Sunday, May 25, 2014

A religious dream

A woman in her early sixties complained that she was recently having a lot of intense senseless dreams. When asked for an example gave the following, labeling it as a religious dream.

We are in some religious place - strange since we never go to Church or anything like that - and a man comes and says don't worry, you will be alright. Larry, my husband, is with me. I knew wherever we are going we will be going there together.

Patient recently has been under lot of stress. A number of her close relatives are dying, her daughter is in throes of bitter divorce and is having numerous medical problems, she feels completely overwhelmed and sometimes feels she should just give it all up. Based upon that knowledge, without asking for associations, which usually she is not keen on giving anyway, I hazarded a guess and made the following construction:
"Is it an assurance that if you die you will go to heaven and since Larry would be  with you, you need not fear such a fate?"
It is technically not correct to interpret without first asking for associations unless, as once in a blue moon happens, one can see through the structure of the dream at a single glance.
 "You are right. Because the man who was telling me that I will be alright was no other than Jesus Christ himself. And lately death and dying is lot on my mind. Larry's brother suddenly died of heart attack you know. "
"Why does Larry come in to the dream?"
"Because if I am going down he is coming with me. I am not going anywhere alone.  If I die he better die too. He will be completely lost here without me anyway. We have been together for fifty years."
At that point she recalled another dream which confirmed the accuracy of the interpretation of the first.

"Every now and then I dream this. We are at a street which ends at a beautiful house. The house has two floors and a basement. It is abandoned and ready to be occupied. It has beautiful furniture on both floors. The basement has three shelves where my children's toys, trucks, dolls and games, everything connected with their childhood, is stored."

The dream was another version of the assurance that there is no need to fear death so much. It is not going to be end of your existence. The road symbolized her life trajectory, the end of which had an abandoned house just waiting for her to walk in to and continue living with her husband and all the precious memories of her children. The two floors symbolized herself and her husband, the three shelves her two children and her only grandchild.
Patient's illness is due to extreme fear of death. She often wakes out of her sleep in panic, fearing the end of life.

Thursday, May 22, 2014

Haunted by a Flipino ghost

A patient dreamt the following:

A ghost with a beard was standing in the room. I took a swipe at him. That is all I recall of the dream. Everything was hazy and the dream was very short anyway.

