Sunday, December 20, 2015

Adderral stopping Restless Leg Syndrome and acting as hypnotic

A single woman, in her late forties, who had too much unwanted sexual attention paid to her as a child because of her blond hair, very fair skin, delicate frame and attractive features, all of which give impression of vulnerability, and as a consequence of which she developed a hysterical fear of men, told me in her psychotherapy session that often in the night she develops Restless Leg Syndrome (RLS) which keeps her awake, and only when she takes Adderall does she get relief from it and can fall asleep.
Now we know that hysteria is running away from the demands of genital sexuality. When the body and mind are not yet ready to meet the challenge of genital sex, if the child is  sexually irritated (sexually abused), or even if the over-stimulation is done without actual physical contact (seduction from a distance), she reacts with great fear to any future demands of genital sexuality and becomes anesthetic to genital sensations (sexual frigidity). In such women non-genital components of sexuality become hypertrophied. Most of the sexual bombshells like Marilyn Monroe owe their sexual appeal to this overly expressed pregenital sexuality over the genital. There is hysterical suppression of the latter.
This patient loves to come to my office with her yoga mattress, which she puts on the floor and starts  her yoga stretches, ostensibly to treat her body aches and pains (fibromyalgia due to childhood sexual overstimulation)  but which are thinly veiled hysterical seductive actions, in which non-genital aspects of her sexuality is displayed in the guise of yoga postures.
What is most noticeable about this behavior is how she jumps up with fright at any noise, or anything startling, while she is doing this yogic behavior, as if she fears getting caught doing something forbidden and naughty.
It is not surprising that this excessive fearful response, partly innate (inherited), partly due to sexual overstimulation in childhood, which was always accompanied by fear of getting caught and punished for it, persists during the night and emerges as Restless Leg Syndrome.
Restless Leg Syndrome appears to be running away from life's troubles (dangers) even when one is in bed and safe from actual harm. One cannot fall asleep because one is anxious and all aroused to run away from the anticipated harm. The thought processes are busy making up scenarios in which one is protecting oneself from impending harm. And in some this is the extent of their motor response to anxiety. However, in some the thoughts alone are not able to deal with the fear. In them the motor response spills into actual physical action of running away though an aborted one. They run but only through the restlessness of their legs.
How does Adderall, an amphetamine salt, a psychostimulant, reverses this fear response? Amphetamines release dopamine in the brain. A chemical that is released on receiving signals that happy things are happening, something good has fallen in your lot, or is about to fall in your lot, for there is a relaxation of your muscle tensions, and drop in the level of brain activity, because there is good and not danger around you.
Receiving this message that all is good where you are, and therefore there is no need to run away out of your bed,  the mind at last takes a sigh of relief, stops worrying, stops sending orders to the body to prepare for running, the racing thoughts and restless legs cease, and one falls asleep.

Monday, May 18, 2015

A typical Oedipal Dream

A woman in her mid fifties who lives by herself upon her disability income, and depends heavily upon an older man, who is in his late seventies, for transportation, and for bailing her out every now and then with small sums, half way through the session declared that she went to bed with this benefactor of her's.
Though she started treatment less than an year ago, and sees me only once a month, due to successful analysis of a few of her dreams, has shown a good improvement in facing up to the shackles of her agoraphobia, and had actually come to the session driving all by herself for the first time in years.
In the session initially she talked about her boyfriend - who is different from her benefactor - and how she is finding him more and more unappealing because he is a control freak who constantly judges her, finding faults with whatever she does. Their relationship is not that deep. They met only a few months ago, and she feels that he, who was divorced a couple of years ago, is using her as stop gap girlfriend till he finds somebody better. But lacking confidence in herself she has been unable to leave him.
She triumphantly declared that while her benefactor's wife went to Florida,  he invited her to his house to stay overnight and they ended up making love. And though he is much older than her, she declared that the sex was highly satisfactory. When asked if he could perform to her satisfaction, considering he is in his late Seventies, she said sexual satisfaction and dissatisfaction has less to do with how one performs than how one feels about the person one is making love to. Pleasure and unpleasure from sex is all in your head.
Then after talking some other things she suddenly brought up the following dream.

