Restless Leg Syndrome, Cracking of joints, Fibromyalgia, Catatonia: different manifestations of Obsessional Neurosis

A young man, now  21, developed severe obsessional neurosis at the age of 16 when a disfiguring bone tumor emerged on his left upper arm. The tumor, though benign, could not be removed right away because the growth plate next to it had not matured and early resection would have shortened the arm. So he had to live with this growing menace for a couple of years before the surgeons finally went in and removed the unsightly growth.

 During this waiting period, the obsessions grew by leaps and bounds.

In the session the patient insisted, and the mother who came with him, agreed that the whole of his mental problems could be accounted for as a reaction to the  emergence of this misfortune. But a more careful history taking revealed that he was given to severe temper tantrums even earlier, and in fact they were already so severe by the time he was 13 that in his fits of anger he would put holes through the walls of his house, one time he had shattered a flat screen TV, and mother added that every cell phone bought for him had been smashed via getting violently hurled upon the floor.

It was easy to see that the narcissistic injury that had changed this wellspring of anger to frank obsessions was the disfigurement - the tumor was very embarrassing and scary to him - but its pathological strength appeared to have been derived from the repressed wish  for the misfortune to have struck his younger brother instead of him. This younger brother was his rival from the earliest childhood. His earliest memory is of his rage at his brother and the  first time he put a hole in the wall was when he saw his brother wearing his clothes.  

The patient then gave a whole series of obsessive symptoms which were all manifestations of saving his mother from his death wishes or getting even with his father. These obsessions the patient had to admit were present even before the tumor emerged. From a young age he would check and recheck the stove twice, and sometime three times, to make sure that some bad luck does not befall his mother or him or his entire family.  Patient added that it is crazy for he loves his mother very much so he does not understand why he is preoccupied with her death.

The patient then shifted to describing his obsession with symmetry which were to get even with his father who had left the family when he was 2. Anything that was done towards right side - all activities had to be initiated by the right hand - had to be countered by similar action towards the left. Also the number of times something was done towards the right side had to be counter-balanced with exact same number of times towards the left.  He then added that this obsession for symmetry is what lies behind his Restless leg Syndrome. He may spend hours moving his body right and then left, leaving him awake and exhausted through the night.  His mother added that yes, he has RLS. It is painful to watch him in his bed, for he  moves his leg this way and then the other way all night long, vainly trying to fall asleep and even after he falls asleep, often the movements continue.

Patient added that his Restless Leg Syndrome extends to his hands as well and coming to think of it to his whole body and that Restless Leg Syndrome is just a mini-version of Restless Body Syndrome. "I am always on the run, day and night, and my body is still running mentally as I lay there in bed. Restless Leg Syndrome is nothing but my running away from the disaster that is about to happen to me or my family." He then gave some details of his Restless Hand Syndrome. He had to  move his wrist in clockwise and then counterclockwise direction. This process started with having to make wrist motions to make sure that the stove is turned on and off : starting the fire and then undoing it.

All these movements causes constant muscle tension and pain which is only relieved when he cracks the joints. Patient said that the cracking of his joints gives him pleasure and it is part of his OCD. It is no different than checking and rechecking the stove.  He demonstrated this cracking of joints, which were, as claimed, impressively loud, in his knees and neck. He did not say so, but the way he described his body aches and pains they could easily be viewed as fibromyalgia.

When asked why he has to crack the joints, the patient claimed the tension in his muscles locks them up. In my mind this raised the thought that catatonia itself perhaps is no more than an extreme form of muscular intent in cross purposes rendering the person immobile (catatonic) - and mobility is restored to them only if the joints to which they are attached is cracked.


That the cracking of joints is a from of OCD is furthered bolstered by the following case that I saw recently.

A 15 year old girl, who is depressed for years over her parents separation and their neglect of her, and who because of her overweight gets bullied at school, and who fights with her sister all the time to discharge her aggressive impulses, reported that she has a tough time stopping herself from cracking her knuckles.

She gave the usual explanations that it is a habit, that it makes her feel good, but there was little doubt that it was continuation of her obsessional defenses. For every time she cracked her knuckles in her right hand she had to do it in her left in a symmetrical fashion. At one telling demonstration in my office she cracked her knuckles, then touched the mobile phone which she was holding between her thighs and which was sticking up from her pubic area as a symbolic penis, and then symmetrically touched her right and left knees. The touching of the upstanding phone was no different than how obsessive-compulsive must touch a particular part of the body which is symbolic of the penis every few minutes. In many obsessives the touching is quite openly of the genital area.