He wanted to dismiss the dream as of no consequence, but we still had 15 minutes of the session left, and with nothing else pressing to deal with, we embarked upon its analysis.
"Why the ghost has a beard?"
"The beard actually belongs to Rob. He is my boss at the bookstore. In fact, he is second in command there."
"And why his beard comes in to the picture? What comes to your mind regarding Rob?"
"Rob is nice to us [by the plural, he was referring to his brother Michael, who works with him at the same store]. You know how much problems I have had with whoever has been in charge at that bookstore, since the old boss retired.
" But for a change in Rob we finally have somebody who is protective of us."
"Why then would you take a swipe at him?"
"Not at him! I took a swipe at the ghost."
"Well if the ghost had Rob's beard then he had something in common with Rob. So at least some aspect of Rob was being attacked, even if the ghost represented more persons (and/or concepts) than Rob."
This led to his recalling that within a day or two prior to the dream he had seen the movie Avenger. There was plenty of swiping there. Aliens and strange metallic characters, which made him think of ghosts, fought and took swipes at each other in it.
He added "I believe in ghosts and spirits. When I had my nervous breakdown, I thought my house was full of  them. I could hear the campus security guards, dressed in black, talking about me outside my window, while inside the house the spirits were sitting in my attic with a voice recorder. They could see, hear and record my thoughts.
"So yes, the dream is a direct response to seeing the movie. There was so much violence in it, with dust and debris flying all over [the haziness of the dream?].  My brother and I love action films, especially the ones which have Marvel Comic heroes - Superman, Batman, Spiderman."
Now the two brothers are the poster children of meekness and timidity. Christians to the bone, they will not dream of taking a swipe at anybody or more correctly only in the dreams they will dare to do so. And yes they will do it in waking life too, but only in proxy; through watching the actions of the ultimate good guys - the Marvel Comic superheroes.
For when they were boys - they are just a year apart - they were relentlessly teased, bullied and beaten by their schoolmates. Every attempt on their part to resist was dealt with even more bullying. Why they became the target of  bullying was partly due to their frail frames, but also because of emotional problems in the parents, and disturbed family dynamics, which had greatly exaggerated their sense of guilt, their need for punishment and their fear of everything unfamiliar,  traits which were genetically strong in them to begin with. And the bullies picking upon these traits found them easy prey. They had adjusted to these adverse circumstances by turning into pious Christians. It was not difficult for them to do so because their parents were devout Catholics. The buck of the vengeance was then easy for them to pass on to the Lord [and the action heroes], and all the energies were henceforth diverted to becoming extraordinarily considerate towards their ill wishers [and then to everybody], always ready to turn the other cheek when slapped.
"Are you taking a swipe at Rob because it is safe to do so? With others in that bookstore you are always on the run, fearing for your life at any prospect of confrontation, and naturally the co-workers take advantage of your timidity, knowing that more they will push you around, the more you will bend over backwards to accommodate them, and as icing on the cake hold no grudges. But while you think that you forgive and forget their transgressions,  the revenge feelings continue to exist in your subterranean mind, and finally seek discharge when you fall asleep, in your dreams. But the fear of retaliation comes to haunt you there too, and though you are a little bolder in dreams, and do strike back, the fear forces you to swipe only at those with whom it is safe to do so - like Rob."
"That is very interesting and perhaps true."
Then the patient proceeded on his own accord. "A day or two before the dream there was an interaction in the bookstore between Rob and a businessman which may explain why I took a swipe at him. You know our bookstore is for college students. And currently the trend is for renting the  books instead of selling them. But there is a big penalty if the books are not returned on time, even by a day or two. Now this guy cones in and on learning he was slightly late and will have to pay a hefty fine for it, got real nasty.  It looked like he was going to take a swipe at Rob. But Rob was as patient and as unruffled as his trimmed beard, and without giving an inch, listened to the man's boast as to how he is owner of two businesses and how he will get Rob in to trouble. I was impressed by Rob who did not react or retaliate. He behaved just the opposite of Tracy, who is a new girl at the store, very kind and nice to everybody, and who broke in to tears and ran to the back room when somebody called her names on the phone, so sensitive she is to anybody being nasty to her."
After listening to some other related thought chains, I intervened, and asked him if there were any other associations to the ghost independent of the beard.
Hesitatingly he volunteered that the ghost was a Filipino.
"A Filipino? Why in the world a Filipino's ghost will come to haunt you?"
The patient replied that he is really in to ghosts and spirits. And tried to convince me that ghosts exist for real, and that there was a Montel Williams show which conclusively proved the existence of a parallel spirit world from which spirits crossover to this side every now and then.
But when it came to psychoanalyzing why a Filipino's ghost was making his way into this side and specially in to his dream, he was as puzzled as me. Then the session's theme shifted to ghosts and spirits in general, and I learnt that the patient had started hearing voices not with his first nervous breakdown, 6 months after his father's death, but even before while his father was alive but dying.
His father had died of liver failure. Patient stated that it was caused by his TB test - which really measures any exposure to TB, not actual infection - coming positive which led to the overzealous public heath officials putting him on a highly toxic TB drug. The drug was subsequently withdrawn from the market because of its liver damaging property. Patient bitterly stated that his father did not have TB, and they just pushed him in to that unnecessary treatment to abuse their power.
"Did you sue them for causing his liver failure and death?"
"No. We are Christians, and we don't believe in suing. Also it would have been hard to prove. He was in WWII and stationed in Philippines and perhaps got his liver problems from there. They use so much agent orange and other chemicals during wars. Maybe it was not the TB drug but the chemicals he was exposed to in the Philippines."
"So along with those public health doctors you may be holding a grudge against Philippines for giving him the fatal liver disease and by association with Filipinos?"
"I don't know about that but when my father was very sick and dying I was in throes of some weird  emotions which ended with my hearing voices."
"What were you hearing?"
 "They were more orders than anything. Ordering me to do pushups etc."
"Do pushups?!"
"Yes, they would not let me alone, demanding I exercise all the time. Some days they would not let up till I did 250 to 300 pushups."
A number of associations at this point, which will be too tedious to describe here, led to the following conclusion. The motive behind the command to do the pushups was for him to become so strong that if he took revenge upon the TB doctors and the World War II Filipinos, both of whom he held responsible for his father's death, and as a consequence they came after him, he will be able to protect himself.
But there was an additional motive for him to become highly muscular. It was to protect himself from his father as well, who was now terminally ill and helpless and hence at his mercy. In his unconscious he harbored extensive death wishes towards his father. He was not a kind father. He was distant, looked down upon them, and had failed protect them from the bullies. And to make matters worse, he was a barber, who when his business took a nosedive in the Sixties with everybody growing their hair long, had punished his sons severely when they tried to do the same and had given them the most short hair cuts imaginable, worsening their fate in hands of the bullies. In his unconscious his father was just another bully. It is interesting that once they reached adulthood they started sporting Beatles' style hair cut, and to this day they do so even though with extreme thinning, it borders on the bizarre. 
Was the ghost then his father's? But if so why did he come in to his dream on that particular night or more accurately why he entered in to patients thoughts that night - for dreams are nothing but our regular thoughts just clothed in the language of sleep/dream.
And then patient was not even sure if the ghost was a return of his father. Why would somebody as standard American as his father, return back from the spirit wold as a Filipino?
With no associations forthcoming, the session drifted to other topics. And the patient talked about how once as a teenager he had idolized Rocky Balboa and had learnt to do pushups in an attempt to become like him. He had even memorized the movie's theme song, and when playing baseball would sing it to himself hoping it will enable him to hit home runs. But the breaking of his spirit by the bullies easily overrode the courage-boosting properties of the song and he remained a dud as a hitter.   
And that reminded him of his brother playing baseball with two other kids, Jerry and Joe, both of whom went on to become doctors. "My brother was as good as them in studies, but I guess my brother became too afraid to do anything as high class as a doctor"
"Why?"
"I guess my brother and I are not meant to rise above our humble station." Behind this bitter complaint of course was lamentation that if only they had had more support from their father and if they had not been bullied, his brother would have become a doctor.
"Though I guess in a way it was good. For Jerry got killed the other day in Afghanistan. He was such a nice man. Just like Michael. I don't understand why they would kill him. He was running a children's hospital there.
"And now I know why the ghost was Filipino. It was Jerry's ghost. Jerry is Filipino-American. And the dream occurred I think on the night when I first learnt of his fate on the news."
While the patient was not aware of any of it, it was my analytic deduction that Jerry's ghost came to haunt him as a revenge for taking satisfaction at his death out of loyalty to his brother. This satisfaction took place completely out of his consciousness, and of course it does not mean that he did not feel sorrow for Jerry's death. But there was also there anger and jealousy of those who he knew were equal of him and his brother, but had succeeded in life more than them.
The psychological processes were similar to what happened when his father was terminally ill. At an unconscious level there was some satisfaction that finally my father will be dead and I will be free to do as I please. But there was also sorrow at the thought of losing him. And it was the guilt over the satisfaction that was making him do 250 to 300 pushups. The guilt was also peopling his house and his yard with malevolent spirits and security guards respectively who could keep an eye on him and prevent him from hastening his father's death. The pushups were punishment, but also the means to make him strong so he would be able to fight the doctors and the Filipinos who were responsible for causing his father's liver disease. Taking the swipe at the ghost was similar to doing pushups - defending oneself from the punishment which he anticipated from those whose death (in father's case his impending death) had given him satisfaction.
It may not be out of the way to make a few comments upon why people see ghosts or believe in ghosts as our patient did. In his case he had lot of reasons to hope that after we die we continue to live as ghosts. His childhood had been marked by abuse and bullying. If we continue to exist beyond our death then the possibility of getting even with the bullies also existed. If you have an ax to grind,  if you feel that the fate has not dealt you the right cards, and people have harmed you and escaped getting punishment for it, then there is powerful motive to believe in the world of spirits, in hell and heaven, divine justice and for those hailing from the East in reincarnation. 
Ghosts ultimately are nothing but resurrection of demons from our past. Conjuring up the dream images/illusions/hallucinations of those with whom we still have unfinished business but who have passed away. We can still deal with them but only by conjuring up their spirits.
It is interesting that in Hindi the word for ghost and past is exactly the same: "bhoot".

