Saturday, February 26, 2011

A dream exhorting the patient to mourn for her father's death

A woman in her mid-thirties, who suffers from severe anxiety and always dreads harm coming to her from unknown quarters, reported this recurring dream, which was going on for couple of weeks, and had started a few months after her father's death. The immediate cause was her going to Detroit's winter bash where young people were skating on the ice rink and feeling envious of their vitality. [She is an envious person by temperament.]
After returning from the rink she dozed off on the couch and the dream occurred for the first time.

My father is there in the apartment. I cannot see him but I can feel his presence as a tremendous pressure. Then I hear voices. The voices tell me that I forgot something.
n asking if the voice is that of her father. She said: No it is not my father's voice. But I know it is my father. The voices are more like a drone. Many people talking as if I am in a restaurant or a public place where you feel the presence of others without interacting with them.

atient complained that the dream is driving her crazy because she cannot for the world figure out as to what she forgot. She has thought of million things, gone through every drawer in her bedroom and every nook and corner of the basement and racked her brain to no end, but still she cannot figure out as to what she has forgotten.
Then she conjectured that maybe she did not pay her father's money back, and there is guilt over it. "You know I always borrowed money from him but never returned any of it. I feel so bad about that. He was so mad in the end about my ceaseless borrowing he would not talk with me. For that George Washington you see on that dollar bill that was his God. By the end of his life all he lived for was to collect little amount of cash that came his way from all the rickety little businesses he had built around town. Not paying back his money sits on my chest like a brick. I wrote a letter to him as to how sorry I was for doing him that way but never gave it to him. There was some psychological block there.
Or may be I forgot to mention somebody at his funeral, maybe left out saying something about one of his three children [her three siblings] when I spoke there. I was the only one who spoke. I was the only strong one at the funeral. And it surprised everyone because I am the most messed up."

Patient then added that her dreams come true. She once dreamt a friend of her's shooting someone. The next day the friend got shot, and exactly on the same spot on the chest, where he had shot the other person in the dream. She could not explain as to why her prophetic dream did not show him getting shot the way it was going to happen the next day, though accurately telling the method of injury and the site of the wound.
She reported another dream where she saw the death of her father's best friend, Earl, who the next day did die.
Now such premonitory dreams of death is a symptom of obsessive thinking. The obsessional neurotic person believes that his or her thoughts are so powerful that they can magically cause death. And since obsessional neurotic's unconscious is filled with thoughts of causing others harm, usually by death, they are always doing away people in their dreams. And since dreams are nothing but our daily thoughts couched in the special language of dreams, the death of other people is a staple in the dreams of obsessive people. And therefore it is not surprising when someone close to them does die they can immediately recall recently having had a dream of somebody or other dying.
When asked if she also dreamt her father's death before it happened she admitted she did not. But immediately added that just before his death she did see him in a dream standing next to a window looking out of glass pane and then turning to her to assure that everything will be alright.
She claimed that the dream signified that he was going to die and it was his way of telling her that he was looking out of the glass pane at his approaching death and was assuring her that she will be fine with that."
And I was fine throughout the funeral," the patient claimed. "I did not even cry, not even quivered my lips. In fact I was so strong and in so much control that my family was convinced that I was high on weed. I thought people were talking about me for not feeling any sadness and not crying. But I was like a preacher who is not affected by the death of somebody about whom he has to give eulogy. And my father did not look dead. He looked so good and young."
Now failure to cry or feel emotions at the death of such an important figure as one's father, especially in case of a girl, means that there is lot of undischarged anger or grudge, and the affect of revenge is holding back the tears.
I conjectured that the dream/her father was telling that she forgot to cry over his death. The love for her father was telling her that she should cry for his death while the revenge feelings were blocking out the last part of the command and the dream was allowing the expression of just half of it : You forgot something.
The woman was stunned and said, "I would have never thought of that," which is usually a phrase that declares yes I always knew that to be correct but only in my unconscious for I could never allow myself to think of it consciously. And then went into describing how she was her father's favorite, his little girl, and would sit on his lap as a little child till everything changed with onset of puberty and in the end they were not even on speaking terms.
"And why was that?"
"Because he favored boys over girls. He favored even a strange men, who would approach him for help and would give them start up money for their businesses but would never do that with his girls."
"That must be the reason why whatever money you took from him you did not return and could not make yourself to hand him the letter of apology and could not cry at his funeral."
"Yes," the girl agreed. But cried my heart out at the death of E, my father's best friend, who died two months before my father."
"So the tears for your father came out at the death of his best friend."
"Yes," the girl agreed. "I knew my father would be dying very soon too. Both E and my father were buddies from the earliest childhood, and both were on the brink of death. So you are right, I must have begun to mourn for my father at E's funeral."
"Why you would cry for E, but not your father when both were in the class of fathers for you?"
"Because E was gentle and unlike my father was not always exhorting me to be tough. Toughen it up. Don't let anybody see your weakness. Tighten it up. These were his favorite words and it kind of ruined my girlish nature. I became tough towards everything soft and feminine. In fact I became a tomboy. I have a real bad temper. I can really wallop anybody if they aggravate me beyond a point and that may be the reason I am always fearful because I can never trust myself as to when I will fly off the handle and maul whichever idiot is rubbing me the wrong way. So I guess by not crying at his funeral I was following his command to suck it up and not show any emotions. Giving him his own medicine you could say."
"Why did the voice not come from your father but from a number of people as if you were in a public place?"
" All it means is that not just my father but all my relatives and other people who were at that funeral are telling me to give up my grudge against my father and mourn over the loss of those happy times with him. These people are kind of authority to me just like my father was."

