Friday, November 10, 2017

The underlying cause for seeing hallucinatory faces in a schizophrenic patient

A patient who is in her late fifties and has suffered from paranoid schizophrenia since her twenties, which, fortunately, for the most part, remains in remission, came to the session and reported that after her Primary Care Physician started her on Gabapentin (Neurontin) 400 mg. three times a day for peripheral neuropathy and knee pain, she started feeling miserable and began seeing faces in everything she laid her eyes upon. "I see faces in clouds, on my wall, on the patterns of my couch, the knickknacks on your window sill, even the mug from which you are drinking your coffee."
"Are you just inferring faces from the random lines and patterns that are always present in these objects like one does in Rorschach test or are they actual hallucinations?" I asked her.
"Well I don't see too much difference between mistaking the patterns on objects as faces and their popping up as pure hallucinations. And you know in the past I have had florid hallucinations so I know what I am talking about. Also when I close my eyes and try go to sleep faces pop up then too without my looking at any objects. In fact they are even more intense when they emerge while my eyes are closed; so intense they prevent me from falling asleep."
Now the purpose of all mental symptoms is to prevent one from getting out of control (going wild/going crazy). What looks like crazy behavior (madness) to an outside observer is actually a watered down (relatively harmless) versions of something totally unacceptable and violent behavior.  When one's unacceptable impulses (internal world/id) become overwhelming and threaten to disintegrate the ego, or act against one's moral precepts (the superego/conscience) or come into conflict with others (the external world/reality) then one gives outlets to these impulses in form of bizarre behaviors (mental symptoms).  By restraining one from acting out the impulses in their pure (directly destructive) forms, one protects oneself from wrath of others and one's conscience. The agency that suffers by this seeking of refuge in madness is the ego which instead of seeing reality correctly, sees it in distorted forms, that make it easier for it to act out the destructive impulses in their displaced  relatively harmless substitutes.
Were these hallucinations there to prevent her from doing or thinking something unacceptable?
"Do these faces scare you and keep you from doing wrong things?"
"They are not scary but they do prevent me from thinking weird thoughts. I get so caught up with these faces, I can think of nothing else."
"What kind of weird thoughts?"
"Like my son coming to harm. You know he acts as head of security for rock bands when they go on  tours. He is right now with a rock band which is touring South America. I was worrying about the crowds getting out of control and his security team unable to contain them, resulting is his and his people getting injured or even killed."
The patient who has been with me for over twenty years and therefore I know she she suffers from great fears of harm coming to her loved ones (which is a displacement of harm coming to herself). She harbors, in her unconscious, very strong impulses to destroy the world and everybody in it. These wishes emerge in her conscious mind as fear of world falling apart and coming to an end (because of her). And the guilt over causing world-catastrophe, when it becomes too strong, emerges as hallucinations.
I asked her "Who are the people whose faces pop up?"
"Faces of people I don't even know. Especially at night, when I try to sleep, the faces of people emerge who I have never seen before."
Now we know from psychoanalytic study of dreams that people who we are very close to us, specially family members, to hide their identity, the dream-work substitutes them with faces of total strangers. So the fear of harm coming to herself was displaced on to harm coming to the family member - now we also know that irrational fears of harm coming to one's family members and altruistic worries about their safety is really projection of fear of harm coming to oneself. - and the hallucinatory faces were of family members who were coming partly as a retaliation for thinking of harm coming to them and partly to prevent her from thinking such weird thoughts.
At this point she recalled that the faces started popping up after she had a very frightening dream. In this nightmare a nuclear explosion had occurred. She was in her car trying to get away from its after effects. She noticed as she drove that there were people all over who had been afflicted from the nuclear fall out and needed help. But she could not help them because her dead relatives and friends were there too, but now appearing alive, and were warning her not to touch or help any of the person on the road because they had been afflicted by the nuclear explosion and she would suffer the same fate as them if she touched them.
The dream had woken her up in fright and from that time onward the hallucinations of popping faces had begum.
Patient went on to say that besides what the gabapentin had done to her mental stability, the frightening exchange of words between Trump and the leader of North Korea about nuclear war that had triggered her fears of world coming to an end and which had triggered the nightmare and seeing on TV the devastation that had occurred n Texas and Florida due to hurricanes Harvey and Irma, they had all contributed to the emergence of the hallucinations.
Then she remembered that this  hallucinations of faces had once before occurred and that time it was a premonition of some disaster happening and to her surprise a few days later 9/11 and World Trade Center collapse had occurred.
Patient opined, "The faces were popping up as a premonition of what was to occur due to Hurricane Irma and Harvey. Just like in 2001 the same hallucinations occurred as a premonition of what was to happen on 9/11."
Patient lays great store by her ability to cause massive destruction by her thoughts.
The patient added, "You know how I worry about the world coming to an end soon. I worry about going to sleep and not waking up (because in my sleep when I have less control over my thoughts I can cause world destruction). I have to pray in the night for God to make sure that I wake up in the morning with the world still there and I still alive. But all  this happens when I am down and depressed. I think that gabapentin made me depressed and triggered my fear of world coming to an end and the faces emerged to prevent me from doing so."