Saturday, April 26, 2014

Ringing of doorbell in dream as symbol of death knocking on the door

A man in his early fifties who suffers from agoraphobia and cannot go beyond a few miles from his house brought in the following dream to the therapy session

I am sitting with my eldest sister on a couch, along with her ex-husband. The door bell rings and her ex-husband and I feel that we must protect her. 


There were no associations to any element of the dream, which was laconic to begin with.

I asked him,"Is there anything in common between your sister's ex-husband and yourself?"

"Their daughter who is my niece."

But this association did not help and knowing how much the patient dislikes this sister of his, who was oldest in a family of four children, while he was the youngest, and who would hit him, lock him in the closet, scare him in other ways, after their mother died due to breast cancer, when the patient was just four, I asked him if her ex-husband also dislikes her.

"Yes, he must. She is a pit bull. A mean mean bitch. She cheated on him and then took him to the cleaners. Just like she cheated me and my brother. She, and my other sister went to my father's house just before he died, and took everything of any value there, including all the family pictures, albums,  including  the pictures of my mother's and her family, so I have nothing left to show my children and my grandchildren. My father was a prolific picture taker, and we had tons of pictures from Polaroid instant camera."   

"So there is something in common between you and your sister's ex-husband. Both of you got cheated by your sister and have a reason to wish her ill. So the compulsion to protect her must have arisen to counter the ill wish.."

"But I have not seen her for 10 years. Neither her ex-husband. Why would they come in my dream now?"

"Yes, good question. Why now?" Though both of us knew the answer.

Recently his son had gone in to ancestry.com and had unearthed that his mother had a half-sister, who lived just a few miles from his home, and from her he had learnt a whole lot of family history and also viewed a lot of pictures of his mother when she was a child and of other relatives of theirs. He also saw pictures of a second cousin of his who looked identical to the dream sister. The wish had then arisen for him to meet his sister and demand to get some of the pictures that she had taken from their father's house. But his past attempts to contact this sister to do so, even request that if he could just come to her house and scan those pictures into his laptop, had been refused, arousing death wishes towards her.

So there was a renewed wish to contact his sister, anticipation of rejection, and arousal of death wish. The dream however, under the influence of conscience (superego), showed the counter-wish: to protect her sister from his death wish and sharing of the blame with his ex-brother-in-law.

 I conjectured that the death wish was given a concrete pictorial representation in the doorbell's ringing.  This was based upon my observation as to how old people at the eve of their life,  dread so much a knock on the door, or any other noise or unusual sound, which signifies that someone is trying to make an entry in to their house. Some of them stack chairs and other objects at the door so as to prevent messenger of death making an entry. Some of them will try to caulk or put insulation on every nook, corner and crack, as if to seal every single entry point and window of vulnerability through which death in the garb of cold air may sneak into the house - the house itself symbolizing themselves.

When I conveyed these thoughts to the patient he remarked, "Yes, ringing of the bell probably did mean death knocking on the door."


Sunday, February 9, 2014

American Bipolarity versus Real Manic-Depressive Illness, Urethral Eroticism and Human Ambition