Dream of a delectable unique fruit

A young girl not yet out of her teenage years and full of self-doubt about her self worth and who thinks of herself as lacking in something despite being very pretty and attractive dreamt the following:

I am in downtown. I am with a bunch of kids from school. None of them are really my friends. I know them but none of them I can really call  as friends. Then we come to a fruit-shop. I enter inside. There is a fruit there like no other. It is green and it is not like any other fruit.  I cannot name it. I eat just a little of it for I don't want to finish it. For then that fruit will not be there.  

"Why the dream chooses the downtown as its venue?"

To this she said it was not Detroit downtown but Chicago. Associations showed that she wants to pursue her studies in Chicago after graduating. The dream was showing this wish as  already fulfilled.  However, she has mixed feelings about leaving Michigan for she would have to leave her friends behind. The dream was showing this objection too as "yes you have friends to hang around with in downtown Chicago but they really cannot be looked upon as your friends.

She could come up with no associations to the fruit-shop or the fruit. All she could tell was that the fruit was like a peeled orange with the white fibers that surround the pulp still there but it was not shaped like orange but like a tear drop. The white fibers and tear shape raised the possibility of it being considered the genitals but this thought was held back from expression. Instead I asked her to retell the dream. The way she narrated the dream again made me think that eating of the fruit had to to do with sexual satisfaction. Eating sweet things in dream is often symbol of sexual satisfaction and body parts are often presented as fruits.

This time she added two new elements. To enter the fruit-shop she had to climb down a flight of stairs. And the fruitship was tripartite. There were three rooms to it and the center room was made of glass.

Now climbing up or down flight of stairs is perfect symbol of sexual intercourse - mounting/climbing the sexual object - and looking through glass, arising out of scoptophilic instinct, usually depicts curiosity about sex.

"Did you have sex that night?"

The patient who is quite young and had never talked about her relationships intimate or otherwise hesitated our of embarrassment and then judging that I had no prurient interest in the enquiry confessed, "Yes, I have a new boyfriend. I don't know I should name our relationship to be that. I don't know how to name it. I am more into him than he is in to me. But yes, we did have sex on the evening of the dream. And it is strange that he too had a dream that night. He never dreams, but he did that night because I gave him an amethyst when he parted and that amethyst must have made him dream - because amethyst is my birth stone which will bring him good luck and protect him. His dream was also about being in downtown with a group of people. But his dream was full of fear. They were stopped by the police who accused them of doing something wrong. Somebody then shot him in the arm which was so painful that it woke him our the dream/sleep.

Without getting side-tracked into her boyfriend's dream which appeared to be punishment for his having had sex with her, I asked her if not being able to name the one-of-a-kind fruit was not derived from her inability to name their relationship as being that of a girlfriend and boyfriend..

She immediately confirmed it  by saying that she has been wondering as to how to label their relationship. It is not casual friendship but not yet so intimate as to be termed as a boyfriend-girlfriend relationship.

"Why the fruit-shop has three rooms?"

"It was not quite three rooms. There were two sections on either side of a glass enclosure that had the fruits."

Was she describing the two buttocks and the genitals were being depicted as the unique fruit? This conjecture could not be approached and confirmed because of the delicacy of the subject.

"Why is the fruit green? Was the amethyst you gave him green?"

"No, amethysts are purple." But she came up with another element of the dream that she had not described so far. Her best friend M was with her and she allowed M to taste the fruit a little bit too.

This led to the theme of jealousy for green is often symbol of jealousy. So she was letting her best friend get a taste of her experience, partly to make her jealous, partly to share the experience.

So the dream was about enjoying her sweet tasting body (one of a kind fruit) through the eyes of her lover. The girl agreed with the interpretation.

Childhood sexual trauma revisited in two dreams

A young girl brought the  following two short dreams in succession.

1st dream: I meet a football player. He is very handsome. But awkward and nerdy. He keeps telling me how beautiful I am. He is overly interested in me. Tells me how cute and attractive I look. I tell him that I cannot have a relationship with him because I am committed to someone.


The patient immediately added that even in the dream I knew he was exaggerating his praise of me, and then proceeded to tell the second dream which at that moment had suddenly popped up in her head.


