Monday, September 20, 2010

A Dream confirming psychoanalytic theory of Paranoia

A paranoid schizophrenic patient brought in the following dream:

My father is urinating in a bucket and then dumping it on my head. This makes me so angry that I take out a knife and go after him.

The patient started the session by reporting that his depression has been worse in the last few weeks. He gave the following explanation for this worsening, which on face appears ridiculous. "I am depressed because everything is peaceful around me. My wife is doing good. The relatives are behaving. Everything is going the way it should."

This appears paradoxical till we realize that when things are hectic, and one is in throes of life's pressures one does not have the luxury to allow one's inner conflicts to find an outlet in one's consciousness and behavior. But once external pressures are lifted, inner demands come to the forefront and neurotic problems take over.

Patient did not disagree with the interpretation that the depression had descended upon him to control some unacceptable thought or temptation.

Depression, at its very core is nothing but an attempt to inhibit one's participation in the world, with greatest pressure falling upon motor activities. But he had no clue as to what such a temptation could be.

Both of us agreed that the clue perhaps lies in the dream. Now, theoretically, I immediately saw through the dream that it was given expression to his desire for homosexual humiliation in hands of his father. But I did not want to throw in that interpretation and wanted to see if it would be independently confirmed by the patient's associations.

The only puzzling part of the dream was as to why the father was not urinating on his head directly. So I asked him where the detail about the bucket was taken from. After some denial that no associations come to his mind, he recalled that his grandparents lived in a shack at the back of their house in the woods , which did not have a toilet, and would do their business in the bucket and then bring it to the house to flush it down the toilet.

Why is it that your father is pouring that piss over your head?

To my surprise and gratification for it confirmed my hypothesis, and at the same time a little horror, the man brought the memory of his brutal father forcing the patient into partial rape at the age of 16. For some transgression - the boy was extremely unruly, always getting into trouble, and was always provoking brutal punishment - the father had whipped him with a belt and then stripped him off of his clothes and then had rubbed his penis against his buttocks, telling him that that is what awaits him, if he does not change his defiant ways. For sooner or later he will land up in prison where homosexual rape is the norm.

So the dream was portraying the homosexual humiliation in hands of the father in regression, with sexual process depicted as a sadomasochistic activity where his buttocks were replaced by his head and the penile penetration was replaced by getting pissed upon.

The next set of associations were something that he had often recalled in the session in the past. In his early twenties he had a serious breakdown, when he heard voices telling him to kill himself. He had driven his car at 85 miles per hour in to an electric pole. He had been arrested and left to languish in jail for over two months, and subjected to homosexual assaults, before getting to see a judge. The judge had seriously reprimanded the lawyer for not getting him to court earlier and getting him to a hospital, because he belonged in a mental institution not the jail. Further associations hinted that the judge stood for the grandparents and the lawyer for the father and depiction of the thought with that intermediary bucket that my father was brutal to me because his father was brutal to him.

So the theme of homosexuality emerged in two sets of associations.

Now the psychoanalytic theory teaches us that in paranoia the person develops a hostile attitude towards other men to combat his overwhelming impulses to submit himself to them. The voices that he hears are means to prevent him from giving into this passivity. When the voices say: 'go kill yourself' to make sense of it one has to complete the sentence by adding the prefix 'rather than getting fucked'. So what the voices are saying is "Rather than getting fucked go kill yourself." When the voices are calling the paranoid patient an asshole, wuss or a faggot, it is really jeering at him to provoke his manly pride to prevent giving in to homosexual submission.

When this interpretation was made that the dream was satisfying his passive homosexual wish, he confirmed the interpretation by bringing up the following:

"I think I became depressed when I could not stay at that McDonalds for some weird thoughts that were coming to my mind. I go to that McDonald all the time to while away my time."

"And what were you thinking there?"

"I was getting worried about the children who play in their play area that they will be sexually abused by their fathers. First I dismissed the thought as ridiculous for just because I was sexually abused does not mean it happens to everybody, but then the thought became stronger and stronger, and I started getting depressed over it, and finally I stopped going there and going everywhere else because I did not want my thoughts to influence their fathers' behaviors towards them."

So the man's homosexual thoughts that he had tried to deny in himself began creeping back in guise of a fear of the same thing happening to children at that McDonald's which led him to flee to the sanctuary of his bedroom.

Now in his actual conduct the man shows no trace of passivity to other men. As a young man he was a "badass", a hellion, always getting into fights with other men in bars and wherever else he could.

And in the dream too, once he submits himself to homosexual humiliation he tries to avenge it by taking the knife and going after the father.

No comments:

Post a Comment