Saturday, March 31, 2012

A bisexual defense against castration anxiety

An Irish-American man in his early thirties, possessing all the typical Irish disposition that makes them such an interesting people brought in the following dream:

I am in a full contact fighting octagon cage, like they show in the TV.  It was so fucking scary that I cannot even describe to you. There was a tiger in the cage and there was this bed. I was on the bed.  I was scared to death of the tiger. He was going to come after me. There was a girl on the bed as well. Don't even ask who she was. I pulled back the sheet  to hide underneath. And below the sheet was a body whose head was severed. And the girl threw the head towards me as if to use it as a  bait for the tiger go after me instead of her. I tossed the head back to her. We were tossing the head back and forth as if to deflect tiger's attention. It was so crazy and scary. I can usually wake myself up from dreams when they get too scary. I tell myself you are dreaming, you are dreaming and it usually works but not this time.  I was like transfixed and could not even think of waking myself out of it. It was so fucking crazy. I was so glad when finally the alarm went off and woke me out of the nightmare. I was drenched in cold sweat.

"Since you have been analyzing my dreams, and I am reading couple of books by Freud, I can make some sense out of my dreams but not this one."

Now the dream uses extraordinary number of typical symbols, and therefore I could grasp the essence of the dream by just the manifest content but since divining something is not the same thing as confirming it with associations I proceeded on. I told him that usually frightening and ferocious animals symbolize the ferocity of one's passions, but they also symbolize the father in grip of these animal passions which can overwhelm his human side.  "Was the tiger symbolizing your father and the fear of him?"

"I don't know about that. But animals in dreams frighten me. Especially snakes. Oh I hate those mean sneaky slippery things."

"Who was the person under the sheet?"

"I don't know. But wait a minute. I think now that you bring up the topic of father, that man could have been my father. He had the same dark hair. And he did look like my father. Only difference was that my father wore glasses but this man was not."

Now the severed head allows no other interpretation but an allusion to castration. So I asked him if missing spectacles was also not continuation of the same theme. After losing his head he was losing his glasses as well. We know that losing one's vision or eye is classic symbol of castration - Oedipus blinded himself on learning that he had committed the forbidden Oedipal transgression - and glasses being extension of the eyes their missing on his father's face was another allusion of the same.

The patient had no reaction to it.

But it is the son who dreads castration in hands of the father why the dream was showing the father as getting castrated?

The explanation could only that it was showing the retaliation on part of the son. "If my father wants to castrate me then I will castrate him back. Tit for tat." Recall here how Zeus castrated his father Cronus and how Cronus in turn had castrated Uranus, his father.

So the full contact fight ring was symbolic of his mother, inside whom - the womb - he was in struggle with his  father, dreading castration and dealing with it by castrating his father in retaliation.

I asked the patient as to who was the girl on the bed with whom he was tossing back and forth the severed head.

Patient claimed he knew nobody who looked like her but on my asking if she could be the feminine aspect of his own self, the patient was incredulous and then admitted, "Well the girl was blond." After a little reflection added, "I am blond too, strawberry blond. But when young I was quite blond, like the girl in the dream."

So if the tiger was his father, and the severed head was allusion to castration, then he was in his dream vacillating between masculine and feminine attitude in dealing with the threat of castration from him (father). The logic would have gone like this: "If I was a girl then I would not have come into conflict with my father over my mother and aroused his ire so profoundly that he would have come after me to castrate me. And so let me give up my masculine/aggressive strivings towards my father and adopt a passive feminine attitude."

 But the passive attitude is as fraught with submission to castration as the active. For becoming a girl to appease the father amounts to the same thing: giving up of one's masculinity. So the severed head was getting tossed back and forth to symbolize the patient's inability to decide whether he should adopt a masculine attitude towards the father and risk castration or to adopt the feminine attitude and risk castration. Fear of getting eaten by the tiger was depiction of castration in regression. Instead of severance of the penis from the body - as was clearly shown in displacement in the revenge fantasy towards the father - the castration was depicted in the language of the oral phase - getting eaten by the father/tiger. 

Saturday, March 24, 2012

Phone Addiction a manifestation of Anxiety-Neurosis

A young woman in her mid-twenties reported that she loves her new razor phone for it makes her feel as if she is carrying the whole world in her pocket.