I am with my younger sister. She is asking me to do methamphetamine with her. I am refusing it. I  tell her it is stupid. Then I hear children laughing. There are 5 of them. But two do not have faces to them.


I asked her if the children were laughing at her. This was based upon my assumption that the dream had to do with some childhood memory involving her sister and herself of which she was ashamed of and the shame was finding expression by showing children mocking and laughing at her. I knew that she had been sexually abused as a child which when growing up was like a shameful secret that had to be hidden from other children. Therefore hearing children laughing could have been connected with her childhood fear of others finding out this secret and laughing at her.

But the patient categorically rejected that construction. "No the kids were not laughing at me. It was the laughter of children that makes a house home. It made one aware as to how fun it is to have kids laughing and playing in the house."

"Who were the kids?"

"They are my nieces and nephews. One was my older sister's and the remaining four were my younger sister's, the one who appears in the dream and tempts me with methamphetamine."

"Why do two of those children not have faces?"

"My sister is negligent towards her children. She lost custody of two of them. In fact I never saw those two. So I know of their existence but can't put a face to their names. So the dream made them faceless. My sister has no right to have those kids. All she cares for is drugs and being with men who feed her habit. She is 21 but living with a man in his fifties. She is so promiscuous. She has 4 kids already and all four with different men. Though she might as well  have not had them for she has no time for anything but sex and drugs."

Now I know this patient somewhat, and I knew that her sister and her both had been sexually abused by the boyfriend of an aunt. Since they both had been sexually stimulated at a very early age they have tremendously strong sex drive though pregenital in nature. It flows towards older men, it causes both of them more pain and suffering than pleasure, and has made them highly obsessive-compulsive as a strategy to control their tremendous temptation to act out the childhood trauma - the inexorable repetition-compulsion. The younger sister as mentioned lives with a man old enough to be her grandfather and patient while just 23 lives with someone who is in his thirties.

Based upon some of her previous dreams which show that she nightly visits the trauma of her childhood  I made the following construction:

"Is your sister's asking you to do methamphetamine is actually her asking you to do the sexual activities that you were subjected to as a child? Since both of you were abused by the same man, she and you know what exactly the experience was like, and so it is replaced by the euphemism of doing methamphetamine.

"I never thought of that, but now that you say that I do remember when he was abusing me he did make me do drugs. Yes we did cocaine and methamphetamine. I must have guessed my sister was being offered the same drugs by him. So her asking me to do methamph may be her tempting me to start behaving like her, become promiscuous and do drugs, which I do not want to."

"Why does the football player come in the first dream?"

"It is once again temptation to get sexually active. The man who abused us would praise us to make us not dislike what he was doing to us."

"Are the children's joyous laughter there to show your envy of your sister having children?"

"Yes. My sister who is so promiscuous and who does not care for children has four of them while I cannot even get pregnant. My aunt told me if I get pregnant I would look so beautiful but I guess that is never to be. For I have never been able to get pregnant. Not even once."

"Why do you tell your sister she is stupid?"

"Because methamphetamine can cause all kinds of problems with your skin. I looked up in the book its side effects. It can really destroy you. So I was warning her that it is stupid to do it."

This warning and trying to save the sister was interpreted as reaction against the impulse to cause her harm out of jealousy. The presence of the laughing children in the dream was also a form of punishment - wishing her side effects from doing methamphetamine/indulging in promiscuity. Its logic went something like this: it serves you right not having children like your sister because you have evil thoughts towards her and wish her to come down with some illness due to promiscuity.


  

A dream of mourning, revenge and finding a way towards forgiveness and loving again

A young man whose marriage came to an end because of the discovery that his wife, whom he loved dearly, was having an affair with a close friend of his, and who was filled with rage over this betrayal and could not even think of ever reconciling with her, or forgiving his former friend, and detested even their sights, dreamt the following.

I am driving on the road towards my friend's house. The same friend who betrayed me. I am in my  Ford Taurus. I cross the familiar roads but as I approach his house I say to myself do you really want to do this and I turn around my car. All the while there is a mailbox in the background popping in and out of the dream. 

The dream occurred  a few months after the marriage ended, when he was quite lonely.  Almost all his evenings and nights were consumed in his taking care of their only child, who was staying with him and who is still a toddler. He felt guilty about leaving the child and going out on dates for it would be tantamount to betraying his son - behind which was hidden the guilt over betraying his ex-wife to whom  in his unconscious he was till bonded - and then the infidelity had embittered him towards women which acted as a powerful hindrance towards finding fresh outlets for his libido.

