Wednesday, December 31, 2014

Three dreams of an agoraphobic

A woman who suffers from advanced obsessive compulsive disorder, numerous touch phobias, and barely leaves home because she has to dress and undress repeatedly, and do other cleaning rituals, before she can step out, brought in the following three dreams. She prefaced it by saying that when she was young her dreams were pleasant, but as years pass by they have become increasingly frightening, and now they wake her up almost nightly.

1. I have to go to work at the store at 3.  My mother who also works there is pressing upon me to go or at least to tell them that I will be late, but I cannot find my key, or the phone and anyway I am still in my pajamas.

2. I am being chased by bad people. I am running through streets. 

3. My brother comes to my house with his girlfriend, and destroys everything inside.

For the first dream the patient stated that she did work at that store but 30 years ago, when she was 18, for 3 or 4 years and then had come down with her illness and had stopped working altogether.  Her mother had worked there too at that time. What was different in the dream was that the store now was at a different location.  The store where they had actually worked no longer exists.

So the patient who during waking hours is virtually a cripple from her agoraphobia, was attempting recovery at night and seeing herself as cured and working again. Alas only in dreams. For the illness   was at the heels of the cure, and her neurotic fear of leaving the house was finding excuses to not be at work by still being in pajamas, not finding the car key, not finding the phone etc, despite the support she was receiving from her mother to overcome her phobia and show up at work.

From psychoanalytic theory I knew that agoraphobics avoid going in to public places afraid that while not in right mind they may do something [sexually] inappropriate. And I wondered if this expectation will be fulfilled by further associations.

And to my pleasant surprise this was confirmed when the patient had following to say about the second dream on being asked why those bad people were chasing her.

"They wanted to have sex with me. I had landed up I don't know how [the typical dread of agoraphobic that in a state of amnesia, or by some other inadvertence, they may land up in a sexually dangerous situation] in a bar or club or something like that. Those bad people were there. Along with some shady women. They were all like hanging together. And looked as if they were expecting me to join in whatever lewd thing was about to start. I think they belonged to a motorbike club or something like that for they ruled the town and nobody could challenge them. They could do whatever they wanted to. When I took off,  they came after me, trying to find me. I ran in to the trailer home of a middle aged woman. But instead of giving shelter, she said,  why don't you submit yourself to them. It will be so much easier. It will save you all this trouble of running away. All of us in this town do whatever they ask. They are so powerful. In fact I am going to that orgy myself. I have been there many a times."

So being chased and subjected to violence in the manifest content of the dream, which one would simply look upon as running away from ordinary aggression, also had an underlying layer: running away from sexual temptation. The patient agreed to the construction that the middle aged woman was  her mother. And just like in the first dream she had come in to the second dream to help her  overcome her agoraphobia. Here she was trying to help her get over her illness by telling her not to disown her unacceptable sexual impulses and run away from them but to give in to and thus be able to face the world again.

I wondered in my mind how the third dream would fit in with the other two. Was the coming of her  brother into her house was continuation of the bad people chasing her right in to the house to enforce sex upon her? And was his destroying the house another representation of sadomasochistic sex - the house representing herself? But I could not tell any of this to the patient to avoid influencing her associations. Instead I asked her as to what thoughts occur to her in connection with her brother.

To my astonishment the patient said, "My brother is no different that those bad people. Given a chance he would destroy my peace of mind as those bad guys. You know when I was in my twenties, he one day came to my house and forced sex upon me."

"Did he rape you?"

"No, it was not quite rape, for I did not protest. I was so stunned I just went through the motions. You know I grew up in a very chaotic household. There was no order, discipline, or sense of right or wrong in it. My parents did drugs and let us run wild. Anything we did was OK with them. So when my brother came upon me like that I could neither say yes nor no. But when he tried to do it more than a few times I told him to get out of my house and never come back again. In the beginning I felt  sorry for him, because he looked on verge of nervous breakdown, and I thought he will go over the edge if I did not let him have his way with me. But I quickly realized that allowing him to do such a crazy thing as to have sex with his own sister could not be good for him, however disturbed he was. So I put a stop to it."

"Did you stop working at the store after your brother enforced sex upon you. Was that the beginning of your agoraphobia?"

"No. I had phobias and fears even as a child. Even when I was a teenager it would take me forever to leave the house, so afraid I was of the world."