A friend of mine who takes a cynical view of things American, despite being as hardcore American as one can get - even has one-eighth Indian-American heritage - remarked that America has gone completely Bipolar, everyone and his dog is now suffering from Bipolar Disorder. Then she  wondered if she was Bipolar.
She does have a giant anger problem.
I joked that she was "Tripolar". This one came from a patient, who, while expressing her frustration with and contempt for her boyfriend, declared him to be a "friggin' Tripolar". "He can freak out at the littlest thing. A misplaced towel, a missing cookie, somebody having looked at him the wrong way or had not answered his instant message instantly, all become international conspiracies. I am afraid to speak to him lest it interrupts his thinking and turns him in to a jerk. I rather live with a bunch of 16-year-olds-in-their-period than handle his mood swings.  He is more than Bipolar, he is an asshole, a flaming Tripolar." On another occasion she described him as a "Super dick who thinks of himself as a Superman."
Bipolar means different things for different people, but the most popular one is a sudden and massive switch in mood. People who get "pissed off" at being crossed, even if the obstruction to their will was miniscule and unintended, and after unloading their anger - sometimes through physical violence - revert to their normal self, which is surprisingly mellow and apologetic, full of contrition and guilt.
It is this switch from an angel to the devil in matter of seconds that makes the layperson find the word bipolarity so apt to describe this volatile behavior.
But the phrase "pissed off", which evolved to denote the quality of the anger, causes us to wonder whether the language with its infinite wisdom is not giving us a clue to the source of this giant emotional reaction at the slightest 'putdown/frustration'. 
Is this brittle emotionality a result of a disturbance of the psychosexual phase when the function of urination was of great importance?
Here, because of our familiarity with psychoanalytic literature,  a number of concepts immediately want to make an inroad in to our consciousness though without any particular order: urethral eroticism, enuresis (bed wetting), fire setting, inordinate ambition, cruelty to animals, and infantile masturbation.
Uretheral eroticism is libidinal/sexual pleasure that accompanies urination. It is a "burning pleasure" closely associated with penile and clitoral masturbation of the Oedipal  phase; and with ambition.
And as soon as we reflect upon urethral eroticism, enuresis and ambition as a group, the phrases "setting the world on fire" and "having fire in the belly" also want to make an inroad into our consciousness.
For one way to look at ambition is to consider it as a desire to reach such a high stage in life that one can have access to whichever female one wishes, implanting as many seeds in their wombs as one can manage, and with no challenge from other males.
Now implanting one's seeds in multiple female bellies can be allegorically expressed as setting the world on fire. For world, earth, mother, woman are interchangeable concepts in the unconscious. So impregnating is setting the woman's womb/belly on fire, and if one is doing it to innumerable women then it would be setting the world aflame through one's sexual potency.
The expression "fire in the belly " as a symbol of inordinate ambition, perhaps, has its origin in showing the same concept in "reversal"  - an "identification" with all the females that one would wish to impregnate. For what one cannot achieve, one identifies with it. If one cannot get an object that one desires very badly then one transforms part of oneself to become like that object.  So if one cannot impregnate all the females one would like to in reality then one can identify with them and accomplish this task in fantasy - feeling pregnant oneself (having fire in the belly).
But one's masculinity fights against this feminine identification and struggles to "undo" it. A violent flight back to activity from passivity occurs.  The feminine identification which impels one to submit oneself to other males - for it was out of fear of them that one gives up pursuing females in the real world - is energetically rejected with development of a vitriolic hostility and a great resolve to outdo all of them.  Its essential nature is to cover up one's passive/feminine identification. It is a Reaction Formation against being a sissy/patsy/submissive homosexual. A crude version of this reassertion of one's masculinity - especially when it is accomplished through petty obstructionism of others' goals and through fault finding in others - is captured in the phrase "behaving like an asshole".
So what goes wrong during this phase when uretheral eroticism is at its peak that turns the person in to someone who goes ballistic at the slightest put down?
Such an excessive and wild reaction could only be the result of an interference with infantile masturbation during this phase. Since masturbation is a sexual activity - and as we defined earlier that ambition is closely linked with sexual impulsion and achieving the potential to leave as many carbon copies of oneself with as many women as one can manage - its impediment is perceived by the child as a threat to his ambitions - an obstruction to "set the world on fire".
Now parents are biologically programmed to put a stop to child's masturbatory behavior. For if sexual gratification is achieved in self-stimulation then the child will have little sexual impulsion to seek others for gratification and thus will not reach his full potential and growth.
Now not only when the parents accidently discover the child playing with his genitals do they tell him to stop it with words like it is dirty or it will cause his ruination or physically deform him,   sometimes reacting to it with outright physical violence, the child is also impelled to entice the adults - usually the ones he is fond of, like his parents  - to join him in his masturbatory behavior.
 He tries to seduce them by playing with himself in front of them, so they would join him in the fun and exhibit their genitals as well. This behavior is highly motivated by an intense curiosity on part of the child to see the parent genitals. It is filled with expectation of it being far more magnificent than his, and to compare his own size against theirs.
Anyway, a punishment, or even a slight by the parent/parent substitutes for this seductive behavior, provokes the child to fly off the handle.
Oedipal period temper tantrums, defiance, oppositionalism, while they have antecedents in anal-sadistic phase, reach their definitive form around the age of 4-5, and appear to be a direct result of this rebuff and the overall stoppage of infantile masturbation due to parental pressures.
Human ambition itself starts as oppositional defiant behavior towards parents. The grudge against the mother for not giving in to the seduction leaves a permanent hostility towards the female sex and a desire to put them down whenever opportunity presents itself. With father the vengefulness is far more sinister. A desire to subject him to all kinds of torture and put him to death. Cruelty to animals, with the animal symbolizing the father, has its roots in the same complex. Attempts to block this aggressive fantasies towards the parents - especially the father - primarily by not paying attention to them lies at the heart of attention deficit disorder. With sublimation this attitude transforms from inflicting direct injury to a burning ambition to simply change places with the father. Ambition to a great extent is reversing of the situation between oneself and one's father. Showing him and the world as to who is the real magnificent one.
This desire to turn tables upon the parents which would become the blueprint of how one would conduct one's life in pursuit of excellence, in the beginning,  necessarily has to be just in fantasies. And these fantasies can become very intense - hot - especially if the child is subjected to traumatic putdowns, or sees intense conflicts between parents. Parents fighting, specially physically, strengthens the child's wish to become stronger than the father and kill him. 
And since one has to wait for these fantasies to be converted to actual behavior, and which can never really happen in reality, but in displaced muted forms, they have to be treated, to a certain extent, as foreign objects needing an extrusion out of one's system. [Here may lie the explanation as to why unfulfilled fantasies can provoke the same cascades of inflammatory and immune responses which body does when dealing with a physical foreign object like virus or bacteria or tissue damage due to trauma]. These  fantasies keep smoldering inside the psyche as fiery introjects. They are like touch of fire embedded within us that we want to get rid off but cannot.
Here also we get an insight into enuresis. Enuresis is an attempt to douse the burning fantasies which is disturbing the sleep.
If the fantasies become too hot they can be like a touch of fire within oneself. They become like a kindling points (quasi-seizure like activation) in the brain. And while during the day these fantasies remain controlled by the inhibitory inputs reaching them from other parts of the brain which are awake and active, at night, as rest of the brain goes in to sleep mode and becomes inactive, they become uninhibited and cause wakefulness in the child. Since their character is that of burning ambition they are felt like a touch of fire and the child urinates to cool/douse them.
Here I am reminded of how in India children are told to not sit next to the hearth or campfire because it will cause one to wet the bed in sleep. 
As the child grows up the burning fantasies/touch of fire/the bottled up rage no longer can be dealt with enuresis.  There is now an impulsion to physically masturbate again and to discharge these fantasies out of one's system through the sexual act. However the fear of punishment for doing so, along with the entire complex of conflicts with the parents over masturbation, including the wishes for their death for interfering with the act, closely follows the temptation.
The person vacillates whether to give in or not give in to masturbatory behavior. In most cases the act of masturbation remains in the background and is never physically practiced,  the entire conflict remains confined to struggle over indulging or not indulging in the fantasies. [It may be worthwhile to point out that even this indulgence in the fantasies, and the struggle to not yield to the temptation, happens in the unconscious. In the conscious mind, vague and weird thoughts appear, along with aggressive irritability and other complex affective states, which are connected to the fantasies, but so far removed from the original conflict, due to distortions and displacements, that the origins of these weird violent thoughts and emotions remain a mystery to the patient.]
When the person manages to triumph over these fantasies - frees himself from them for a while - there is a massive rise of self esteem and a triumphal attitude. He feels at the top of the world, free from his past and his sexual attachments to the forbidden Oedipal objects, sometimes entering in to an outright manic high, rushing hither and thither, searching for non-incestual objects to love.
When the fantasies become more powerful - and this happens if the person is subjected to frustrations and putdowns in his attempts to find fresh extra-familial love objects, for that causes the libido to regress and hark back to finding satisfaction in masturbation - there is reemergence of a sense of guilt and impending doom. This guilt and sense of doom - at bottom fear of castration - causes a massive inhibition upon one's behaviors and slipping into the depressive phase.
Is this tendency for immediate anger and destructiveness followed by guilt and contrition  - the brittle mood - the lay people's Bipolar Disorder similar in nature to the official psychiatry's Bipolar Disorder (what used to be called Manic-Depressive illness)? In the standard Manic-Depressive illness mood changes last for weeks and months. Depressive phase is generally longer and can persist for weeks, months, even years. The manic phase is usually shorter but still lingers for weeks and months.
Despite the difference in duration of the mood changes the basic conflict which the person is unable to master and which gives rise to the illness appears to be the same: a pathological defiance of authorities sparked by interference with childhood masturbation, followed by guilt once the rage is discharged.
The duration of the mood swings differs between the two primarily because of difference in upbringing. People who grow up in more stable families, where discipline was not erratic,  frustration tolerance was encouraged, and instant gratification was frowned upon, they are less likely to react to putdowns with immediate anger.
They can bottle up the frustrations for extended periods. But once they have their fill they retaliate too and go into a manic mood. Once again due to good upbringing  they are often able to cover the rage/ hostility with a veneer of good hearted riotous bonhomie. This makes it difficult to see that mania is more a rage reaction than a state of happiness.

