Wednesday, April 4, 2012

Death wishes underlying Generalized Anxiety, Obsessions and Agoraphobia

An 18 year old girl, who suffers from sever anxieties, to the point that she cannot even leave her house, and has developed extensive obsessions to bind/nullify the overwhelming affect of fear, had the following dream which disturbed her to no extent. "What happens in the dream, let me make it clear, I absolutely don't feel that way."

My mom, dad and my sister are in it. We are in my grandmother's backyard. Somebody got rid of my mom and dad. I didn't do it myself. In fact I did not do it. Some crazy person got rid of my parents for some reason. The backyard has no grass, just dark dried up dirt. There are ropes around their neck. Little pieces of rope. I think I am untying them. They are looking straight at me. I was kneeling over my dad. He is like totally silent. He could looked right through me. It was the creepiest feeling. Everybody was so calm. Even I was so calm. That is what so creepy about it. How could I be so calm about what had happened to them. I can remember it all so perfectly. I was on phone with my grandmother who said, what did you do and I said I didn't do nothing. But she said you will have to live with that for the rest of your life.

Since the patient mentioned her sister I asked her where was the sister in the dream.

She was inside the house. She was on the second floor watching through the middle window. I was standing under the tree. She then tells me Mom and Dad hung themselves. I did not see that. I just saw the small pieces of rope lying around.  But the way she told me is like I almost did it and I am covering it. She looked really disappointed with me and walked away in disbelief. I notice that I was still in my night clothes and I must have just walked down the stairs. I felt so horrible till I realized that wait a minute your mother is already dead and your dad is in jail so I could not be responsible for their death. And my sister is not alive either. I woke up in panic my heart pounding. I don't want to have a dream like that in a million year. I wouldn't even hurt a soul. I want to see  my mother come home so badly. And my sister too. Just the opposite of what is in the dream.

At this point the patient began to cry and declared that she does not want to have another dream for life. "I don't want to even remember this dream ever again."

The central theme of the dream could be analyzed without associations. It was clearly fulfillment of death wishes towards her family perhaps connected with some early childhood sexual activity which she was afraid to practice unless there was nobody watching her which involved doing away with her parents and their watchful eyes. That activity had to do with masturbation was supported by the fact that the only association she brought to the dream was that it was sparked by watching the play "Wizard of Oz" the night before. Dorothy had walked the dog on the stage with a thin white rope. The same thin rope had reappeared in the dream and had been used to hang her parents. Viewing the dog being walked with the rope had  sparked the memories of touching herself. The dog substituting for the clitoris. Though this construction was not conveyed to the patient who would have anyway rejected it. But there was little doubt from analysis done in previous sessions that her obsessions were two step in nature: doing away with the parents and undoing the effects of such horrible thoughts. Her mother and sisters untimely death, and her father being sent away to jail, all of which happened in the last two years, has not helped matters and has made her obsessions worse. Her obsessions are now mainly seeking of forgiveness through symbolic motor rituals for all the misfortunes that has befallen her family and which in her unconscious she takes responsibility for.

The reason I report this dream here is because this girl who suffers from crippling anxiety, agoraphobia and obsessions, her symptoms have their roots in these childhood death wishes towards her parents, which she is terribly horrified and guilty of, and it is the anticipation of retaliation arising from the guilt which keeps her constantly anxious.

The fear of harm coming from her evil thoughts turning into reality has made it very difficult for her to leave home. She anticipates meeting the same fate as her mother and sister - most strangely her brother died as well during the same period - and thus sees the world as nothing but a menacing and dangerous place. She has begun to do what another of my patient put it, "Every morning on waking up I quiver in my boots because of my catastrophizing the world." 

No comments:

Post a Comment