I am setting up a party event at of all places in the White House. Obama and I sneak around and we make love in a corridor. But Michelle was catching on to it. For she looked as if she was wondering as to why Obama would like to hang around so much with a help.

Patient added that she feels no sexual attraction towards Obama, so it is weird that she was making love to him in the dream. Now we know that kings and queens, presidents and celebrities, are used by the dream-work to represent parents. So behind Obama stood her father and behind Michelle her mother. Her Oedipal wishes towards Obama (father substitute) being hindered by the spying Michelle (mother substitute).

Confident that this Oedipal dream was sparked by her making love to her benefactor while his wife was away in Florida, I asked the patient if the dream occurred immediately after the event.

Patient said no. The dream had occurred a few days before that.

But after talking a few other things she went back to the dream and said, "The dream occurred before we made love because I knew that is what is going to happen. The dream occurred on the night when I first heard she was going to Florida, and the thought had flashed through my mind whether it will land up in our making love. I did not give much attention to the thought and actually till that night we made love, I did not think it was going to happen because I respect his wife. But may be unknown to me the wish to make love to him must have been aroused in me when I first heard that we will be alone together and it was that wish which saw its fulfillment, before its actual occurrence, in that dream." 

Saturday, April 4, 2015

Mall Phobia and Returning to the Womb Fantasy

A single woman in her mid- thirties, who lives a rather solitary life, and almost never ventures more than 2 miles from her house, brought in the following dream, and, because in it she was driving a car inside a mall, declared it to be weird.

I am driving in a mall. The only detail about the mall I can recall is of there being a bathroom in it. The stores are indistinct and the whole place is painted in a peachy-tan color. Also I don't think there were any people. Just my car. In the dream it did not feel strange driving a car inside a mall. 