Thursday, December 25, 2014

A revenge dream showing dreamer as a superhero

A patient who comes once every two months, and who rather not come because of his shyness and because he feels he is letting me down if he does not bring up something significant to the table, has discovered that a good way to fill up the 45-minute session is to narrate a dream or two, for he knows how it immediately perks up my attention, declared triumphantly that he has five dreams for me to analyze. But as he began, he apologetically confessed, he can now recall only three, and then proceeded to tell me the following four laconic dreams:

1. I am in a house and suddenly on top of me the glass shatters. It is strange that though there is extensive breaking of glass they don't hurt me at all.

2. Somebody is terminally ill.  I feel real sad for him.

3. A teacher with whom my brother and I went to Europe on a college sponsored group trip and who died not too long after we returned due to breast cancer was alive again. She looked young and had resumed teaching classes.

4. My mom is laying on hilltop on a grassy nice area. And she was young. 

To the first dream patient expressed his puzzlement as to why suddenly the glass will break over his head and why it caused no injury to him. But at my suggestion - based upon psychoanalytic theory and my knowing the patient for over two decades - that shattering of glass could have symbolized loss of virginity and gave the example as to how in Jewish weddings smashing of glass is a standard ritual and most likely an allusion to the rupturing of the hymen and consummation of marriage, the patient said that what I say could be correct for in real life he has never been able to look at any woman as a sexual partner but in dreams he often does so.

After some other things that the session drifted into he returned to the dream and talked about another association that had popped up in his head regarding breaking of glass. His passion for reading Marvel Comics and how in them superheroes like Superman, Incredible Hulk, Batman, Captain America crash through glass walls while in pursuit of supervillains and nothing ever happens to them. The crashed glass never ever even scratches them.

So the patient who in waking life is the very model of meekness, utterly respectful of women, who finds sexual as a violation of a woman's dignity, in his dream had turned into a superhero - the ultimate phallic symbol - boldly going through the glass wall - deflowering a virgin without a thought- and coming out of it unscathed.

In the second dream as to the person who was terminally ill, patient could think only of Professor J, who is director of the theater program at the college where he works, and whose health is rapidly deteriorating because of liver cancer. He had run in to the professor on the day before the dream and feeling sorry had asked if he could do anything for him. The professor had told him, "Pray for me." The meeting had aroused associations in the patient's mind connected with the theater but through the bridge of cancer primarily about a co-worker, M, who gets parts in the plays staged by Professor J. Now this lady had beaten lung cancer. In fact, given that she is in her late seventies and had smoked all her life, it is remarkable that she had survived the cancer. And the patient expressed his admiration for her in that she can still act on stage and recently had done an excellent job of playing a funny alcoholic.

As to why the association to M came in connection with J, besides both having cancer and both connected to the theater, the patient recalled that couple of weeks ago, M had met him and his brother at the church and had joked that she would love to fix them up with suitable matches but alas they were past the age when people date and get married. This putdown, which was at least on surface done to provoke humor, had provoked impulses of revenge, which at that particular time could not emerge in consciousness but which perhaps ran on some such line:"if the bitch had only died of lung cancer how much better the world would have been".  But true to his nature, which due to his religious upbringing forbids him to see or think any evil, what had emerged in his consciousness was seeing her playing the drunkard on stage which the patient did not fail to tell me with a laughter, was incredibly funny.  

The third and the fourth dreams were continuation of this vision of seeing M as a funny lady, alive and well and not dead due to her lung cancer. But there was a slight modification. Instead of M being brought back from dead, it was the person who the patient and his brother had gone to Europe with, and who also had cancer, and had died because of it, who was being being made alive again. The logic of course was that it would have been so much more fair if M the bitch had died of cancer instead of the professor. Whom he not only brought back from dead but also gave her additional presents of being young and back to teaching at the college.  This granting of reprieve from death had also been extended to his mother, who had died a few years ago.

 The mother had been brought into the equation because underneath his great filial piety and love for her, there was an equally strong resentment for her making such strong bonds with her sons that they could not dare venture away from her and find mates for themselves. In fact all their lives they had lived in the same house where they had been born and raised. They were now in their late fifties and even though their mother had died they could not leave the house as if it would have been betrayel of their mother.  In fact his inability to develop courage to have sex with [strange] women owed to this excessive loyalty to his mother and which part of his mind greatly hated. So the dream was showing his mother young and enjoying herself on the grass on top of a hill instead of showing her dead and six feet under.

