Wednesday, October 30, 2013

A recurrent dream of castration

A man in his mid thirties, who suffers from paranoid illness, is single, still lives with his mother, her only child, reported that for the last two weeks he is troubled with a dream that won't leave him alone.

I feel there is a baby on my back, like a backpack. I feel responsible for it and have to worry about its safety. I want to do things but cannot because of the burden.  My dreams which use to be full of adventures now are cut short because I have to worry about the baby coming to harm. 
When I wake out of the dream I find my head hard pressed against the pillow. 
Initially the only association the patient could come up with was that the backpack reminds him of going to school.  But that association led to no where. And soon we drifted into his usual paranoid complaints about neighbors keeping a watch on him and how he cannot get away with any transgression no matter how minute.
"Every time I have sex with a woman I get in to trouble. It is not like I am having sex with married women. But neighbors look at me as if I am trying to have sex with their wives. If I just wear a different style of cloth they start wondering if I am up to something. Recently I was hired by a lady to drive with her to New York to help her load some mattresses for her business, and while I was eating at the White Castle she was watching me as if I was wolfing down my food.  If I exercise in my backyard my neighbors come to their windows and stare at me. Even my mother doubts my abilities. She tells me that I am a dreamer. But so was Martin Luther King. My mother accuses me of doing nothing that has any practical value and for earning no money. But hardly out of school I became a connoisseur of classic cars and flipped a couple at a profit. I have a collection of old comic books which one day will fetch me a neat sum."

By expressing to me all these persecutory thoughts and feelings, which his mind is constantly conjuring and no doubt to keep a lid (inhibition) upon his taking chances with the world - even his ability to free associate -  undid the repression partially, and the patient now could come up with the following association, "I read, or perhaps saw on TV, that if you see a child in a dream it is yourself."

This immediately solved the riddle of who the child represented. And I asked him, "Behind the facade of protecting the child is it yourself that you are protecting?"

"That makes sense. But why I am protecting myself through creating a double of me as that child instead of protecting myself directly?"

"Because when the fear of harm coming to oneself is overbearing, the mind plays a trick to lessen its impact. It starts worrying about somebody else who if harmed will cause one even greater pain. This way one's fear for one's safety is lessened. The focus shifts to somebody else getting harmed instead of oneself. This reduces the autonomic and other physiological responses that are triggered if one is anticipating danger. For the harm coming to somebody else, even if to somebody very close to oneself like one's child, still does not pose as much terror as harm happening to oneself. Or at least does not mobilize body's physiological responses to the same degree. The body does not have to activate the cascade of stress factors to protect oneself, because the injury is going to happen to somebody else. It is a very important defense: shifting worry from one's own person to worry for one's child's, or a spouse, or a favorite nephew or the federal deficit or the future of mankind or the disappearing rain forests, or the global warming.

"Since in real life you do not have a child, in fact you do not have anybody close to you who you really care for, you are working out your fear of some harm happening to you by creating an imaginary child who you must protect. And since you deny your fears in daytime, and in fact do not feel much emotions when you feel threatened by your neighbors, for that matter the world in general, for you experience the world as a hostile place, these fears emerge in the night when you are sleeping and you try to work them out of your system in your dreams.

"But why did this dream start just two weeks ago?"

"Because for the last two weeks I am struggling with a bad crook in my neck?" the patient replied

"Crook in your neck? What in the world is that?"

"I don't know what you call it. But us black people call it crook in the neck when we sleep badly and wake up with our neck stiff and hurting. Generally it clears up in a day or two. But this one has been a bugger and has persisted for two weeks."

This explained the immediate cause of the dream. The pain in the neck was disturbing the sleep and the patient who is always anticipating grave harm because of his paranoia had raised its significance to that of a mortal danger. This was consistent with how he experiences the world: a dangerous place. The need to do something about "this impending catastrophe - the crook in the neck" would have woken him out of sleep. But to protect the sleep - for him to continue sleeping - the brain mechanisms responsible for dreaming generated the dream. And the dream, by showing that the mortal danger was not coming to him but to his dream child, lessened the overbearing emotion of fear which otherwise would have woken him out of sleep.

"Why is your head getting buried into the pillow?"

Patient countered it by stating that the dream was in color. Now we know that if the dream is  vivid, feels very real, is in color, it symbolizes intensity and it is reflection of the intensity of the wishes/desires that are invoking the dream. Many scenarios of wish fulfillment have been condensed in to one. Not unlike how in some movies the director starts in black and white to portray the emptiness of the lives of the characters, and then, as circumstances change, and the characters meet new people and new sources of pleasure, their lives become multidimensional and full of happenings and the director shifts gears and ratchets it up from black and white to color.

