My subject is a very short story by William Carlos Williams called "The Use of Force," about a doctor who forces a spoon into a little girl's mouth to reveal diphtherial membranes that she has been hiding for three days. But, as so much else in Williams' art, it also represents the dynamics of violence, the convergence of motive and situation which transforms the apparently ordinary into the revelation and partial recognition of sadistic desire enclosed by it. In this condensed expression of a critical incident in the life of a doctor we see the precarious closeness of therapeutic and destructive motives. I want to subject the story to a detailed psychoanalytic reading, to identify its core fantasies, to explore the relationship between manifest and unconsciously acted roles, and to suggest some explanations of its violence. In spite of its brevity, "The Use of Force" brings together central aspects of our current concern with the psychodynamics of aggression. It provides the literary critic with an opportunity to relate careful textual analysis to the more comprehensive concerns usurping our energies.

A doctor, who remains anonymous, is called to the house of "new patients" named Olson. He enters an atmosphere which he perceives as distrustful. In the kitchen he attempts to examine the throat of the daughter, named Mathilda. The girl refuses to open her mouth. Fearing the presence of diphtheria, the parents and doctor coax, threaten, and finally overpower the child, who resists violently, tearing at the doctor's eyes, crushing his tongue depressor and, finally, lunging at him after the exposure of her throat is complete. The doctor himself oscillates between his professional role, with its emphasis on social welfare, money exchange, and controlled authority, and his more basic impulses. He "fall[s] in love with the savage brat," finds "pleasure" in attacking her, grows furious. The girl's parents act in collusion with the doctor's wishes, and in the short space of five pages all four characters regress to levels of behavior which the doctor-patient relationship is usually designed to defend against.

The story deals with the breakdown of what is typically a highly ritualized situation. Doctors are called when the capacities of real parents (known by the child) are inadequate to meet the real demands of a situation. They are bound to be seen, on one level, as rescuers embodying both maternal (nurturing) and paternal (prescriptive, authoritarian) powers, and as surrogates for the parents (specifically, in the story, the mother). As surrogates who take up the nurturing task where the parents leave off (in the story, the mother's giving "don't do no good"), they are bound to be viewed ambivalently by both parents and child, for in seeking recourse to the doctor's mysterious powers, the parents become symbolic children. The burden of ritualization is very great, partly because the doctor represents a "pseudo-species," a class of intimate strangers who rescue us from disease or death, like "gods." Ritualization regulates the power over others and the gratification of unconscious aims which can be exercised or derived from a situation. Anyone who has been treated by a doctor who does not speak his language will realize the potential for anxiety generated by the situation over and above the dangers presented by the disease. It is no accident, then, that the father in the story asks the doctor to "come down" to them, and that the parents seem to view him both as a figure beyond reproach and as a repository of true words which they will buy for money. For them he is depersonalized; for him, they are "patients."

In the course of the examination, the boundaries which regulate the situation are violated, so that the role difference between parent and child, doctor and patient, fails to defend against underlying erotic and aggressive impulses. The reader is made to experience the conflict in the doctor between the wish to preserve psychic distance and the wish to make the girl an object of his own violent, libidinal desires. Professional defenses and techniques become instruments in the service of id aims they are meant to control. The result of the doctor's regressive response to the girl's violence is reciprocal violence, the behavioral opposite of ritualized cooperation. The characters become identified in violence and through violence. Sadism replaces the professional mask of caring, and parental collusion replaces autonomy.