When asked for associations to the mall she said she hasn't been inside one in years; they provoke panic attacks.
Another association to malls was her fear of not finding her way out of them; they curve and twist and one gets confused as to which way is to the entrance and exit. Another concern about malls was not finding the car in the parking lot on coming out.
She then expressed her skepticism about the value of the dream. "How could a car have gotten inside the mall?"
As to why the dream showed a bathroom, she could tell nothing. She was not sure if she had used it or not, but remembered that it too was painted inside with the same peachy-tan color so she had at least perceived it from inside.  
She added that it was her car that she was driving because she distinctly recalled its color being red. 
All these associations did not immediately throw light upon the problem and we drifted in to exploring her fears in general. She fears crowds and avoids public places especially where she anticipates running into more than two or three people hanging out together.
She has not driven on highways in 7 years. She drives to work early in the morning when roads are empty, and reaches there 45 minutes before the starting time. Though she does not get paid for putting the extra hours, she likes doing it because that way everything is in order when the doors open for business. This reasoning appeared to be a superficial rationalization (false explanation) for the deeper motive of avoiding rush-hour traffic.
She then expressed anger at customers who come 10 or 15 minutes earlier than 7 and try to make her work before the official opening time just because she is there.   
When asked how far is her workplace from her house she said exact two miles.
She then talked about how her fear of malls does not quite extend to Target [Department Store] and Kroger [Supermarket]. They are large but not quite as big as malls. And in them she knows where everything is, including the entrance doors, and thus can get out quickly if the need arises. And both the stores are within her self-imposed 2-mile-limit. Even at these stores she is in and out, picking only couple of items at a time which she knows beforehand she needs. And she goes there in the mornings, on Sundays, when hardly anyone is in the store and on the roads.
She then talked about her going to the Target to buy incense sticks which she loves, and getting disappointed at not finding them. Her wish to go to the mall perhaps arose from this frustration. For she does not know where she will find those incense sticks now. Target use to carry them but not anymore. She was hoping the incense sticks will be available in some mall because that is where the specialty shops that carry such items exist. 
Now per psychoanalytic theory what one is currently fearful or phobic about is something which was once dearly loved. Our current fears are our former desires. The oedipal love for mother becomes the greatest taboo of mankind. People who once loved getting behind the wheel and enjoyed taking long drives are the ones who usually come down with agoraphobia. The repression targets our strongest suits. The libido tries to find outlet through those functions which we favored the most and were most proficient at. It is the child with great desire to look (hypertrophied scopophilic instinct) that develops eye tics.
So I asked her if she loved going to malls before she came down with her phobias. And she said, "Oh yes, that was my most favorite thing to do. I loved it as a child and I loved it as an adult. But when I moved to this town, away from my old neighborhood, 7 years ago, the fear crept in."
Now I know this patient for some time, and I know too that her agoraphobia was precipitated by two very abusive marriages. She had developed a fear of going out which perhaps had at its root a desire to escape meeting men and getting in to another relationship. Getting involved with men she now had begun to believe invariably turn abusive. So her psyche was thrown into a dilemma. The libidinal wishes implored her to go out and seek men, while the memories of the physical and emotional abuse provoked fear (panic) over fulfilling this desire.  
Knowing how much she seethes with anger towards her ex-husbands, and because of it towards mankind in general, I asked her if the peachy-tan color was not derived from feces. Her fear that she may inadvertently defecate all over the mall to express her anger towards the world. The bathroom was there to lessen the fear that if the impulse to shit upon others becomes overwhelming there is an escape. Encopresis in children, and various forms of colitis in adults, are often expression of undischarged anger. In non-verbal mentally retarded, unhappiness with the way things are is often communicated through smearing the walls with feces.
She did not quite agree with this interpretation, but did confess that whenever she leaves the house she immediately has to worry about going to the bathroom. She wondered if she does not go beyond 2 miles of her house because she fears she may not find a bathroom in time. She added that when she comes to my office the first she thing she does is to go to the bathroom.
But when asked if this worry to find the bathroom is for an urgency to urinate or to defecate she said to urinate.
But it was not clear if she said this because there is greater embarrassment in humans about defecation than urination. Also she may have hidden the real state of affairs because she could sense the hesitancy in my voice when I was trying to search for the right words to convey correctly what I had to say regarding the use of excremental functions as a means to express rage. The patient goes only as far in revealing about herself/himself as the analyst is capable of handling.The analyst has to be completely comfortable with his own body functions before his body language will convey to the patient that he or she can talk about these matters without resorting to distortions and allusions.
She added that the fear of not finding the way out of the mall is similar to her fear of getting lost when driving. She does not trust the GPS. "The voice tells you to turn right or left but only after you have passed the turn."
"Any other association to the peachy-tan?"
"They are the color of your pants." I was wearing khaki pants that day. "And now I know where that color is taken from and why. In Target the employees wear peachy-tan color pants. So the dream was lessening the fear of the mall by showing it also as the Target which does not frighten me as much. And those employees along with tan pants wear red shirts which made the red color of the car noticeable in the dream."
"Was the absence of people in the mall also an attempt to lessen the fear?"
"Yes. I wanted to go to the mall but I am afraid of people. The dream therefore did away with people. And I go there in a car so I can be in and out in a jiffy. The shops were of one color and looked alike for the same purpose. I am scared of malls because it has such a variety of stores and they are on two or three levels. Variety sparks the fear that I will get lost in them and never find my way out while sameness lessens that fear."
"Is going inside and never finding one's way out, derived from the wish to go back to your mother's womb and never leave its security?"
"Sometimes I wish I had never come out of it. For life is so painful and men are so nasty."
So here was the confirmation of the rule that a formerly desired entity is what changes into a phobic object. It was in our mother's womb that we felt most secure and free of all dangers.* Under the spell of phobia it becomes the most dreaded place to seek refuge.
Her fear that she will not find her way out of the mall/womb was a "signal anxiety"/warning that the security of intrauterine existence (death) would be so alluring it would be impossible for you to return back into this stressful world.

* This pull of the intrauterine existence where all our needs were taken care of and where we felt completely safe may lie behind as to why the Las Vegas casinos are huge cavernous entities where all one's needs are taken care of and getting out of which is not an easy affair. The casinos are designed to create the illusion of being in a completely safe place and where fulfillment of every bodily need is immediately guaranteed like it was in the womb, which encourages the gambler to take greater chances with his/her money.
The way IKEA stores are designed, where finding one's way out is so difficult, and where one is tempted to be lost in shopping from one section on to the next, appears to utilize the same human wish to return to the womb.