Saturday, February 19, 2011

An interesting example of the defence of Splitting in a young girl

Freud in the last year of his life wrote a paper on "splitting" declaring it as another ego defense. He never completed the paper - it was published posthumously - because of failing health and because death overtook him. In the few pages that he managed to write, he expressed doubts whether "splitting" is an entirely new concept or something long familiar, and whether he was justified in introducing an unnecessary technical term instead of explaining the clinical phenomena by already known metapsychology. But he opted to incline towards considering it something entirely new and hitherto unexplored way of looking at how the mind - rather ego - deals with instinctual processes which forebode danger from the outside world.
In the paper he states that when we are confronted with something dangerous, something which qualifies as a psychic trauma, and which forces us to abandon our usual means of gratification of an instinctual drive, the mind creates a split. One part of the mind continues to indulge in the gratification, behaving as if the danger does not exist, while the other part takes full cognizance of the threat, abandons the gratification, and creates defenses against the emergence of the instinctual impulse.
This sounds strange. For either the mind can work towards the satisfaction of an instinctual impulse or against its satisfaction. How can it do both? Here the process of splitting comes in. What the mind does is to give outlet to both the trends. It finds compromises that allow satisfaction of the instinctual need while at the same time giving representation to the demands of the dangerous reality.
The example Freud gives is that of the clinical phenomena of fetishism. In a fetishist an object unsuitable for genital sex - such as a shoe, undergarment, lock of hair - draws all his sexual interest. Origin of fetish of course lies in the Oedipal Phase. The little boy at the peak of indulging in infantile masturbation, between the ages of 3 to 5, and imagining that his mother has the same sexual organ which he is manipulating, when faced with the absence of penis in a sibling or a playmate, while in throes of satisfying his sexual curiosity, or in the mother herself by some chance observation, reacts to it with the severest fright. For he immediately associates the spectacle with threats of punishment that he has received in the past for playing with his penis, or for bedwetting at night, or for even indulging in some other naughtiness which he equates with masturbation in his unconscious, and he is seized with fear of losing his own penis by castration.
The fright is followed by the mind's refusal to believe what he is seeing. The defence of denial takes over.
But this disbelief/denial is only partial. One part refuses to believe what he is seeing, for he cannot imagine anybody being deprived of such a prized part of the body - the manual masturbation is vigorously practiced at that age - and he creates the illusion that the girl does have a penis, and it is either too small therefore not visible, and will grow to size later, or that it is hidden inside waiting to be explored and brought out. This illusionary belief is then further elaborated by creating the fetish. Some other part of the woman, usually the last part that was seen with rapt curiosity before being confronted with the sobering vision of the female genitals such as lingerie, underwear, blooming buttocks, hair, legs, high-heeled colorful shoes is elevated to the status of a penis with a reasoning that runs "so what if she does not have a penis, look at her large buttocks or her silky soft lingerie or colorful shoes." Now instead of mother as a whole with the penis, the boy is enamored with the fetish, which is really a substitute for the absent penis in the mother. And as long as he can keep the fetish in sight or even in imagination, he can overcome the fear of castration and continue to indulge in masturbation. Later on as the sexual activity matures from masturbation to genital contact with women, the fetishistic attraction persists in a woman's buttocks, or breasts, or some other alluring trait like her earrings or other adornments or even the light in her eyes.
So by creation of fetish sexual activities can continue on as if no threat of castration exists.