Given this situation and this collective regression, how can we account for the specific form of these violent events? In a partial Freudian reading of the story, R. F. Dietrich observes that a close examination of the text reveals "connotations of rape." The girl is "flushed" and "breathing rapidly;" as the "battle" begins, "her breaths were coming faster and faster." The doctor "tried to hold [himself] down but [he] couldn't." When he inserts the tongue depressor, "she reduced it to splinters before [he] could get it out again." The girl begins to bleed, grows "hysterical," and a "heavy silver spoon" exposes the membrane, which is called her "secret." Certainly, the accumulation of language appropriate to disease and sexuality seems to revolve around a fantasy of rape. Not only does the story convey violence through genital symbolism, it mobilizes (at least in this reader) castration anxiety, fear of the mouth as a displacement upward of the vagina dentata, ambivalence toward the brutal act, and a wish both to subjugate and to glorify the object of sadistic attack. But if Dietrich points out the symbolic weight of Williams' language, he stops short of the story's psycho-analytically accessible meaning. It is not enough to say, "The prevalence of sexual connotation is simply testimony to the animal nature of the conflict." Animals do not confuse sexuality and violence. Besides, the girl is described as a "heifer" before the doctor attacks her. The degradation is a prelude to the "rape."

If the fantasy of rape organizes Williams' representation of the violent encounter, why is this fantasy provoked by the doctor's situation? And does the latent desire to possess the girl sexually adequately explain the doctor's treatment of her? I think not. The prevalence of sexual connotation in the story is symptomatic of a more basic crisis of identity and identification than the idea of the return of repressed sexual impulses suggests. Here is the doctor's description of the girl:

The child was fairly eating me up with her cold, steady eyes, and no expression on her face whatsoever. She did not move and seemed, inwardly, quiet; an unusually attractive little thing, and as strong as a heifer in appearance. But her face was flushed, she was breathing rapidly, and I realized that she had a high fever. She had magnificent blond hair in profusion. One of those picture children often reproduced in advertising leaflets and the photogravure sections of the Sunday papers.

The emphasis here is on the visual attraction of the girl; she is like a picture, to be taken in with the eyes. Yet she is paradoxical and threatening, at once a "little thing" and "as strong as a heifer," someone who seems to be "eating [him] up." Even as he first encounters the girl, the doctor describes her more as an image than as an independent person. We may find phallic significance in her profusion of hair, but symbolic labeling misses another, more significant aspect of her presence. He experiences her as powerful, perhaps threatening, but she is excluding him. She is blank, cold, a depersonalized surface. The doctor imagines this inaccessibility as a form of incorporation, as if the boundary between them were jeopardized not by the experience of fusion but by the perception of unbridgeable otherness. The violence in the story has its genesis in this motionless inaccessibility.

It is not surprising to find the story filled with language whose psychological referent is the oral phase of childhood. The story's visual and oral language emphasizes the failure of basic trust and its replacement by suspicion and shame. We are located in a "warm" kitchen meant to protect the girl, a place obviously associated with nourishment. The parents are "eyeing [him] up and down distrustfully." The doctor, they think, should "look her over." Twice he asks the girl to let him "take a look." "Just open up and let me see." As the professional smile gets nowhere, the mother prods the girl with, "He won't hurt you," and the doctor's response suggests controlled oral aggression: "At that I ground my teeth in disgust." (Disgust: an appropriately oral word.) In their habitual language the parents regard sight as a moral category: "Look how kind he is to you." "Look what you've done." Taking things in, visually or orally, has become an activity bound up with superego inhibitions, not an activity of pleasure. As often in scoptophilic people, the eye has become an organ which admonishes or robs or eats. Ocular control comes to replace ocular pleasure. The girl's fixed stare may be an unconscious attempt to ward off or take in threatening others (or, perhaps, an attempt to ward them off by taking them in), a strategy designed to prevent their attempts to take her in with words. ("'Look here,' I said to the child, 'we're going to look at your throat.'") When her eyes fail in their magic, when she is immobilized by the men, she "shriek[s] terrifyingly," and in the end "tears of defeat [blind] her eyes." We move anxiously from eyes to mouth to eyes as the psychological and physical space between her and the doctor closes to penetration. Psycho-analytically, the dominant loci of gratification in early infancy are experienced as focal regions of pain. No defense supports trust, and distrust supports the permission of the will which releases violence.