Patient expressed surprise as to why he would want to go to the house of the man who stood up in his wedding, was one of his closest friends since they were knee-high, and who then stabbed him in the back. But then provided the answer himself by saying that it was his habit to go there for years. "That is where all the friends hung around, socialized, played cards, partied etc. We all grew up together. And now that I am cut off from them, for I tend to avoid most of them because of painful associations, when I did get free time it would have been but natural for my mind to travel that way. But since the very idea of those two provokes rage in me during waking hours, the wish to go there could creep up in my consciousness only in my sleep and as a dream.

"Perhaps deep down in my heart I do not hate my wife and that bastard as much as I would like to believe. For she is a beautiful woman. I loved her very much.  At least loved the beautiful outside of her. For her heart is evil. Nobody but an evil person could betray somebody who was as  much in love with her as I was. She was a virgin when I met her.  I was her first love and we got married. Granted she was much younger than me but I gave her all I could and she took it. But she never quite reciprocated my love. She is a cold woman. My whole trust in humans has been broken by what she did. She should have called it quits and then gone out with somebody. But I guess she would never have had the courage to break up unless she knew there was somebody out there waiting for her for she began to date me when she was just 18 and had known no one else before me."

"Why does the dream show you driving the Ford Taurus?"

"That is an interesting question. It used to be my car. I bought it from my ex-wife's grandmother. Then when I got the company car it became her's."

"Does the Taurus symbolize your ex-wife?"

"I guess so. Our happiest memories are associated with it. So  now that it belongs to her and I was the one driving it perhaps it means that we are still together and I have possession over her. Which in a million years I don't want. Or perhaps who knows I want it somewhere deep down. For she is beautiful. You have no idea doctor how beautiful she is. She looks like she just stepped out of a fashion magazine."

"Why does the mailbox keep popping in and out of the dream?

"My son and I just moved out of the house where we lived to an apartment. After she left me I stayed at the house with our child. Now the court has finalized the terms of separation giving the house to her and I had to find a place elsewhere. Before moving I gave my forwarding address to the post office in which by mistake I checked the box that said family instead of self. So for a few days the mail addressed to her came to my mailbox."

 "So in the dream not only are you wishing to visit your friend but also hoping that she gets delivered to you by some fluke the way her mail did."

"That is so strange. But if I could be driving to the friend who I can't stand then it is quite possible I am wishing for her who I hate to be arriving by mail as well. But why would I do such an asinine thing? Something I would not ever do in reality."

"That is why we dream. Things we would never do during the day because of various objections by the higher faculties of the mind, in the dream the wish can easily lay them aside and see its fulfillment. Your hatred for your ex-wife and your former friend has completely been ignored by the dreamwork in order to fulfill the wish to be back with them."

"But why in the world would I put aside my hatred for them in the dream?"

"The motive of revenge should never be underestimated. You might be hypocritically returning to your friend to get even with him. And though the desire for your ex-wife may be the main force behind the dream there could be a secondary motive to get even with her which the manifest content of the dream gives no hint of. And then let us not forget the love has to finally triumph over the hatred in order for you to resume your life. At present you are so consumed by hatred that you cannot stand any of your friends and even the idea of going out with women. But that hatred has to be discharged and come to an end in order for you start loving again and enjoying friendships and for that to happen you have to forgive your ex-wife and your former friend. And you are not willing to do it without getting some revenge."

Dream of Ronald Reagan making love to Shirley Temple

A woman in her early fifties who declared that she has ran out of things to talk in the session suddenly asked, "Your board outside says you interpret dreams. I have this weird child molestation dream." And then she told the following dream:

Ronald Reagan is making love to Shirley Temple.

When asked to give more details, for what she reports looks like a bare sketch of the actual dream, she said there is nothing much to add. She refused to give the details of what exactly Reagan physically was doing to Shirley Temple by saying that the whole thing is silly anyway, and may be there are no specifics, and the only reason the dream even got stuck in her mind is because it is improper for an old guy to be making love to a little girl.

She could come up with no associations regarding Ronald Reagan or Shirley Temple other than that they were actors.

Since no associations were forthcoming, the technical rule of psychoanalysis allowed me to give interpretation of the typical symbols. "Generally presidents, kings and queens, film heroes and heroines, celebrities, stand for  parents. So Ronald Reagan must symbolize your father."