The patient then gave some more associations which hinted that his burying his head in the pillow was trying to retreat from these intense wishes. For intense wishes are often accompanied with heightening of danger. Striving for things invites competition, threats and actual aggression upon one's person. In digging himself into the pillow he was actually retreating from the dangerous world and seeking to hide in its crevices - it was a variation of the fantasy to return to the womb. It was this intense fear too that was perhaps causing him to keep his muscles defensively tight while sleeping, causing "the crook" of his neck.

The correctness of this view was further confirmed when patient said that his dreams are full of adventures, or rather a wish to embark on adventures, which are cut short because "I cannot be involved with dangers and cannot accept daring challenges because I have this burden, this responsibility for the baby."

When asked to give specific examples of adventures which are cut short by the fear of harm coming to the child the patient said, "Like climbing up a mountain or some other steep structure. Or to get out of a tense situation, like being in a small space with so many people around me."

Now we know that climbing symbolizes sexual intercourse. In fact in Hindi the vulgar term for sexual intercourse is a man climbing on a woman akin to mounting in English. Being in a tight spot with so many other people around perhaps symbolized competition with siblings and father over exclusive possession of mother's genital passage. And considering that a little child often symbolizes penis I made the following construction.

"Is it possible that the adventures are symbolic of sexual adventures and the danger is of castration, with the little child being your penis which will come to harm because of it?"

Little child symbolizing penis is a well known psychoanalytic fact - people often refer to their genitals as their little one -  and this kind of conjecture could be made with this particular patient for he has been seeing me for many years and is quite familiar with the concepts of Oedipus Complex, castration, and dream symbols.

To my great surprise patient said, "It is interesting you say that because the child who I am saving always is naked, he has an erect penis, despite his being a baby, and I may as well add that it is over my left shoulder that I look at the child."

This association strengthened  the view that the dream was an attempt on part of the patient to avert castration for forbidden sexual wishes.

I asked the patient why the child had erect penis and he recalled:
"When I was 11 I developed torsion of the testicles. My mother took me to the Children's Hospital. But they did not treat me right away, and sent us home and told us to come another time for there were so many children who had to be treated before me. And my problem could wait. But then a few days later the problem suddenly worsened. I was rushed to the hospital and they did the surgery right away. The White doctor who operated upon me said that the condition had gone so bad that he was about to cut them [testicles] off. He added that the left one looked worse than the right. The White doctor had a serious look on his face as if he really meant what he said. I did not want to lose my manhood. For I knew one could not have kids without the testicles. After that I had dreams of that white doctor cutting of my testicles for quite some time. I also thought that they would have operated upon me when I first went there if I was a white kid. And for them to operate upon me so quickly when we went the second time, I must have bumped off some white kid who was scheduled for surgery that day."

The patient at this point added another element of the dream.

"The child on my back is whiteI was pretty white when I was born. Just like my grandmother."

So the patient's genetically determined excessive castration fear was further worsened by this unfortunate episode when the possibility of castration in hands of a White man almost became a reality. And to defend against it he had taken refuge in the belief that he was not black but white just like his grandmother. If he could turn white then the likelihood of getting castrated would disappear. And so in the dream he was defending himself from the fear of castration by making a double of himself as a white child. And a child who was not just white but who had an erect penis all the time - denial of castration through impudent defiance.

In his next session, a month later, he brought the following dream.

 I am a few streets away from my house playing basketball with my friends, two brothers, who I grew up with and who were nice to me and treated me with respect. Then another kid, a  neighbor of theirs, and I start fighting with each other. It is a martial art fight. The kid's uncle comes out who is blind. He has a white cane with red tip. We stop fighting and apologize to him for fighting like that and I explain to him that I live on Anna street. Then I return home and find that the boy with whom I was fighting had done a break-in and entry in to my mother's house. I call the police and grab hold of the boy. I see the boy wrapped around my hand as a backpack. I feel as if the burden of the boy who was always on my back as a back pack has disappeared for he is now wrapped around my hand.

We will not go in to analysis of the whole dream but only the parts that deal with the baby on the back.

The patient spontaneously associated that the boy who he is fighting with his own self. It is the part of him which he wants to [reject, project out, and] fight with. It is that part of him which if one follows the dream has failed to resolve the Oedipal conflict and is still seeking to find libidinal satisfaction through his mother - the boy with whom I was fighting had done a break in and entry in to my mother's house -and which was at the root of his illness.

Patient claimed that once he had this dream the  recurrent baby-on-the-back stopped. The patient and I agreed that the baby now instead of being a monkey on his back had shifted to getting wrapped around his wrist. So instead of the fear of castration completely controlling his life- sitting like a monkey on his back - it was now wrapped around his hand and thus under greater control.   

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