"The thing has so many applications that it is like having control over the whole world or at least the world that matters [to me]. Of course, the most important thing is to be able to see through the webcam my 5 year old son to make sure that he is safe when I am away from him. And I feel the same way about my parents. Making sure that no harm comes to them. You know what a nervous wreck I am about something happening to them. I am their only child and they always worried about me when I was growing up, restricting my life to the point that I had sometimes wished they were dead. Not really dead now, but kind of dead. It is so strange as to how the roles have reversed. The shoe is now on the other foot. I have to call them all the time to make sure they are OK."

And I wondered if the tendency to be on the phone that is so much more prevalent in women than in men, does not arise from anxiety. For in this patient, the affect of anxiety is so overwhelming.

"We are such worry warts especially my mother's side of family. Her mother would start worrying about the red light even when the car would be a mile away, driving my father crazy by the backseat instructions on how to deal with it. My mother is a nervous nellie, forever cleaning or doing some other obsessive ritual to prevent harm coming to all her relatives. And I am of course a basket-case unless I have that phone with me to call and make sure that everybody is doing fine. Per you, not that I accept it, it is because I fear my own death, and when this fear becomes difficult to handle, I deflect attention from it by starting to worry about the death of those who are close to me, and then to protect or at least to make sure that they are OK I start calling them. My mother does not call, but does her obsessions which are kind of magical behavior to undo the harm coming to her loved ones. It all makes sense but I am not convinced of it."

This made me wonder about a family member of mine who is always on the phone calling her relatives all over  the world and making sure that they are all doing well. And she has phenomenal memory for their birthdays. I had long suspected that her obsession with remembering their birthdays was to undo the death wish towards them, the roots of which lay in her wish for her younger brother, to have not been born. So this wish against her brother, which lies in her unconscious, for consciously she is very fond of him,  has got generalized against all her relatives, distant and close, and is countered by making sure that she never forgets their birthdays. It is as if to assure herself and them, "Far from wishing you all to have never been born, I care so much for your birth that I never forget that date."

Tuesday, March 20, 2012

The great moving game to avoid death

A woman in her early seventies after having a wonderful Christmas dinner, which was held at her house, and in which all her children and grandchildren, and other relatives whom she is fond of could come to, had the following dream which she declared was totally meaningless.

All my family is there and we are involved in some type of game or activity in which we have to keep moving from one spot to another. We start doing something which suddenly comes to a stop so we can start doing something else then that comes to a stop too and we have to move to yet another spot and do something else and the cycle is repeated ad infinitum. This went all night long. We have to reach home but we can never reach home because we keep getting stopped from whatever we are doing to do something else. The perpetual cycle of  doing and stopping keeps delaying us from reaching home. 
Then the kids in the family see us doing this endless moving on the TV and they start doing it too. The only person who is out of this cycle is my grandson Aron. He is just sitting there crying. But he does not look like the way he is now, but how he was when he was 8 or 9. He was very contrary then. He is sitting there and crying because he is not part of this endless move.

Initially there was no associations to any part of the dream. Just some more protestation that the dream is crazy and meaningless and not worth wasting time upon. Then she recalled that a cousin of hers had called her on that Christmas day from a far away State, after a long hiatus. He wanted to know if she was doing OK or not.

Now when people worry about somebody's health like that whom they have not seen in a long time it is usually making sure that the other person has not died and it is usually a projection of the fear of their own death.  So perhaps the dream had some connection with death.

But was there any hint of it from the dream?

I asked her what kind of things they were doing that kept coming to a stop, can she give an example. First she claimed that the dream was so ridiculous that she cannot describe what exactly were they doing but on some encouragement she recalled that "at one spot we were between a fence and a wall and we had to  reach home through that narrow passage. But before we could do that that activity had to stop and we had to take up something else."  

Now reaching home in dreams is a typical symbol of reaching the womb and reaching death (reaching the womb of mother earth). For the aim of life is to be reborn and that is accomplished by reaching home (womb). But being reborn through one's children also heralds one's own death, and in dreams the symbols of death and rebirth are often interchangeable. Fantasy of rebirth is often symbolized in dreams by entering or getting out of water.