"If you say so. Though my father did not look anything like Reagan. But now that you bring this up, I do remember what sparked the dream. I was in my bedroom almost falling asleep when from the next room,  where my boyfriend was watching TV, I heard  from the show somebody saying" Don't trust an adult who tells you to keep a secret." Its connotation to childhood sexual abuse must have started the dream process."

"Any other memories that emerge in connection with Ronald Reagan?"

"All I can think of is that Reagan was a Republican. And there is so much chatter on the TV about those three Republicans trying to be our next president. As far as I am concerned all three are the same. They are jerks who want to make rich richer by stealing from the poor. They are against labor, against car industry, against Planned Parenthood so women can have children who they cannot afford to take care of. They want to screw those mothers and children by forcing them to live  in poverty."

"Just like the Republican Reagan was screwing the child Shirley Temple!?"

"Maybe."

But even if that was one of the meanings of the dream it could not be the central one. Such political issues do not have sufficient emotional investment to forge a dream. Dreams are invariably connected with issues that are close to one's own heart. Impersonal third party matters do not make a dream. They may act as facades  but cannot be its wellspring. So I took the next step and made the construction that If Ronald Reagan was symbolizing her father then Shirley Temple had to be herself.


To my gratification she immediately confirmed the correctness of the interpretation.

"That makes lot of sense. I wanted to be so much like Shirley Temple, to act and dance like her. And when I was nine my father regularly took me to singing and dance classes to help me achieve my dreams."

"How old did Shirley Temple look in the dream?"

"Nine."

"So the dream is personifying your sexual fantasy towards your father. And now as you told me earlier in the session,  before we started analyzing the dream, there is hardly any intimacy left between you and your boyfriend, and recently you had asked him that at least he should hold and hug you, and he shows no passion even in that, so your mind is harking back to your childhood and seeking outlet for your love needs by settling upon your first love, your father?"

"Well, first of all my father never molested me. Second, I have no such thoughts towards my father. So what you are saying does not make any sense."

"Well they will not make sense immediately. In fact they will appear weird when first presented to you. Such thoughts from Oedipal Period are not present in the conscious mind. Only in hints and allusions do they dare  make a passage into the consciousness. They have easier time finding expression in dreams, but there too not directly but almost always in displacement."

"I do remember missing my father very much when my parents got divorced. For a period he was completely out of my life. And then I missed him so terribly. So you are right that I was very attached to my father. And when he came back in to my life to make up he took me to those singing and dance classes ."

"You think the fantasies of your father making love to you arose during that period when your mother and father got separated and you could not see him?"

"Who knows. But now I remember another dream."

The fact that at this juncture a dream emerged into her consciousness was affirmation of the correctness of the interpretation. And the theme of the second dream left little doubt that I was on the right track.

"I dreamt it when Loopy (her husband, twenty years her senior and a father figure) was still alive. Somebody is coming down the hallway of my home. My bedroom was at the end of the hallway. I could hear the rhythmic sound of his footsteps: thump, thump, thump. He was after me.  And I could not move. I was like frozen. I could not yell, scream, move, or do anything. Finally somehow I managed to pick up the black lamp that was on the end table next to my bed and threw it inside the drawer that was open and it started a fire. That woke up my husband and stopped that person halfway in the hall. I woke up out of the dream, my heart pounding."

The dream could be easily seen as a continuation of the same theme of Ronald Reagan [father] having sex with Shirley Temple [her]. The long hallway with her room at the end was interpreted as the genital passage with the womb at the end, and the rhythmic thump thump as depiction of sexual intercourse. The imagery of throwing the lamp into the drawer, in conjunction with the rhythmic thumping, as the man made his way up the hallway, made me think of the shower scene of Psycho where sexual intercourse was depicted in the sadomasochistic language of the knife going rhythmically into Janet Leigh.

"Is that man coming down the hallway your father?"

"Well the guy who was coming down the hallway was somebody big and larger than life like Big Foot. And coming to think of it my father was a big man too."

The change of father imago into something like Big Foot was seen as distortion of the image of father to hide the incestuous origin of the thought and lessen the anxiety. And I proceeded on with the analysis by asking, "Where is that lamp taken from?"

"There was a lamp like that next to my bed. If I had to grab something to fight with that would have been the most logical thing to grab."

"The dream took that detail into consideration to depict something important. Dreams do not care two hoots for logic and do not incorporate things to make it logical."