 

Saturday, January 18, 2014

Two recurrent dreams from lingering Oedipal attachments and the associated fear

A reader from Pakistan wrote:
 
Dear Prof,
I have read your blog. So amazing! I'd like please to get your ideas for interpreting my reccurring dreams
The first one I was  being chased by a lion in different occasion the lion was after me
I was terrified
The second one which was recently in the last few years, a war attack and plane strikes in my city or country , as the sky was filled with impressive unique fighter planes bombing the city and I was just watching, some solders parachuting and so on
dream also of  military vehicles and tanks flying along the airplanes which is weird
The war dream I was just impressed and enjoying watching the action not terrifying.
 
Dear friend,
                             Wild animals in dreams usually symbolize (the strength of one's) passions - the id impulses.
But they also symbolize the father.  For id impulses - the libidinal and aggressive drives - when they manifest, during the Oedipal phase, towards the mother and father respectively, the child reasons, they will come into cross purposes with the father's wishes and arouse his ire. And that provokes the great castration fear which lies at the heart of anxiety dreams.
So if you are being chased by a lion then it also, most likely, is representing the dread of the father from the Oedipal period; to which you return to in your sleep and dreams.
It is fear of the Oedipal father for one's out-of-control id impulses that are depicted in running away from a dangerous animal in dreams. [In women the anxiety dreams appear as dread of being bitten/eaten by animals/snakes or being chased by strangers who will shoot or knife one.]
One recalls here the dread of castration in hands of the father that caused 'Little Hans' to fear the horses biting him (Analysis of a phobia in a five-year-old boy) and 'the Wolf-Man' to fear the wolves eating him up (Notes upon a case of Obsessional Neurosis).
 In Little Hans the dread of castration was for positive Oedipal Complex - love for the mother and fear of the father. In Wolf-man's case it was inverted Oedipal complex; the fear of overwhelming homosexual impulses; for submitting himself to the father was tantamount to taking a feminine attitude towards him and giving up one's masculinity.
Animals are chosen to represent the father because one's own abilities and strength are compared with that of the father, and the latter's prowess is felt to be akin to that of a ferocious animal.
The second set of dreams are new version of same conflict. Here the father is no longer viewed with overwhelming anxiety. One is no longer totally helpless against a wild beast. The conflict is the same but now clothed in a later period of psychosexual development. He is attacking one, but not in the form of an animal but weaponry. Warplanes, military vehicles, tanks are all excellent symbols of the penis. And the fear is being replaced by the affect of competition. Many unique fighter planes would be new versions of the father - new father substitutes - with whom one wants to indulge in phallic competition. Parachuting soldiers and military vehicles floating alongside the planes are most likely symbolizing erection. One is no longer dreading father's phallic prowess but competing with him toe to toe.
Defiance of gravity/flying symbolizes erect penis. For erection is not just defiance of father's fear, but literally defiance of gravity; for the flaccid penis becoming erect is visually a form of defiance of gravity. 
 