Was trying to reach home through that narrow passage was it symbolic of trying to reach the womb through the genital passage?

But before I made that construction to her I asked her if she could recall any other 'spot' from which they had to move away from in that great moving game of the dream.

Patient recalled that "at one spot we were in a carnival and as we started to really get into it we had to leave there as well. And all the while we were at the carnival there was this dread that whatever we are doing we must not forget the aim to reach home."

Now carnival, fair, mall in dreams usually represent the hustle bustle of life.  So once again the patient was seeking death - ultimate peace - which was being countered by the opposite impulse of seeking hustle bustle (carnival) of life.

At this point I made my interpretation: Reaching home means reaching death. And the fear attached to the fulfillment of this ultimate wish is getting transposed and in a twisted fashion to the fear of living and enjoying life. There are two wishes here. One seeking the final peace of death and the other wish countering it with the desire to keep participating in the carnival of life/getting continuously reborn.

To my surprise patient totally agreed with the interpretation which was not only conceptually difficult to understand but also so difficult to enunciate.

When I asked why she is so sure that that is what the dream means, she said, "At one point in the dream I had this dreadful feeling that if I do not reach home I won't last, I won't survive. Anyway the affect associated with the dream was that of dread of death."

"Why do kids start doing the same moving game after watching you all do it on the TV?"

"It has to do with the fact that during that Christmas dinner I was thinking how beautiful it is being with the  family but before I could enjoy this thought for too long the disturbing counter thought came that this enjoyment is so temporary and will soon stop and at the end all of us will die; myself, my children and my grandchildren. So I guess when the kids started playing the game of moving too, they were just following our footsteps and entering this great game of avoiding death by indulging in the distractions of life.

As to why her grandson Aron is sitting there and crying and not part of the crowd, she brought in some associations about his being very contrary from childhood, and doing everything opposite to what is expected. Perhaps it was the projection of her wish that being an absolute contrarian while all others will die he will somehow manage to escape this great game of life and death. 

Thursday, March 15, 2012

A hypocritical admiration to hide the underlying satisfaction at a friend's misfortune

A man in his early Sixties, a highly intelligent obsessional neurotic, who despite his brilliance, due to neurotic guilt,  has never made any money in all his business ventures, declared: " I had this most vivid dream this morning and cannot for the world understand why would I dream of someone who I had not thought for ages. And then with such clarity as if he was right there. In fact his presence was so vivid that even after waking up I felt he must be somewhere there. Patient then told the dream:

Garth is dead for years. But he could not be more alive in the dream.  He was wearing a brown plead shirt. I could not compliment him enough on how well and trim he looks.

Patient could remember nothing from the day before - the day residue - as to why Garth made his appearance in the dream and as to why he was wearing brown plead shirt.  All he could tell was that the shirt was well tucked under his khakhi pants, making him look more debonair.   "He was a heavy set man you know. 6' 3", a big man.. But in the dream he looked as he was taking good care of himself."

The theme of the session before he embarked upon the dream was of death.  Nancy, wife of his friend Jack,  had died of pancreatic cancer. "She was such a nice person. Took good care of herself. Did everything by the book. Ate well. Exercised. Never smoked. And then died in a matter of 8 weeks. It is just not fair. And I was with Jack at St. Patrick Day parade, yesterday. And he is so lonely without her."

"Did talking with Jack about his wife's death sparked the dream?"

"Could be. For Garth died very suddenly too.  We grew up together. Though he did better than me. Married his high school sweetheart, moved to a beautiful custom made house in a wooded area, away from hustle bustle of the city. Then one day he developed sudden intense pain in his calf. Out of nowhere. Called his wife to take him to hospital. He was not kind of guy who falls sick, so it was a big surprise. By the time she reached him it was too late. The clot broke loose, went to his lung and killed him instantly. He was fifty. "

But at this point I could not help but notice that despite his best efforts, there was a slight, though an unmistakable expression of satisfaction on his face alongside sorrow for the premature death of his friend.

"Didn't you marry your high school sweetheart as well?"