"Yes," she agreed, "There is no logic to the lamp starting a fire. Throwing the lamp into a drawer does not start fires."

"Tell me more about that lamp?"

"It belonged to my daughter. I had bought her this canopy bed and this lamp. For a while it was in the room next to mine. She slept in that room when she would come from her father's to stay with us for the weekend. And when she was not there Loopy's brother Mick, when visiting us, would sleep in that same bed. Later I found that Micky was a child molester. He is in jail for it now. I don't think he ever abused my daughter, but the very thought of Micky sleeping in the same bed where my daughter slept I feel guilty that I had subjected  her to the possibility of child molestation."

So once again there was the theme of child molestation. And with this association the meaning of the dream became clear. The second dream was continuation of the same incestuous fantasy. Her inability to move, scream, run etc. while the big man was approaching her showed the ambivalence towards giving into the incestuous fantasy versus fighting against it. Part of the mind was seeking the incestuous satisfaction while the other part, out of fear of it, was rejecting it. Her being frozen and paralyzed was depicting her refusal to run away from it. And she could find courage to stand up to the temptation by showing that such a satisfaction will be so passionately strong - lamp starting the fire -  that it will take away her will to protect her own daughter if she is exposed to similar situation (child molestation).

It was the fear of harm coming in this manner to her daughter that finally gave her strength to get out of her frozen state (sleep paralysis/catatonia) to pick up the lamp and throw it in the drawer to start a fire which would wake up her husband and put a stop to the terrifying incestuous fantasy from getting fulfilled. It was soliciting the help of her love of her husband to act as a counter-force to the attraction of her father.

One may remark that the original wish continued to make inroads even as she struggled against it when one considers that the lamp and the drawer and the fire make excellent symbols to depict the male and female genitals and the consummation of sexual passion respectively.

Obsession of cleaning the kitchen sink in a dream and its analysis

A woman in her mid-forties reported the following dream which she dreamt all night long, waking out of and going right back in to it over and over again.

I am at my kitchen sink, and I am cleaning it with a hose. My husband comes from behind and hugs me which irritates me.


When asked for associations the patient mentioned that she is a neat freak who must have her kitchen sink clean all the time; anybody leaving unclean dishes, for that matter anything dirty in the sink, irritates her to no extent and she must immediately give up whatever she is doing to clean the mess; spaghetti sauce or something red in the sink makes her especially angry.

Now we know that fear of contamination, germ phobia and horror of touching are all different version of the same complex;  fear of sexual contact in displacement. And the watering hose in the dream can be immediately interpreted - for it is such an obvious symbol - as a watering penis.

Was she taking the male role in sex through identification with her husband?

 But her husband coming from behind and hugging her had irritated her. Now we know that hugging from behind is indicative of obsessive-compulsive proclivities. Obsessive people have greater fascination with the buttock (nates) and prefer sexual intercourse by mounting the woman from behind, like the animals. Humans perhaps are the only mammals who routinely have sex through frontal contact (missionary position). Preferring sex in this manner points to the factor of regression and the emergence of archaic modes of sexual expression in the obsessional neurotics - a regression to anal phase of sexuality and attraction to sado-masochistic forms of sex. And this patient does suffer from severe obsessions. Everything in her house, especially kitchen, has to be arranged and put in perfect order. Her need for control is so great she must keep in touch with her children and husband at all times to makes sure that they are not in trouble like having met an accident.

Now the regression of sexuality to anal-sadistic forms comes at a price. There is generally severe reaction-formation to its expression as well. There is greater guilt over indulgence in sex, and a person may undertake all forms of motor rituals and other obsessive games - especially involving playing mental games with numbers - to "undo" giving in to the temptation and indulging in the prohibited (regressed) sexual behaviors. There is a fear that since one indulged in the dirty anal sexuality all kinds of harm and punishment will follow. In this patient the (unconscious) fantasies of indulging in anal form of sex was followed by all kinds of fears of harm coming to her and her family as a punishment.

There is one more peculiarity about obsessive-compulsive and which applied very much in this case. They hate to be second best. They always want to be on the top. They forever want to compete with you. Our patient had given up all social gatherings out of fear of coming out second best with people she would run in to there. Her hated rivals from childhood. The very fact of meeting someone the next day even for the most inconsequential thing would keep her awake all night out of fear that in the meeting she may come out lesser of the two.