In the course of the story, the doctor tries to approach the child with coaxing words, with his best professional smile, with a display of harmless intentions. But as he moves closer she attacks like a cat, clawing at his eyes and knocking his glasses off. She would rather have her private disease, it seems, than be penetrated in any sense by the adults in her world. Her attempt at symbolic castration evokes guilt-inducing words from the mother. When the mother threatens to send the girl to a hospital, the doctor's response expresses his perception of the psychological structure of the situation; by now he has abandoned the pretense of a formalized doctor-patient relationship:

Oh yeah? I had to smile to myself. After all, I had already fallen in love with the savage brat; the parents were contemptible to me. In the ensuing struggle they grew more and more abject, crushed, exhausted while she surely rose to magnificent heights of insane fury of effort bred of her terror of me.

"Oh yeah?" reveals a childish defiance of separation. Now that the child has been provoked, and has provoked him, he does not want to lose her. Having projected responsibility onto the parents, they now become impotent participants in the sadistic love affair, and, in his mind, the child gains the potency they lose. When the girl's blankness gives way to violent exclusion, the doctor moves from professional gesture to an imaginary relationship of love in which the girl is given an identity by him. Now she is seen as actively different from him ("the savage brat"), and her excitement is perceived solely as a function of his power: "bred of her terror of me." Is there not an implication in this phrase that she is his creation, the product of his omnipotence? In the face of exclusion the doctor is affirming in fantasy his conception of himself as godlike and his conception of the girl as "savage" and, a few paragraphs later, as a "damned little brat." When the ritualized situation designed to prevent violence fails, the doctor fills the vaccum with a structure of relationships based on reciprocal violence, as if his violence could create her or rescue her from death.

In the forced penetration which follows the girl's repeated efforts to escape examination, the doctor's instrument is described first as a "wooden tongue depressor," then as a "wooden spatula," and finally as a "wooden blade," a progression (or regression) which suggests increasingly aggressive genitalization. The blade is "reduced to splinters," an exaggeration which reinforces the reader's anxiety and emphasizes the regressive loss of differentiation between professional and sexual objects. While the violence escalates, the father's participation is confined to a role of sheer force (he pins her to his lap) and the mother is reduced to rhythmic futility, "raising and lowering her hands in an agony of apprehension." The confusion of identities claims them all; the parents are not the only ones turned "inside out."

"The Use of Force," then, reaches down to the level at which identities are formed and dissolved, and it depicts the doctor's attempt to act in accordance with and then to reclaim his professional identity by answering his patient's inaccessibility and violent exclusion of him with a violent attack of his own. He mirrors the "savagery" he finds in the girl. First he rejects the possibility of delay, although he sees delay as a positive moral alternative:

Perhaps I should have desisted and come back in an hour or more. No doubt it would have been better.

Then he utterly depersonalizes his relationship with the girl:

But I have seen at least two children lying dead in bed of neglect in such cases, and feeling that I must get a diagnosis now or never I went at it again.

To "get a diagnosis" is a far cry from concern for the girl. The doctor pretends rationality to butter his illegitimate pleasure. As Freud recognized, depersonalization leads to a split in the ego, and the professional rationalization is immediately followed by a confession of pleasure in attack:

But the worst of it was that I too had got beyond reason. I could have torn the child apart in my own fury and enjoyed it. It was a pleasure to attack her. My face was burning with it.

The girl's attempt to negate him, expressed in imagery of incorporation and castration, elicits his reciprocal negation of her as an independent person, also expressed in imagery of castration and sexual arousal. The collapse of social differentiation (the doctor-patient relationship) and familial differentiation (parent figure and child) reduces the doctor and the girl to an identity; each is furious and each is blind. The reciprocal incorporation of one personality by another here takes the paradoxical form of mutual repudiation, each by the other. In the structure of their violence, the more the doctor finds himself appealing to differences based on social role and professional self-esteem ("I know how to expose a throat for inspection"), the closer he comes to a premoral and prepersonal assault, and the more bound they become as mirror images of one another. First she attacks, then he attacks, then she does.