Friday, November 8, 2013

Smoking cigarettes as a means to do away with others and self

A man in his early Fifties who lives an isolated personal life, though gregarious when he goes to local stores or is siting in doctor's' office lounge or in other public places, treats his two cats as his family, reported that since he quit smoking he is having visual images of killing himself.

So the smoking was preventing his suicidal thoughts to emerge in his consciousness. For an impulse to turn into action it must first makes it way to consciousness - there are of course exceptions - and this was being blocked by lighting up of the cigarette. The pleasure that ensued from filling his lungs with warm smoke blanketed out the dysphoric destructive thoughts.

But before we go some more into the metapsychology of this defense, let us examine a little of his life history.
The patient's parents were old fashioned 'Church of Christ' followers from the South, who had migrated to Detroit when he was 9. The family culture was to quote the Bible frequently and to punish readily if  the children deviated from the straight and narrow. This made the core of his heart God-fearing. Though in his late teens and early twenties he lived recklessly and indulged head over heels in wine, women and songs with nary a thought of the afterlife.
 
He had a stormy Oedipal Phase, emerging out of it with typical death wishes towards the parents, stronger towards the father than the mother, consistent with Positive Oedipus Complex.  These death wishes were further accentuated during the Latency Period, because he faulted his parents for giving him his slight built - he is otherwise a good looking man - and his Southern manners, both of which invoked bullying from kids in school.

When he first began driving he had a horrible car accident which killed one of his buddies and left  another paralyzed from waist downwards. There were four teenagers in the car. His girl friend and he were in the back seat. A friend of his was visiting them from the South and was on the front passenger side. As a joke this Southern boy started making racial comments  to a Black man who was driving alongside. The man pulled out a gun and came after them, causing them to take off at a dangerous speed. While trying to escape through a dirt road, the car careened out of control, flipping multiple times, leaving the visitor from the South dead and the driver paralyzed. The patient and his girl friend escaped with minor injuries. 

His sense of guilt was markedly accentuated by this event and his death wishes had worsened. There also was now a tremendous need to repeat the trauma of the accident. It was a typical "Repetition Compulsion" to a devastating Traumatic Neurosis.

These death wishes and the guilt that followed  now shaped all his conduct. His life mostly became the game of getting into aggressive stances with people on the slightest provocation and then profusely apologizing to them for not behaving like a 'Christian'. He became a massive people-pleaser to cover up his death wishes towards everybody he came across. In his dreams, he was forever doing away with people, even committing mass murders, and in brutal fashion, recreating the bloody scene of the car accident, sometimes directly sometimes in displacement. His people-pleasing ways of praising whoever he came across, being kind and helpful to one and all, were of course every now and then punctuated by threatening to fight with them. He was very sensitive to being taken for granted, slighted or mistaken for a sissy when he was trying to appease people.

His adolescence and early twenties was marked by the emergence of a remarkable talent in singing. He formed his own band, which was highly successful, and for a while it looked like he would be a rock star. He had a big following, slept with innumerable women, and lived as if there was no tomorrow. 

During this music phase of his life he took a break for 2 years to join the Navy. He was shipped out to Middle East and was assigned for most of his stay there in the war torn Lebanon. Here he witnessed more turmoil and bloodshed, which, while stressful, also satisfied his urge to re-witness and abreact the trauma of the auto-accident.

His career, however, in the army did not last long. For he always felt restless in it, with an urge to be doing something else and finally checked himself out of it feeling like a failure.

He returned and formed another band. And once again just as he began to get successful with his music, disbanded it, cheated upon his wife which destroyed his marriage, and became a loner.

These failures, which were unconsciously engineered by him, and were as a punishment for his death wishes, caused him tremendous unconscious rage at the unfairness of it all. And this rage found an outlet in excruciating headaches. His whole life now centered around nursing his headaches, imbibing narcotics, alcohol and marijuana for its cure, and getting into oppositional defiant attitude towards authorities.

And he smoked all the time.

Analysis revealed that his smoking too primarily was an outlet for his death wishes. Whenever the death wish emerged  to get even with his parents for his Oedipal grudge, and all others who were the new editions of those original enemies, he would light up a cigarette. And then the warm smoke and the irritation that were generated in his lungs gave him the satisfaction of their burning; as if he was roasting them in hell-fire. Since the warm smoke also destroyed his body there was also the element of his burning with them which served as a self-punishment for the wish.

When he quit smoking these death wishes were no longer finding satisfaction in bodily self-destruction and could emerge undisguised and as plain visual images of killing himself.

He would see himself running in to one of his swords - he had more than 30 of them, along with all other quaint weapons of destruction - or taking a long needle and sticking it through the rib cage straight into the heart. A method of suicide that would puncture his heart and cause instantaneous death and spare him from pain. He declared only the fear of going to hell - for God forbids suicide - and the fear as to who will take care of his cats prevented him from doing the deed. 

When the interpretation was made that these imagery of suicide were punishment for death wishes against his parents, the patient pooh-poohed it on grounds that his father was already dead, and he loves and respects his mother more than anybody else in the world, so for him to harbor such a thought towards her was ridiculous.