The motive for the first dream became clear as well. Unlike what K had claimed that he was no longer fit for being fixed up with a girl, he was not past his sell-by-date but a young and vigorous superhero, invincible, devouring a virgin with impunity.

Saturday, December 13, 2014

Role of unconscious Oedipal guilt in shaping the structure of two dreams

A patient brought to two dreams which he had dreamt on consecutive nights and had typewritten for the session:

Dream on Saturday, Nov. 22nd

I was driving a car with my friend Al. We were driving down 6 Mile road in a big Cadillac which is strange as I always buy Ford vehicles. We stopped at my house and I noticed All had a large cup of coffee. He tripped and splattered the entire cup of coffee on the big picture window at our house as well as two other smaller windows. I remember there were a total of 3 windows he hit with coffee. In true life I haven't talked to him in a while because of a disagreement we had over the way he was treating his sister. She has multiple sclerosis and he and his wife were her caregivers. He lost patience with her and became rejectful. As a result she was taken away from his care and moved to a nursing home where things are much better. However, since that time last year I haven't talked to him.

Dream on Sunday, Nov. 23rd

In the other dream I was sleeping on my bed when I found myself flying up into the sky where there was stormy weather. As I got near the clouds I spun around really fast like a spinning top and in front of me when I stopped there was a former girlfriend I met in Germany while in the Army name Julie. She said to me, "I've been thinking about you Sargent Hall, we should go back to Austria." (This is where we actually went in 1971 to visit her grandmother.) Then she handed me a rectangular box with 3 metal balls in it. One of them had a black dot in the middle. She then said "which one do you want?"

Patient who came to the session on Monday morning handed me the paper on which the dreams were printed out and wanted to know which of the two dreams should he associate to first. I of course told him that is entirely up to him. In all these matters it is the dreamer/patient who takes the lead.

He picked up the first dream and started talking about Al. How Al was a close friend of his. And then elaborated upon his disgust at this friend for the inhumane way he treated his sister and mother, even his wife, and how it shocked him to the point that it ended the friendship. The details of Al's ill treatment of his family members did not lead us too far in to solving the mystery of the dream, so I took up another element of the dream, choosing that particular one because the patient had shown visible pride over it when I had made him verbally repeat the dream in addition to reading what he had written, and which had risen my hopes that associations to that element may be more copious. "Why are you driving Cadillac instead of Ford?"

The patient worked for Ford as the head of its security operations for many years and thus feels great protective loyalty towards the company.

"That is strange. For I would never drive anything but Ford. And the funny part is that it is a vintage open convertible Cadillac."

Riding in an open vintage Cadillac on a busy thoroughfare had to do with satisfaction of the component sexual instinct of exhibitionism. Now the patient shows no trace of flamboyance in his manifest behavior. In his daily life he is a thoroughly modest man. Whatever desire to "show off" exists in him, it is limited to getting appreciation for volunteering in a nursing home and taking care of old folks, and yes he has a passion for rescuing stray animals from alleys. But there it was emerging in his dreams, his cruising down the street in a convertible Cadillac, which shows that the drive to exhibit oneself is a most powerful instinct of humans, and even those who have in their waking lives matured into great modesty can still show it quite openly in their sleep and dreams when their guards are down.

But for our present purposes all I was interested in this exhibitionism of his was to find out as to how it fitted in with the rest of the dream.

The patient did add that on Saturday, the day before the dream, he had gone with his son to Home Depot and had helped him load and carry brand new appliances to his rental house in an open truck. So the day residue of "showing off" the new appliances in an open truck had been exploited by the dream-work to show off himself, and Al, in an open vintage Cadillac.

Also behind the figure of Al was showing off of his son. Al was a composite of his son and Al. At daytime it was him and his son who were riding in an open truck. In the dream it became him and Al in a convertible Cadillac. The Al of the dream was the straw-man behind which his son was hidden. As we will see a few paragraph down Al was also serving as a straw-man for the patient. And the reason why his son was being shown off was because he has a tumor in his brain. The tumor is benign and the size of a small coin but the patient worries about its potential to grow in the future. He has no clear idea as to how serious is his son's overall neurological condition. So along with his own exhibitionism there was the wish to exhibit his son's tumor in the open Cadillac for the world to notice and thus find a cure for it. 

A Cadillac instead of Ford was chosen as an act of defiance towards his father, who he feared would disapprove of his exhibitionism, and because of other ancient Oedipal grudges which resided in his unconscious - Ford Motor Company symbolized to him paternalistic authority.This dream element of disobeying his father was originating from a completely different complex and making inroad into the main dream.