In the telling of the story Williams sharply separates the "higher" forms of self-justification from the "lower" drive for release:

But a blind fury, a feeling of adult shame, bred of a longing for muscular release are the operatives. One goes on to the end.

The doctor himself has become a kind of reflex mechanism. His shame accompanies the symptoms of sexual arousal, but sexual arousal does not account for it fully. As the psychoanalyst Heinz Lichtenstein has shown, the sense of shame is more fundamental than the feeling of sexual exposure it often accompanies or hides. Although the story's pervasive visual emphasis and the exposure of a hidden, "secret," and diseased membrane point to the fantasy of a sexual revelation, shame can be interpreted in a more extensive sense "as the breakdown of the capacity for identity maintenance, carrying with it the threat of metamorphosis" [H. Lichtenstein, "The Dilemma of Human Identity," Journal of the Psychoanalytic Association, Vol. II, 1963]. The doctor's assault can be seen as a desperate attempt to reconstitute his identity by abandoning it.

Shame occurs in such situations where the burden of identity and separateness, the loneliness of autonomy has become unbearable: the temptation to abandon it, to give up one's will, to become a slave, a physical thing, triumphs over our defenses.

[Lichtenstein]

As he "creates" the object of his attack, the shock of physical contact seems to validate his image of her as a "valiant" antagonist, and her violence and disease seem to validate his need for confirmation and release. The longing for motor release which breeds shame becomes in the assault on the girl the doctor's means of reconfirming his professional ego. He does get an accurate diagnosis. Like the release provided by festivals or orgies, the violence in the story becomes a way back to the identity it threatens to subvert. The articulation of motives for restraint becomes a way of neutralizing the power of those motives to restrain. The deritualization which collapses hierarchy orients each antagonist toward a rival who exposes his (or her) secret.

But a secret may be exposed without its implications recognized, and in the final lines of the story Williams focuses almost completely on the girl. It is she who has been hiding her "secret," the secret of disease and, on an unconscious level, the secret of her sexuality. It is she who is blind with fury. It is she who lies to her parents to avoid the disclosure of her disease. The doctor's massive projection of guilt and responsibility is made possible by the actual presence of diphtheria. Inaccessible as a person, the girl becomes humanized as the projected embodiment of what is denied in the shame of adulthood, at once "magnificent" and "insane." And the doctor's violence seems for the moment to be vindicated. "The sadistic act," Fenichel writes [in The Psychoanalytic Theory of Neurosis, 1945], "not only means, 'I kill to avoid being killed,' but also, 'I punish to avoid being punished,' or, rather, 'I enforce forgiveness by violence.'" Certainly the compliant parents in the story will forgive his violence, even if he retains his contempt for them. He has saved the girl's life.

At a price. Mathilda, whose name means "might and battle," does not forgive him, and the story ends in her violent reaction to defeat. She is an embodied creature, displaying no capacity to differentiate intention from experience or action from meaning. For her the examination can only be experienced as a sadistic impingement on her private space. In defeat, she too would reclaim her identity through violence. As the story ends, we have come full circle in this pattern, this antidance of violence. The dilemma of violence is that it restores autonomous identity only at the expense of the other. Reciprocal violence excludes the possibility of mutuality.

Williams tells the story in the past tense, a technique which permits clarifying distinctions among motives that were merged in the event. Written in 1932, during the depression, "in white heat," perhaps as a means of mastering the anxiety associated with an actual episode in his life as a doctor, "The Use of Force" provides us now with more than the experience of the pleasure-pain of its fantasies. It crystallizes an interaction of drive and defense, intensifies the antithesis, in such a way that we are made to see the components of its violence with retrospective precision. The boundaries ruptured in the experience are again demarcated by language. Finally, if Williams the doctor sought to vindicate himself through violence, Williams the writer sought a more therapeutic action. For Freud the beginning of catharsis consisted in putting affects into words. For Williams this was the use of imagination.