Thursday, October 30, 2014

Body pain being utilized by dreamwork to find sexual wish fulfilment.

A widow in her fifties who suffers from multiple physical and psychiatric problems -  her diagnosis flits between Schizophrenia, Schizoaffective Disorder and Major Depression with Psychosis-  brought in the following - as she put it - "crazy dream":

I was in my trailer when some friends came and said lets go to a bar. We go there and I drink a lot.  There is a tall man there who has brown hair.  He buys me drinks and then takes advantage of me.  I come out of the bar staggering, and in great pain, and start walking towards my house to get away from the place, when one of the girls, who had come with me, tells me that you cannot let him get away like that. She calls 911 and the ambulance takes me to the hospital, where they interrogate me with some weird questions. At that point I wake up. 

"Did he actually take advantage of you or were you a willing partner?"

"You are asking me the same questions which the interrogators were asking me at the ER."

"Like what?"

"Like they did not quite believe me that it was a rape, and wanted to know if I secretly liked it, and did I trap him in to it."

"You live in a group home, you do not have a partner, so your need for sex may have been finding outlet in the dream."

"Well, you are right. I did want him to have sex with me. But he was taking advantage of me too. I will not tell you the details, but he was very rough with me causing me great pain."

Living alone it made sense for her to dream of having sex. But why did the dreamwork made it so painful?

"Do you enjoy rough sex. Sex which causes you pain?"

"No. I don't. I was so angry with him for what he was doing to me. In fact I tried kicking him on his nuts to make him go away.  But strangely, my legs would not move, and I could not push him away." [In the next session she claimed that she did kick him on his testicles and hurt him bad. This change in dream recall further confirms the high degree of ambivalence she had about having or not having the painful sex.]

"That shows ambivalence. You wanted to kick him away and yet there was the counter impulse to not do so, and for him to continue to do what he was doing. Why this ambivalence towards him?"

"Because he was hurting me."

"Who was this man? Was he your husband?"

"My husband died an year ago and had gotten divorced an year prior to that."

"He may still become alive in your dreams. Especially since you did not go out with any other man after he passed away."

"This man was not my husband."

"What makes you so sure?"

"Because my husband was very gentle. He never would would have done to me what he (the dream man) was doing. He was hurting me so much."

"Then who was this man? Any other associations that occurs to you about him, besides the brown hair? Anybody else besides your husband he could be representing?"

"He reminds me of nobody. "

"Anybody you know who has brown hair?"

"My husband."

"Any other thing about this man that you can recall?"

"He had green eyes and was 6' 3" tall."

"What was the color of your husband's eyes and how tall was he?"

"My husband had green eyes and he was 6' 3" tall."

"And he was not representing your husband!!??"

"My husband would have never caused me so much pain."

"Any associations to the pain."

"Well. I am having terrible pain down there. In fact when I finish my session with you, Linda (the group home manager) is taking me to the ER to get me examined.  The pain woke me up.  I should have come to the ER in the ambulance last night instead of dreaming about doing so."

The meaning of the dream was clear now. The dream was sparked by pain in the pelvic region. Instead of getting woken up by it she had conjured up the dream where pain was being shown as not due to disease but from sexual intercourse with her husband. The wish for him to be alive and having sex with her had found a common cause with finding relief for the pain.

However the pain was not getting fully masked by the pleasure from the discharge of the sexual drive through the fantasy. This was changing the character of the fantasy from pure pleasurable love making with her husband to rough sex with a stranger who was taking advantage of her. By doing so she could take some action against the man who was causing the pain and thus get rid of the cause of the pain, which she did it by attempting to kick the rapist on his testicles. When these actions did not cease the pain - for the pain though shown in the dream as due to being raped was in reality real and due to a genuine medical problem - the dream conjured up the motive to go to the hospital in her friend insisting that she call 9/11 and she saw herself going to the ER in an ambulance.

Since it was a dream hospital the pain was not being taken care of and instead of the gynecologist coming and helping her the interrogators were doubting whether she was really raped or she had asked for it.

Behind the pelvic pain (belly aching) and its cure through sex whether there was a fantasy of having another child with her husband could not be explored, for the session came to an end.

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