"Yes. But there was a  difference. Garth married his girl right away and they remained together till the day he died. My sweetheart left me for a while to explore the world and experience life on her own. We did eventually get married, but after we went through series of partners for a decade or so. I don't know in that respect if Garth did better than me. You know I have never been able to love my wife the way I had loved her when we were so innocently and deeply in love with each other to the exclusion of the whole world.. That way I guess Garth was luckier."

"But unluckier in that he died at 50. Is it possible that you were seeing him in the dream as picture of health to hide the satisfaction that if he did better than you in the department of love and in making money he nevertheless is dead while you are still going strong in your Sixties?"

Patient did not quite agree with that but said, "While I was admiring as to how fine he looks and could not tell him enough of that, I must admit all along I knew he was dead."

As to why the dream emphasized the details of plead shirt and the khaki pants he could come up with no associations other than that he has an identical plead shirt in his closet. "Though it is black not brown."  The time ran out so we could not analyze this element of the dream, but perhaps it had to do with Garth and him possessing identical yet slightly different wives. Both were high school sweethearts and from similar backgrounds.

The dream appears to have been initiated by his conversation with Jack about his wife's death. Perhaps the figure of Garth in the dream was admixture of Jack and himself. The patient often thinks of his own death and when he does he has to compare as to how well or worse he has done in life when compared to others.  Garth had done better than him financially and in the department of love, but then he had outlived him. So he had done better there. We do know how obsessional neurosis is illness of competition, and the last resort of triumphing over others is to outlive them. There is nothing like taking satisfaction in the fact that one day all who have caused us grief, every single one of them will die. This explains the fascination with reading obituaries in the newspaper on part of those who are obsessives.

This hypocritical complimenting of someone's good attributes only to hide the underlying hostility is far more common than we suspect and just not in dreams. The other day a lady in her early sixties came for the first time to my office and could not compliment me enough from the word go as to how nice of an office I have and how I look her straight in the eyes when talking, and how I listen to her so attentively. As I began to warm up towards her for so quickly noticing my sterling qualities, she complimented me some more this time over the certificates that were nailed to the wall.  By this time I had begun to get a little suspicious and rightly so for just then she threw the first shoe at me.

"I did not know you were a neurologist as well as a psychiatrist."

"No, I am not a neurologist. Just certified by the same board that certifies neurologists."

"Oh and look at that certificate, you are surgeon as well."

"No. My degree is bachelor in medicine and surgery. I am just certified that way that does not mean I do  surgeries. I am just a psychiatrist."

"Tell me what is the difference between a psychologist and a psychiatrist. Aren't you allowed to prescribe medication which the psychologists cannot? And how are you different from a neuropsychologist? I bet you are a neuropsychiatrist which is better than being a neuropsychologist."

"Lady," I told her, "Can we cut this out and shift our focus on what is wrong with you and not me."

 Alas I wanted to say it but had to bite my tongue. For I knew that all these insulting remarks that she was spewing at bottom rose out of her fear of me. She was tremulous and extremely respectful as she hurled these backhanded compliments. The paralyzing fear she felt at the presence of authorities and which she was trying to handle through noticing everything that she could find to bring me down, was also behind noticing everything about me that she could praise and thus avoid any punitive aggression coming her way from me.

Sunday, March 11, 2012

A Dream of revenge struggling against filial piety

A 61 year old musician, reported the following dream which comes to him every now and then since his  father's death.

My father is alive. But he does not look like my father. He looks like somebody else. Though I know he is my father.  

 "While he was alive I never dreamt of him. Why do I dream of him after his death, and then too as some other man? Isn't it strange?"

On being asked who is this other person he replied nobody in particular.

Patient rejected the conjecture that these other people have some common attribute with his father and it is this common attribute that allows the substitution.

When told that perhaps he misses his father, now that he is gone, and therefore when he sees somebody during the day who acts towards him as a father figure he dreams of him in the night, because it enables him to see his father as once again alive, he said that make no sense.

"The person who comes in the dream looks nothing like my father. I can never recognize him. He is not anybody I am familiar with. He has nothing in common with my father."

"Anyway what happens between you and and your father in the dream?"

