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."