The above deduction however was not made from patient's associations but from my knowledge of him from years of therapy. Patient neither agreed nor disagreed with the above constructions.

Since dreams are always narcissistic and concern themselves exclusively with the wishes of the dreamer, we had to assume that behind Al's figure and his spilling of coffee on the three windows, was dreamer himself and his mental complexes surrounding his own impulses to transgress.  The dream was projecting upon Al his own tendencies to do misdeeds. "It is Al who is guilty of ill treating his sister, mother and wife not me. He is blameworthy not me." This line of reasoning which the dream was showing pictorially - with his own figure completely hidden behind Al's - was there to protect the patient's belief in himself as a good man who does no wrong. When this "construction" was conveyed to the patient, he not only agreed with it but brought some more associations that threw light upon other elements of the dream.

Al's spilling of coffee on the three window panes was connected to his being mean not just to his sister, but to his mother, and his wife, as well. The sister who had multiple sclerosis would be incontinent at times and he would force her to sleep on the floor as a punishment. He punished his mother, who has Alzheimer's, quite severely for having diarrhea on the floor. The brown of the coffee was taken from the brown color of the feces.

But behind these accusations of Al being mean towards his mother, wife and sister, symbolized by the three windows, there appeared to be self-accusations (guilty conscience) about his being mean - or more correctly thoughts of being mean  - towards his own father, sister and mother. The big window was his father who he wanted to insult to give vent to his grudges towards him. He also carried unconscious guilt about having not done enough for his sister, who had died in her early forties due to alcoholism, and towards his mother, who had suffered greatly because of the divorce that took place when patient was 10, and about which he felt somehow responsible. His son's tumor bothered him and his sense of guilt had latched upon it, and he felt he was somehow responsible for that too.

After giving above associations the patient drifted into talking about one of his daughters who is causing him even greater mental pain than his son's illness because of her recent divorce. His son's tumor is quiescent while her daughter's life is in total turmoil. She shows up with her children at their house all the time. The children are reacting to the divorce with great degree of confusion, especially one of the boys who seems to have lost direction in his life, getting into accidents, and who reminds him of how he had felt - confused and directionless - when his parents had gotten divorced.

His daughter whose financial status plummeted with her divorce, and is living hand to mouth, had borrowed  the patient's I-Phone, when her own phone had gone dead, and while in an argument with her ex-husband, the father of her four children, had flung it down the stairs to the basement, sending it flying through the air with such vehemence that its glass surface was smashed to pieces.

Since patient's daughter's hurling of the phone through the air happened on the day before the second dream, we wondered if his own flying up into the sky towards stormy weather and then getting spun around like a top in the dream was not his identification with his I-Phone which was being ruthlessly thrown down the staircase. Patient laughed at it and said that sounds about right. For he often views his children's trials and tribulations as bad weather in which he is involuntary thrown in to, and which he often wishes he could just escape.

Further associations revealed that the escape which he was wishing for was being fulfilled through going all the way back - spinning back through time - when he was Sargent in the Army and stationed in Germany and redo his life from that time onwards. At that time he had dated a German girl named Julie, whom he was about to marry. But just before taking the final step he had come home for Christmas, and had run in to his future wife, which had changed everything, for she appeared to him the more right person to spend the rest of his life with. However, few years later Julie married another American man, came to the States, located him, and though she lives in an another State, every now and then calls him, keeping the friendship alive and always still addresses him as Sargent Hall; that particular way of addressing him being the reminder of a time when things were so idyllic between them.

While a devoted family man, who would never think of abandoning his family, he, in his dreams,  often redoes his life with Julie. But only in dreams now. And only when the troubles of his children and grandchildren become too overwhelming for him to handle, provoking the wish for freedom from all his current ties and obligations. And it was only when the daughter smashed his phone did he feel justified in dreaming about how life would have been so different if he had married the other woman.

"Why is she asking you to go back to Austria?"

"Because that's where her grandmother lived. We took a train from Germany to Austria to visit her and that was the most romantic train journey anyone can imagine, with the countryside so beautiful - Austria and the surrounding region is breathtaking - and her grandmother was so nice and gracious. No wonder I want to repeat that experience in my dreams."

The time ran out to analyze as to where the three metal balls in the rectangular box were taken from, but the patient did associate that the one with the black dot perhaps signified his son, the black dot being his tumor, and that Julie was tempting him to choose between her and his family.