But then immediately proceeded to confirm the correctness of the interpretation by recalling that the other day somebody in the grocery store knocked his mother with the cart, and he was so furious at that person's callousness that he went up to him and demanded that he apologize to his mother otherwise we are both going to jail. He could not directly see his own destructive impulses towards his mother but could see it in the action of others. 
 
I even suspect that when people light up a cigarette, it is because some frustration has occurred in the present, or memory of some frustration in the past has been stirred up in the present, and the need to burn the person or the circumstance that is causing the frustration, impels one to do so. The blowing out of the smoke is in a way blowing away the person who has caused one pain in to oblivion. This blowing away is not unlike how one clears one's throat or indulges in a hacking cough to mentally get rid of somebody of whom one wants no part of.

Cigarette smoking is amply suited to do away with one's enemies. It is quick, it does not cause any immediate pain, the warmth of the smoke gives one pleasure that overrides the pain of the memory, and the action of blowing away the hated person is visible as the emerging smoke, and it makes one feel masculine and in control.

The tendency in some cultures  - which strongly prohibit aggression against others - to indulge in self-immolation when they cannot destroy their enemy appears to be governed by the same mental mechanism.  While burning themselves they are also burning the hated enemy with whom they identify. The psychology of anorexia nervosa is also identical. The girl does not eat - as a reaction to the feeling that she was inadequately nourished by her mother - and sees the fat in herself as a symbol of her mother, and destroys herself and the hated mother (through identification with her) by getting rid of every piece of fat and then every other piece of herself by not eating.

Another patient of mine, who incidentally is the childhood friend of the person whose case history we are using to illustrate here the motive behind smoking, and was his "roadie" during their glory days, after reading this blog, remarked that the psychology of bulimia can be explained on same line. Here the ambivalently loved person is eaten to incorporate into oneself and then spit out as a mark of its rejection.

I remarked to him that perhaps the phrase to chew them alive and spit them out expresses this concept in its visual concrete form. 

Wednesday, October 30, 2013

A recurrent dream of castration

A man in his mid thirties, who suffers from paranoid illness, is single, still lives with his mother, her only child, reported that for the last two weeks he is troubled with a dream that won't leave him alone.

I feel there is a baby on my back, like a backpack. I feel responsible for it and have to worry about its safety. I want to do things but cannot because of the burden.  My dreams which use to be full of adventures now are cut short because I have to worry about the baby coming to harm. 
When I wake out of the dream I find my head hard pressed against the pillow. 
 
Initially the only association the patient could come up with was that the backpack reminds him of going to school.  But that association led to no where. And soon we drifted into his usual paranoid complaints about neighbors keeping a watch on him and how he cannot get away with any transgression no matter how minute.
"Every time I have sex with a woman I get in to trouble. It is not like I am having sex with married women. But neighbors look at me as if I am trying to have sex with their wives. If I just wear a different style of cloth they start wondering if I am up to something. Recently I was hired by a lady to drive with her to New York to help her load some mattresses for her business, and while I was eating at the White Castle she was watching me as if I was wolfing down my food.  If I exercise in my backyard my neighbors come to their windows and stare at me. Even my mother doubts my abilities. She tells me that I am a dreamer. But so was Martin Luther King. My mother accuses me of doing nothing that has any practical value and for earning no money. But hardly out of school I became a connoisseur of classic cars and flipped a couple at a profit. I have a collection of old comic books which one day will fetch me a neat sum."

By expressing to me all these persecutory thoughts and feelings, which his mind is constantly conjuring and no doubt to keep a lid (inhibition) upon his taking chances with the world - even his ability to free associate -  undid the repression partially, and the patient now could come up with the following association, "I read, or perhaps saw on TV, that if you see a child in a dream it is yourself."

This immediately solved the riddle of who the child represented. And I asked him, "Behind the facade of protecting the child is it yourself that you are protecting?"

"That makes sense. But why I am protecting myself through creating a double of me as that child instead of protecting myself directly?"

"Because when the fear of harm coming to oneself is overbearing, the mind plays a trick to lessen its impact. It starts worrying about somebody else who if harmed will cause one even greater pain. This way one's fear for one's safety is lessened. The focus shifts to somebody else getting harmed instead of oneself. This reduces the autonomic and other physiological responses that are triggered if one is anticipating danger. For the harm coming to somebody else, even if to somebody very close to oneself like one's child, still does not pose as much terror as harm happening to oneself. Or at least does not mobilize body's physiological responses to the same degree. The body does not have to activate the cascade of stress factors to protect oneself, because the injury is going to happen to somebody else. It is a very important defense: shifting worry from one's own person to worry for one's child's, or a spouse, or a favorite nephew or the federal deficit or the future of mankind or the disappearing rain forests, or the global warming.

"Since in real life you do not have a child, in fact you do not have anybody close to you who you really care for, you are working out your fear of some harm happening to you by creating an imaginary child who you must protect. And since you deny your fears in daytime, and in fact do not feel much emotions when you feel threatened by your neighbors, for that matter the world in general, for you experience the world as a hostile place, these fears emerge in the night when you are sleeping and you try to work them out of your system in your dreams.

"But why did this dream start just two weeks ago?"

"Because for the last two weeks I am struggling with a bad crook in my neck?" the patient replied

"Crook in your neck? What in the world is that?"

"I don't know what you call it. But us black people call it crook in the neck when we sleep badly and wake up with our neck stiff and hurting. Generally it clears up in a day or two. But this one has been a bugger and has persisted for two weeks."