"I guess, we just talk. As to what we talk I can't tell you. But wait a minute. I do remember now as to where the dream mostly takes place. It is a familiar place. Yet it is not a place I know in real life. Every time I see that place, I know I have been there before."

Now a place which one has never been to in real life but looks very familiar can be immediately interpreted as the womb. A familiar place where we spent our first nine months but which has no existence in reality after one is born. So it was a variation of the Oedipal fantasy:: Meeting the father in the womb during parental intercourse. But this fantasy, which is so often encountered by the therapist while listening to his patients, will sound bizarre to the person who is not well versed with psychoanalysis. It is one of the primal fantasies, arising from the wish to see parental intercourse from the vantage point of being right inside the womb, while being sandwiched between the father and the mother. The bisexual theme of this fantasy is highly arousing and its enactment as a threesome is one of the staples of the porn industry.

Despite figuring out this element of the dream, I could still make no headway as to why his father does not look like himself, but someone else. And with no more associations coming forth, I threw in the towel, and we drifted off to other things.

He talked about how he is the last surviving member of his family. His sister died couple of years ago, and the mother just a short while before that. The father had died over a dozen or so years ago.  How, since the other three are gone, he often thinks of his own death. There is no one ahead of him to die. It is his number now.

Then he began talking about how his mother always put down his father. She could never stop criticizing him for his drinking. It was a relentless criticism. And she used him to further put down his father.

"She loved me. Showered me with all kinds of gifts while did nothing for my father. What love she should have shown him she showed to me."

Knowing the patient very well, I objected, "But didn't you tell me that she use to put you down. Strip you off your self-esteem?"

"She did that too. She put me down with one hand and spoilt me with the other. It was a dysfunctional family. She loved me, yet she hated me. Not that my father loved me any better. He did not find in me what he was looking for. He was looking for somebody who was a jock. Somebody who could work or cars with him. I was not what he was looking for in a son.  I was Momma's boy. He showed no interest in my guitar playing. When I picked up the guitar I was like natural on it from the first day [patient is one of the best  guitarist in Detroit area]. But he never came to any of my shows. Music was not a real job for him. But I take back. When I did start playing professionally, he did finally give me grudging respect. He could play a little guitar himself. Some hill-billy songs. "Wildwood Flower" was his favorite. Only when I played that one to him, he realized how well I played. But by then it was too late. I was already grown up. I have been to his grave only once. I went with my family, and you know how talented my children are,  and we played and sang Wildwood Flower at his grave."

"Since he never recognized you for who you are and he did not see in you what he was looking for in a son, is it possible that you are bringing back from his grave - in your dream of course - and not recognizing him for who he is. You are telling him that he too does not fit the bill of what you wanted in a father?"

"I never thought of that," the patient confirmed the correctness of the interpretation. "I was never accepted by him as a worthy son. And now that he is gone I can finally dare to dream that he too is not acceptable to me as a father. 

Tuesday, March 6, 2012

A Trazodone induced incest-nightmare

A young man in his late twenties, who suffers from anxiety and obsessions, took Trazodone (Desyrl) for insomnia and had the following nightmare:

"It was weird man. I can swear it would not have happened but for that medication. It was so real and so frightening that I could not believe it was happening. I was busted for doing shitload of drugging and drinking. Put in jail. My wife was very against whatever was going on. Against me for what I had done.  She brought my [2-year-old] son and he wanted to hug his dad. You know how much I love my son, and how attached he is to me. But my wife was making it appear to him as if I was a piece of garbage. She was using my son against me. Deprive me of his love.

"Not just my son. Her sister was there too. In fact all her relatives, especially the Mom's side - the Mexican side - were there. Her mom, her grandmom, the entire Mexicans clan.  And I was stumbling in front of her grandmother. She was the one who speaks no English. She was the only one who was willing to forgive me. You know how Catholics are. They forgive you no matter what sin you commit. That must be the reason why the dream brings those Mexicans in to the dream. Those relatives of my wife are super religious people. But even they looked as if they were not willing to forgive me. Only the grandma. She was giving me hugs. Though I could not understand her, for she was speaking in Spanish. I was calling her Ayah. That is what her relatives call her. 