And it was this factor of coming out lesser than the other person that lay behind her irritation about her husband making love to her from behind. The night before the thought had crossed her mind to make love to her husband which she had quickly suppressed. But the desire had persisted into the sleep and dream. All night she had indulged in it but with great irritation for it meant his hose (penis) contaminating her sink (genitals). She had tried to get over it by showing herself as the one who was doing it through identification with her husband. But even then the thought that her husband should make love to her from behind, mounting her, and thus reminding her of her inferior (castrated) genitals was preventing her from having sex with him in real life and in dream as well.

Her especial irritation with red spaghetti sauce in the sink was connected with her abhorrence of the yucky menstrual bleeding and its reminder that men have it better than her in life without any justification. For despite her crippling obsessive problems, which keeps her housebound, she nevertheless is thoroughly convinced that she is much better than her husband.

Death wishes underlying Generalized Anxiety, Obsessions and Agoraphobia

An 18 year old girl, who suffers from sever anxieties, to the point that she cannot even leave her house, and has developed extensive obsessions to bind/nullify the overwhelming affect of fear, had the following dream which disturbed her to no extent. "What happens in the dream, let me make it clear, I absolutely don't feel that way."

My mom, dad and my sister are in it. We are in my grandmother's backyard. Somebody got rid of my mom and dad. I didn't do it myself. In fact I did not do it. Some crazy person got rid of my parents for some reason. The backyard has no grass, just dark dried up dirt. There are ropes around their neck. Little pieces of rope. I think I am untying them. They are looking straight at me. I was kneeling over my dad. He is like totally silent. He could looked right through me. It was the creepiest feeling. Everybody was so calm. Even I was so calm. That is what so creepy about it. How could I be so calm about what had happened to them. I can remember it all so perfectly. I was on phone with my grandmother who said, what did you do and I said I didn't do nothing. But she said you will have to live with that for the rest of your life.


Since the patient mentioned her sister I asked her where was the sister in the dream.

She was inside the house. She was on the second floor watching through the middle window. I was standing under the tree. She then tells me Mom and Dad hung themselves. I did not see that. I just saw the small pieces of rope lying around.  But the way she told me is like I almost did it and I am covering it. She looked really disappointed with me and walked away in disbelief. I notice that I was still in my night clothes and I must have just walked down the stairs. I felt so horrible till I realized that wait a minute your mother is already dead and your dad is in jail so I could not be responsible for their death. And my sister is not alive either. I woke up in panic my heart pounding. I don't want to have a dream like that in a million year. I wouldn't even hurt a soul. I want to see  my mother come home so badly. And my sister too. Just the opposite of what is in the dream.

At this point the patient began to cry and declared that she does not want to have another dream for life. "I don't want to even remember this dream ever again."

The central theme of the dream could be analyzed without associations. It was clearly fulfillment of death wishes towards her family perhaps connected with some early childhood sexual activity which she was afraid to practice unless there was nobody watching her which involved doing away with her parents and their watchful eyes. That activity had to do with masturbation was supported by the fact that the only association she brought to the dream was that it was sparked by watching the play "Wizard of Oz" the night before. Dorothy had walked the dog on the stage with a thin white rope. The same thin rope had reappeared in the dream and had been used to hang her parents. Viewing the dog being walked with the rope had  sparked the memories of touching herself. The dog substituting for the clitoris. Though this construction was not conveyed to the patient who would have anyway rejected it. But there was little doubt from analysis done in previous sessions that her obsessions were two step in nature: doing away with the parents and undoing the effects of such horrible thoughts. Her mother and sisters untimely death, and her father being sent away to jail, all of which happened in the last two years, has not helped matters and has made her obsessions worse. Her obsessions are now mainly seeking of forgiveness through symbolic motor rituals for all the misfortunes that has befallen her family and which in her unconscious she takes responsibility for.

The reason I report this dream here is because this girl who suffers from crippling anxiety, agoraphobia and obsessions, her symptoms have their roots in these childhood death wishes towards her parents, which she is terribly horrified and guilty of, and it is the anticipation of retaliation arising from the guilt which keeps her constantly anxious.

The fear of harm coming from her evil thoughts turning into reality has made it very difficult for her to leave home. She anticipates meeting the same fate as her mother and sister - most strangely her brother died as well during the same period - and thus sees the world as nothing but a menacing and dangerous place. She has begun to do what another of my patient put it, "Every morning on waking up I quiver in my boots because of my catastrophizing the world."