This explained the immediate cause of the dream. The pain in the neck was disturbing the sleep and the patient who is always anticipating grave harm because of his paranoia had raised its significance to that of a mortal danger. This was consistent with how he experiences the world: a dangerous place. The need to do something about "this impending catastrophe - the crook in the neck" would have woken him out of sleep. But to protect the sleep - for him to continue sleeping - the brain mechanisms responsible for dreaming generated the dream. And the dream, by showing that the mortal danger was not coming to him but to his dream child, lessened the overbearing emotion of fear which otherwise would have woken him out of sleep.

"Why is your head getting buried into the pillow?"

Patient countered it by stating that the dream was in color. Now we know that if the dream is  vivid, feels very real, is in color, it symbolizes intensity and it is reflection of the intensity of the wishes/desires that are invoking the dream. Many scenarios of wish fulfillment have been condensed in to one. Not unlike how in some movies the director starts in black and white to portray the emptiness of the lives of the characters, and then, as circumstances change, and the characters meet new people and new sources of pleasure, their lives become multidimensional and full of happenings and the director shifts gears and ratchets it up from black and white to color.

The patient then gave some more associations which hinted that his burying his head in the pillow was trying to retreat from these intense wishes. For intense wishes are often accompanied with heightening of danger. Striving for things invites competition, threats and actual aggression upon one's person. In digging himself into the pillow he was actually retreating from the dangerous world and seeking to hide in its crevices - it was a variation of the fantasy to return to the womb. It was this intense fear too that was perhaps causing him to keep his muscles defensively tight while sleeping, causing "the crook" of his neck.

The correctness of this view was further confirmed when patient said that his dreams are full of adventures, or rather a wish to embark on adventures, which are cut short because "I cannot be involved with dangers and cannot accept daring challenges because I have this burden, this responsibility for the baby."

When asked to give specific examples of adventures which are cut short by the fear of harm coming to the child the patient said, "Like climbing up a mountain or some other steep structure. Or to get out of a tense situation, like being in a small space with so many people around me."

Now we know that climbing symbolizes sexual intercourse. In fact in Hindi the vulgar term for sexual intercourse is a man climbing on a woman akin to mounting in English. Being in a tight spot with so many other people around perhaps symbolized competition with siblings and father over exclusive possession of mother's genital passage. And considering that a little child often symbolizes penis I made the following construction.

"Is it possible that the adventures are symbolic of sexual adventures and the danger is of castration, with the little child being your penis which will come to harm because of it?"

Little child symbolizing penis is a well known psychoanalytic fact - people often refer to their genitals as their little one -  and this kind of conjecture could be made with this particular patient for he has been seeing me for many years and is quite familiar with the concepts of Oedipus Complex, castration, and dream symbols.

To my great surprise patient said, "It is interesting you say that because the child who I am saving always is naked, he has an erect penis, despite his being a baby, and I may as well add that it is over my left shoulder that I look at the child."

This association strengthened  the view that the dream was an attempt on part of the patient to avert castration for forbidden sexual wishes.

I asked the patient why the child had erect penis and he recalled:
"When I was 11 I developed torsion of the testicles. My mother took me to the Children's Hospital. But they did not treat me right away, and sent us home and told us to come another time for there were so many children who had to be treated before me. And my problem could wait. But then a few days later the problem suddenly worsened. I was rushed to the hospital and they did the surgery right away. The White doctor who operated upon me said that the condition had gone so bad that he was about to cut them [testicles] off. He added that the left one looked worse than the right. The White doctor had a serious look on his face as if he really meant what he said. I did not want to lose my manhood. For I knew one could not have kids without the testicles. After that I had dreams of that white doctor cutting of my testicles for quite some time. I also thought that they would have operated upon me when I first went there if I was a white kid. And for them to operate upon me so quickly when we went the second time, I must have bumped off some white kid who was scheduled for surgery that day."

The patient at this point added another element of the dream.

"The child on my back is whiteI was pretty white when I was born. Just like my grandmother."

So the patient's genetically determined excessive castration fear was further worsened by this unfortunate episode when the possibility of castration in hands of a White man almost became a reality. And to defend against it he had taken refuge in the belief that he was not black but white just like his grandmother. If he could turn white then the likelihood of getting castrated would disappear. And so in the dream he was defending himself from the fear of castration by making a double of himself as a white child. And a child who was not just white but who had an erect penis all the time - denial of castration through impudent defiance.

In his next session, a month later, he brought the following dream.

 I am a few streets away from my house playing basketball with my friends, two brothers, who I grew up with and who were nice to me and treated me with respect. Then another kid, a  neighbor of theirs, and I start fighting with each other. It is a martial art fight. The kid's uncle comes out who is blind. He has a white cane with red tip. We stop fighting and apologize to him for fighting like that and I explain to him that I live on Anna street. Then I return home and find that the boy with whom I was fighting had done a break-in and entry in to my mother's house. I call the police and grab hold of the boy. I see the boy wrapped around my hand as a backpack. I feel as if the burden of the boy who was always on my back as a back pack has disappeared for he is now wrapped around my hand.

We will not go in to analysis of the whole dream but only the parts that deal with the baby on the back.

The patient spontaneously associated that the boy who he is fighting with his own self. It is the part of him which he wants to [reject, project out, and] fight with. It is that part of him which if one follows the dream has failed to resolve the Oedipal conflict and is still seeking to find libidinal satisfaction through his mother - the boy with whom I was fighting had done a break in and entry in to my mother's house -and which was at the root of his illness.

Patient claimed that once he had this dream the  recurrent baby-on-the-back stopped. The patient and I agreed that the baby now instead of being a monkey on his back had shifted to getting wrapped around his wrist. So instead of the fear of castration completely controlling his life- sitting like a monkey on his back - it was now wrapped around his hand and thus under greater control.