"And it is just not her relatives who are against me. In the jail there are people from my past. My buddy Jim is there. They are all major problems. For these buddies, the things we did together, were major problems. I have abandoned them. But they were back in the dream, and right inside  that jail. 

"And then it gets even darker. You know I am in jail and how things are in jail. There are big guys there, taunting me that I will be somebody's bitch. Somebody's homo bitch. One of them hits my buddy Jim. It is scary. It was like warning to me.  In fact the dream goes in to the Scared Straight Zone. There is a big back guy. He comes in the movies. He is a big ass black dude.  He was lecturing me as if we were doing the Scared Straight stuff. And I couldn't do anything about anything. I was like restrained.  Finally I woke up. In extreme fear. I would not go to sleep for an hour or so, the dream was so vivid and frightening.

Since the patient sees me just for half hour - he cannot afford more time than that - the individual elements of the dream could not be subjected to analysis, but there was no question that the entire thing was a series of punishment being meted out to the dreamer.  In fact there was hard to see any trace of any wish fulfillment anywhere. To sleep experts like Ernst Hartmann, Alan Hobson and Robert McCarley who do not see dreams as wish fulfillment, this would be a treasure trove of a dream. For it thoroughly contradicts the classical Freudian view as to why we dream. Hobson and McCarley will find it especially heart warming for the fact that the dream appeared totally chaotic and senseless to the patient. This so much supports the contention of their Activation-Synthesis hypothesis that dreams are nonsensical and generated by random stimulation coming from the base of the brain. As to why such a chaotic and senseless visual imagery would cause such severe fear in the patient that he could not go to sleep for an hour, would of course be asking way too much from those Harvard professors.

But I was not ready to give up the idea that the long series of humiliation - the derision of his wife, denial of the love of his son, the refusal to forgive him for whatever transgression he had done even on part of those super Christian Mexicans - was not a reaction on part of his conscience/superego for some momentous crime.

But what could be that momentous crime [wish] which had provoked such a series of  punishment?

For the whole dream is nothing but punishment in one form or other.  His doing drugs and alcohol - which he has not done for years - and getting busted for it! The  taunting that he'll be made into somebody's bitch - a homo bitch on top of it - his admonishment by the black film star in the style of  "Scared Straight",  his friend Jim getting pummeled and made into an example as to what fate awaits him - were more of the same.

Was there any hint of that crime/wish in the manifest content of the dream or had it remained shackled in strong repression and only the violent reactions to it had been able to attract the dream-consciousness?

Now we know that going to jail in dreams is often the manifest content of the wish to return to mother's womb - one of the primal fantasy of mankind. Both are places where one remains confined.

But why do humans dream of returning to the womb?

If life becomes too stressful or painful, the primordial memory of the womb and its safety becomes the sanctuary which one seeks to find;  if not in real life then in one's sleep/dreams. Also the forbidden wish to copulate with the mother, once the incest barriers are erected can only be fulfilled by entering into the womb as a whole person. The dread of incest/castration is so strong that entry into the mother through copulation becomes impossible and the dreamer has to substitute his entire person as a substitute for the penis.  I will not be surprised if more thorough psychoanalytic investigation shows us that many habitual offenders, who prefer confinement over living on the outside, are not fulfilling the womb fantasy in a very distorted fashion, and acting it out in real life not just in dreams.

We also know that  this fantasy to return to the womb to escape from the painful world, when indulged in real life or in dream, hardly brings any happiness. In dreams one's rivals from the childhood, the father, the siblings, and their substitutes in the larger society, they return too  to prevent one from enjoying the fulfillment of this most forbidden of wishes. And in my patient's dream we can see how a whole slew of people were out to spoil his pleasure of being reunited with his mother. The fear that he will be made into a homo bitch in the prison was again a dread of his being subjected to the same treatment by his father which he wanted to subject his mother.

Some of his other dreams from the past on analysis had shown how his dread of his father for the forbidden Oedipal wishes had bred a desire to placate his father with homosexual submission, which he energetically repudiated and which only emerged, and very indirectly, in his dreams.

"Why was the grandmom, the one you were calling Ayah, giving you hugs? I asked the patient.

"I don't know. But she was the only one in that whole frigging dream, who was not against me."