Sunday, February 8, 2015

An incest dream

A man in his late thirties, who still lives with his mother, came to the therapy session and talked about his love for everything old, like classic cars, vintage comic books, turn-of-the-century houses with their turrets and other castle like features, and recalled how as a  young man he took a friend of his to the Boston-Edison Historic area that has some of Detroit's most magnificent mansions, and his friend got mad at him for dreaming of living in such high places, given that they were black and thus not entitled to such uppity lifestyles, and the patient laughed at his friend for being so dumb as to not see that now only bums and prostitutes lived in and around those houses, and they were so run down and abandoned that in all probability they could be purchased for virtually nothing. Then he added that recently houses have been coming a lot in his dreams. On being asked to give an example he narrated the following:

The dream was about this most incredibly beautiful house. It belonged to an older man who is planning to turn it into a church. But I swindle him from doing so by giving him some money.  There is lot of guilt associated with this trickery as if I should not have done that to him. The house is on Detroit river. In fact the river comes right to the house, waves coming over that green grass to the back door and then receding rhythmically. There is a steamer on the river, an old river boat, red in color. What is so remarkable is that I can see every part of it distinctly. It is a showboat with the twin wheels rotating under the water, which I see so clearly. I can't tell you enough as to how vivid the dream was and how much in detail I could see every aspect of it. I think there was a cruise ship too in the dream.  Or maybe the riverboat got replaced by the cruise ship. It had endless number of rooms, the ship was gigantic. Even in the dream I was thinking if it is put alongside a skyscraper no doubt it will be taller than the skyscraper. And there I go again thinking of majestic houses - for skyscraper is in the same category as houses, just a grander version of it. 
Also in the dream I was a seaman, about to go into the water and the river.  I was building a boat to do so or maybe I was already on the boat, or doing something of the sort, something a seaman would do.   

Patient was asked for associations to the house. He said, "It is a white house, a barn house, ranch, very elegant. I walked around it from the back to the front, admiring its beauty. The walls are beautifully carved with round projections that are so pleasing to the eye."

These associations strengthened the impression that the beauty of the house which he could not praise enough was beauty of some woman,  and considering how the dream revolved around old majestic  mansions, the woman whose beauty he was appreciating was no other than his mother as she must have appeared to him when he was very young. But this presumption did not bring us any closer to the essential 'dream-thoughts' that lay behind the 'manifest content'.

Then the patient recalled a detail that puzzled us greatly. The house was not constructed like regular houses are, which are rectangular in shape, but at an angle. When asked to draw to explain how the rooms were not straight but at an angle he drew the following.

The slanted lines which are disjointed in the blog entry because of my inability to draw diagrams using a computer were not broken but continuous in his drawing.  

 \                           \                           \                    \
  \ Dining Room  \  Living Room  \  Kitchen    \
   \                            \                            \                    \   \  Front Door
    \                             \                            \                    \

The association that the patient gave as to why the house was at an angle was rather strange. He said  for years his penis was not straight but bent because he had fallen upon his penis while wrestling in high school. But the problem had recently cleared up and his penis was fine now.

This association was clearly connected with the castration complex and his sense of inferiority about his sexual organ. It is an inferiority complex that no man escapes from, and which impels so many to fall for ads that promise a bigger and better penis with creams, pills and pumps etc. It has its roots in the oedipal phase when one is confronted with the inferiority of one's organ in comparison to the imagined, and thus greatly exaggerated, size of the father's.  This contrasting of one's potency with that of the father's perhaps was responsible for that element of the dream where he is thinking that if he puts the ship next to the skyscraper it will be just taller.

When asked if his penis was really bent, or he just had a feeling that it was so, he admitted that it was more in his head than in reality and there was no objective evidence there was anything wrong with it and none of the women he had had sex with had ever mentioned that there was anything wrong with his penis.

