When asked to give an example, she said like her running across the street and getting run over by a truck that smashes her skull into so many pieces. That she could imagine the violence in such minute details caused her intense shame and horror.
An interpretation was made that obsessive ruminations of violence happening to one's loved ones is a displacement of violence happening to one's own self. The original fear is of violence happening to oneself. However, the mind, in order to lessen the fear, reasons, unconsciously, as follows: there is someone there who you love so much that if this happens to him or her, you will suffer even more. So instead of now worrying about harm coming to yourself you start worrying about harm coming to someone very close to you. And as a rule, this fear of harm coming to oneself - and in displacement harm happening to the loved one - is a fear of retaliation for wishing harm to somebody else.
The patient protested that she wishes evil to nobody.
When it was explained that such irrationalthoughts of violence towards oneself could not arise de novo for nobody wishes harm to oneself for no reason. They make sense once one makes the presumption that they are punishment fantasy for having violent impulses towards others.
She wanted to know why would one want to punish oneself for wishing evil to others.
It is not you but your conscience/superego that wants to do that. It remains in the background, completely unconscious. Even the thought of harming others remains under repression and unconscious. What comes to the conscious mind is the affect of guilt, and images of retaliatory violence happening to oneself and those who are close to oneself.
She was not convinced but added that she has to concede that her constant sense of guilt makes no sense. She always feels guilty, which she should not, because she is a very conscientious person and strives to hurt nobody.
When it was explained that there is no such thing as irrational guilt and if there is guilt which one cannot account for that means in the unconscious mind there are evil intentions/thoughts, she added that she does see visual images of harm coming to herself.
"Like what?" I asked her.
"Like a I am combing my hair with an iron brush and the bloody layers of my scalp are peeling off. It is horrifying image."
"Any other images?"
"I see my head getting cut off or I am getting cut into two or I am hanging myself."
When interpretation was made that beheading is a symbol of castration and perhaps she sees it as a punishment for castrating someone else, she said she had never thought of cutting her husband's penis so I am wrong on that one.
But such a spontaneous association without any suggestion on my part that the impulse was directed against her husband, left me no choice but to assume that the person she wants to castrate is her husband.
When I said that perhaps the impulse is directed towards her husband, she said, "I cannot see that but I do admit that I am a cutter. When in great anxiety I cut myself. In my teenage years I was a great self-cutter."
Is cutting a self-punishment for the impulse to castrate others, I wondered silently.
But loudly I asked her if the imagery of her being cut in to two has to do with her parents getting divorced when she was four. The guilt of separating the parents in to two being avenged by her getting cut in to two.
She drew a blank on that construction. But added that number 6, or any multiple of number 3 is bad for her.
When asked to explain that she said that after her parents' divorce she had to live either with her father and her step-mother or her mother and grandmother. There was always three people, and she was always the odd one out, and she blames it upon her parents divorce.
At this point the patient started dreading that if she talks more about such thoughts, she will start cutting herself again which she has not done in years. She also admitted that she always fears that one of these days she will give into the thoughts of beheading or hanging herself.
It was explained that bringing such thoughts to consciousness protects one from acting upon them rather than other way round. Such impulses are more likely to get hold of the motor system without any hint to the conscious mind, if they are allowed to fester for too long in the unconscious, without any outlet.
Patient agreed and said," Yes you are right on that one. In my teenage years I just would have these irresistible urges to cut myself to get relief from guilt and anxiety and impending sense of doom. But since these obsessive images of harm coming to my children and myself have started coming to my mind I have stopped cutting myself. These images make me very uncomfortable and I feel horrible about thinking of such things happening to my children, but still it is better to deal with unpleasant thoughts than to deal with a cut arm, and having to explain it to the ER doctors."