"Is it because you two were kind of exchanging affection while everybody else was like condemning you for doing that?"

"Yes. It makes lot of sense. That old Mexican lady, she  reminds me of my mother. I could do anything wrong but could still count upon my mother to always be on my side and forgive me. Now she is gone, and I look upon this Mexican lady as my Mom. She is so kind, and looks so helpless, just like my mother was when she was dying and I had to take care of her for almost two years as she lay terminally ill."

"What was the role of Trazadone in all this?" I asked him.

"You know how these psychiatric medications sometimes can bring up the most weird-ass things to the surface. I think the Trazadone just made my mind to dream whatever I was dreaming."

I did not disagree with the patient loudly but I could not help but think that he should be made a Harvard Professor of psychiatry too, for they too, like him, believe that a pill or random signals running up from the Pons to the Cortex can produce dreams.

However, the more correct explanation would be that Trazodone caused enough arousal in the brain that his dream-thoughts  which on other nights would not have attracted consciousness did so on that particular night. For dreaming state is a state of partial wakefulness. The PGO (Ponto-geniculo-occipital ) waves during REM sleep are not responsible for producing the dream thoughts, they are responsible for producing a state of partial wakefulness, which enables dream-thoughts to be perceived, and which gives us the illusion that we are awake and watching what is happening in the dream as if it is real.

Thursday, March 1, 2012

Irritable Bowel syndrome caused by experiencing sexual abuse in proxy

It is almost guaranteed that any sexual abuse in childhood will result in fibromyalgia. Its mechanism appears to be that the person cannot quite give up the vigilance that was first put in to place to watch for and escape the repetition of the abuse. This vigilance becomes such a character of the sexually molested person that even at night, when she is suppose to drop all her guard, curl up and sleep, she remains half awake, not allowing her muscles to enter into full relaxation and rest.  Added to this is the fight the person nightly wages against the ghosts of the past - the abuser/s - reliving the trauma and trying to get even with the perpetrators even if in dreams. This recreation of the trauma causes varying degrees of anxiety and muscle tension depending upon how abusive and painful the experiences were versus the discharge of sexual tension that occurs with the repetition of the memory.

Irritable Bowel Syndrome (IBS) is not too far behind fibromyalgia. Sexual abuse causes this malady as well and with regular frequency. Here too the affect generated by recalling the trauma, whether done unconsciously or in sleep or dreams it does not matter, causes great degree of muscle tension and the anger against the abuser/s is discharged through excessive mucosal secretion from the intestines and the spasmodic muscle activities of the colon.

But I guess I am getting diverted from the original intent of the post which was to give a clinical account of a patient who witnessed infidelity of her mother as a child and this caused her to have the same reaction that happen in children who are sexually traumatized. Her main mode of discharge of this memory and the anger generated by it was through the symptoms of IBS.

Now in her thirties and plagued by depression, anxiety, remorse and guilt, as a child she was taken by her mother to the mall and left in department stores so she could make her escapades with her lovers. The little girl greatly resented this. However, she could not betray her mother to the father because she was taken in to confidence by the mother and the latter would beg her to not tell the father for it would lead to divorce and tear apart the family. The girl tenderly loved her father who was more than 20 years older than the mother, and was in his fifties when she was conceived. When the mother was cheating, he was in his sixties and already old, sick and dying. The girl hated the mother for her inability to restrain her need to be loved by  younger men, but was too afraid to offend her.

She was filled with revenge fantasies against the mother, which now as an adult, when activated by some triggers, caused her bowel to flare up.  To this day she cringes when her mother touches her and refuses to hug her. She remarked that he mother is cold and selfish, only into herself whose conversation is mostly about showing how she can never do no wrong, and even today when the daughter confronts her as to how she could expose her child to such depraved behavior finds excuses to escape responsibility.

 "I can hug my mother-in-law but never my mother.I hate her for what she did behind my father's back."

The mother's extra-marital affairs, which the child knew was resulting in sexual intercourse between her mother and her lovers while she was being bought off with the money to shop to her heart's content, acted as if she was getting sexually abused herself. At least that is what my analytic observations led me to conclude.   And in my mind there is little doubt that it was this sexual trauma in proxy that was resulting in her IBS.