The association threw light on his poor self esteem about his ability to make love, but did not help in coming closer to the basic meaning of the dream. And since there was limited time available to analyze the dream, and also because I was quite familiar with the patients problems and the complexes around which his illness, schizophrenic breakdown occurred,  I took the step of making the following construction: "We know that behind your fascination with these old statuesque houses lies your fascination with your mother. Could it be possible your swindling and buying that beautiful house from the old man so he could not turn it into a church was symbolic of your buying your mother from you father so you could fulfill your aims with her instead of letting him continue to have his will with her." This conjecture was based upon his buying the house to prevent it from becoming a church. Now churches, temples, mansions, statuesque houses are typical symbols of the mother, but that version of the mother which is common property of all men (God's/father's house ), best symbolized by Madonna and thus sexually unapproachable.

The patient first objected to this conjecture  on grounds that the man was Caucasian and his father was Black but then immediately added, "My grandmother was as white as any Caucasian lady and I always put her and my father in the class of Whites."

Then after a few minutes in which he talked about things unrelated to dream he spontaneously  volunteered the following, " I now know why the house is at an angle. My mother was very pretty and thin. And as you know he was a player who had children and relationships with other women besides my mother. So he was in and out of our life. But when he would come to our house I would be afraid that when he would have sex with her, his penis would go right through her body because she is so thin. But then I would tell myself that his penis will be bent and go upwards at an angle and not through her."

He was asked to draw the angle in which his father would have sex per his childhood imagination. He drew a very erect penis, almost vertical, with one testicle, which surprisingly was not dangling below the root of the penis but projecting upwards over it.  

"How did you know about erection and yes about sex itself at that age?"

"I knew about sex and erection as early as when I was 5. Perhaps earlier. I already was having erections then. There were also two boys in the neighborhood, who had access to Playboy and Penthouse, and we would look at those pictures at their house. Also with my cousins, who were slightly older than me, I would sometimes play games in which we would show each other our private parts. I remember how intensely curious I was about their bodies."

"Is your seeing every part of that ship so vividly, a continuation of this sexual curiosity which you were already exhibiting so strongly at that age?"

"That makes sense. I do know that when I first started having sex with women, which was pretty late in comparison to other kids that I grew up with, I would be so curious about their bodies that they will say, 'oh no, you are more interested in examining me than making love. You are supposed to make love to me not examine me like a doctor. "

As for there being so many rooms in that ship, on theoretical grounds, I conjectured that it was an allusion to marriage as well as its contrary: to have sex with endless number of women (symbolized by rooms). It was depiction of his utter fidelity to his mother and always choosing her over all others, and yet it depicted its contrary: a desire to spite her by having liaison with endless number of  women.

But the patient swiftly rejected the latter part of the 'construction' claiming that that is how his father was: a player. But he is just the opposite of his father in this respect. He believes in having children only after marriage, and never having affairs.

Multiple rooms on the ship stood for marriage. It was depiction of marriage by showing all other women that one must give up for the sake of one. The comparison of that ship with a skyscraper also, perhaps, was his comparing other women to his mother and finding them short. It is interesting that he has never been able to make a break with his mother. And though the two are always complaining  about each others shortcomings and continuously squabbling, all attempts by him to live by himself or with other women have failed within no time. The fact that he is her only child, with his father dying when he was just 12, also has contributed to his inability to give up his love for his mother and find an extra-familial object.

When asked as to why the walls of the  house had beautiful projections that were pleasing to the eyes, he could come up with none and rejected my suggestion that it was an allusion to his mother's breast countering it with, "if it was symbolic of any body part it would be testicles and not breasts." When I asked him if he was being sarcastic he said, "No. That is the association that popped up in my mind." I wondered if it was compensation for the lack of penis in a woman by covering the defect with  endless beautiful projections (a phallic mother; testicles through displacement substituting for the penis).

As to why the dream was trying to show him as seaman, patient said - as only a schizophrenic can do, who often seem to have a gift for seeing through dream symbols - that it must allude to semen.

When asked why he said, "Because the water that was coming up to the backyard of the house was shaped as the shaft of a penis, with the advancing tide broad like a penile forehead. And you know what backyard on the street means. So the dream must be my attempting sex with my mother in that fashion. Though it is so strange that the very thought of such a deed during my waking hours would fill me with utter disgust. I have no attraction towards my mother whatsoever."