallowed or not, whether swallowing brass nails, picture frame hooks, and teacup handles is something one does in the privacy of one’s notion counter or something one does for everyone to see, whether this is something we do together or alone would seem significant, especially since the act appears so very isolating. What’s worse? The hiding of a message inside oneself or the assumption of self-sufficiency, an attempt to be everything to oneself, when, in swallowing hundreds of pieces of hardware, a person meets her needs in ways that no one and nothing else can—or so she thinks.

  The women in these cases from the 1920s and 1930s who swallowed hardware were not developmentally disabled, pregnant, or schizophrenic, as far as we know. I’ve opted for the term “hysteria” rather than “pica” in naming their malaise because it was the term that Jackson used to describe similar cases, but I wonder if these otherwise inexplicable and unimaginably motivated acts can be understood as instances of what Ian Hacking (1998) calls “transient mental illness”—and ones, in this case, for which there is no name—if swallowing hardware in quantities great or small exemplifies “an illness that appears at a time, in a place, and later fades away.”