But the threat of castration is not subjected to a total denial and completely warded off with the aid of fetish. A place is found for the fear too. The phylogenetic experiences invariably gives the role of this feared person/castrator to the father, regardless of who made the threat in real life. And this anticipation of castration now emerges, alongside the masturbatory activity, as an exaggerated and intense fear of the father punishing him. The fear requires the whole force of his masculinity to master and the result is emergence of oppositional defiant traits. The fantasies of getting even with the father by attacking and doing away with him, usually devouring him, provokes guilt, which becomes a permanent part of man's character. The fantasy of devouring is probably most preeminent as a means to do away with the father, because the fear of father castrating one, regresses to the oral phase that he will eat me up; just like how Kronos, the father-God sought to swallow Zeus, but Zeus with help of his mother not just avoided getting eaten but castrated his father.
I recently came across this phenomena of splitting in a girl of 26 who would not touch pork because it reminded her of eating another human. Assuming that it was defence of strong reaction formation against her cruel impulses displaced from humans to animals I assumed she was vegetarian. But she proved me wrong by adding that it is only pork she cannot eat, she has no problem with beef and steaks.
"Why just pork?" I asked her.
Because whenever she imagines the part of the pig from where the meat could have come from it grosses her out.
So here was a good example of splitting. Eating meat had become equated with eating human as she herself admitted and analysis showed it to be eating up her father which was being rejected because of guilt. However, the rejection was only partial. A split had been created. The rejection was limited to pork, while she could continue to eat beef.
Now such splitting with food is very common. Children show plenty of it, going in and out of phases, when they will eat certain foods but not others.
In autistic children, who have to struggle with severe hatred of their primary caregivers [for their emotional unavailability during crucial months of their development] this food preference may get extreme. They often eat just very few items and reject almost all other foods.
In adults too one finds such food fetishes, where a person will eat egg white with great relish, but balk at the idea of the slightest yolk getting into his omelet. Similarly people may have fetish for skim milk versus whole milk and some take extraordinary precautions that fish does not get mixed with milk or not a trace of fat enters into their meat.
Quite a few people will never eat everything on their plate, leaving some portions as if they are forbidden to eat the entire content of the plate.
Billion dollar industry of special foods, which attracts the gullible folks into buying gluten free meals, and other fancy foods, by advocating some foods as nothing short of ambrosia full of healing properties while others as literally poison, arises from the same human tendency to split something that is perceived as dangerous. Incorporation of the good parts of some significant person in one's life - phylogenetically the mother - and rejecting their harmful aspects. The simultaneous acceptance and rejection of food is displacement from ambivalent attitude towards that significant person whom one wants to incorporate within oneself but only partially. Eating from the plate partially is taking in of the loved portions of the person while the hated and feared aspect are left on the table untouched.
In bulimia the split is biphasic. Not some food is eaten and other is rejected but the person eats all the food and then throws up, expression the positive and negative attitude towards the food in two steps.
In movies the splitting is often used to contrast the brave aspects of oneself being projected on to the hero while the cowardly parts are projected upon the comedic sidekick who accompanies the hero on his adventurous journey
Psychoanalytic literature is full of articles on "Splitting" as a behavior of "Borderline Disorders" and other such nonsense as if this defense exists only in highly disturbed people who can see other people only as all good and all bad. But these misconception as to what splitting is has arisen because these authors have gone hog wild over trying to exploit Freud's last incomplete writing as something that they can elaborate upon and make a name for themselves out of specializing in it.