Sunday, September 17, 2017

A cause for lack of bonding between a mother and her newborn

A young mother, in her early twenties, who had the child just couple of months ago, complained that she cannot really bond with her baby.
"Is it postpartum depression?" she asked me.
She did not have quite the features of depression. But then these psychological concepts when used to complain about one's problem are so difficult to form a judgment upon.  Depression is after all a word and words are shorthand for complex phenomenon. And while words convey information they can only approximate to what the other person has in mind and cannot evoke the exact image in the hearer. Every individual experiences his or her mental misery somewhat uniquely and they all get lumped under the rubric of depression. Of course there are certain features which frequently cluster together, and gives the core of what we clinically understand as depression, but sometimes there may be none of those core symptoms and patient can still be not doing well and may be having what should be looked upon as depression (which is best defined as a general inhibition of functioning).
What exactly she meant by she cannot bond with her baby?
She described it as that while as a mother she does take care of the baby, she does it mechanically. She is not drawn to the baby as the baby's father and baby's two grandmothers are, who get so excited when with they are with the baby, and cannot wait for their turn to have it because they get so much pleasure out of cleaning, feeding and playing with her, and go into raptures if the baby smiles or does something that they were not expecting her to do.
Then the patient wondered if the baby will develop autism because of  this lack of bonding with her (mother).
While I agree that the etiology of autism may have similar origins, where the baby's caretakers are not quite in tune with the baby's emotional needs and may deal with the expressions of its emotions, especially aggression, without proper feel for it, suppressing instead of allowing them to blossom into age appropriate forms, forcing the baby's psyche to shove the manifestations of these aggressive drives back upon its own self, which will eventually find expression as autistic behaviors.
I assured her that most likely the baby will not have autistic traits because she seems to be getting enough acceptance and nurturance from her father and the two grandmothers.
"And you you may be overestimating your lack of emotional attachment to the child," I tried to be supportive.
Then I asked the patient if she was breastfeeding the baby.
It turned out she was not. She blamed it on some nutritional expert in the hospital who just after delivery came to teach her about breastfeeding but on hearing she was on Suboxone and Xanax immediately declared that it was not an option because Suboxone and Xanax will pass through the breast milk and will harm the baby's brain.
I felt sorry for the mother and the child who were harmed for life because some expert, based upon a single variable that Suboxone goes into the breast milk, had ignored all the other benefits of breastfeeding which easily outweigh the little opiate going into the baby's system. It is better to be ignorant than to have half-baked knowledge.
I asked her if she really wanted the child?
She was not sure if she did. She had known the baby's father for just six months before she got pregnant. They were living together but not because of any strong bond. They just moved in without thinking through and because they could never plan anything beyond what was right under their nose. They both were good looking, so there was physical attraction. But the biggest thing in common was their opiate dependence and addicts like to do drugs together as if they seek courage from others doing the wrong thing. Their partnership had persisted in trying to give up opiate abuse too and both were in treatment with me getting Suboxone, and supporting each other to remain abstinent.
There were couple of other points which held them together. She admired him as an exceptionally good tattoo artist, which he really was, and he once was  flown in to Florida from Michigan to tattoo a famous basketball player and had been feted while he was doing the job by that celebrity, which had made her really proud of him, but overall she did not think of him as a husband material. She claimed he worked only when he felt like - which was not very often - and feared when married they will be more broke than secure.  They were living together more for convenience in her mother's basement than anything else. Then she got pregnant and lacking decisiveness allowed the pregnancy to proceed till she had no choice but to go through the delivery.
Then both of them dropped out of treatment.
Six months later the girl's  mother came for her own session to my office and told how her daughter was back doing drugs, and raising Cain. She was stealing, partying and hanging out with all wrong men.
For all practical purposes she had abandoned the baby.
So the lack of bonding with the child had a motive. If she had gotten really bonded to the child, it would have been a powerful counter motive to return to drugs and party all the time. With the child latched on to her, she could not have abandoned herself entirely to fulfilling her these pregenital primitive selfish drives.
So what looked like a spontaneous failure of bonding was not all that spontaneous. There was a cause,  a hidden motive, the pull of living wild, with no restraints on one's basic animal urges.
One wonders too if postpartum depression does not just arise out of vacuum but has some similar hidden motive behind the profound dip in mood. If we go deeply into the psychology of Oedipal Phase of the female sex, one is left with no choice but to conclude that  the compensation for the lack of penis, which at that age the little girl suddenly realizes will relegate her to second class status in affairs of the world all through life, is having an exclusive possession over her own baby child when she has one.  What she was denied - the male genitals, which are so strikingly obvious in her male siblings and playmates - and the absence of which was most acutely felt during that phase was handled by fantasy of getting compensated on growing up via having a baby of one's own who will be completely dependent upon oneself. But in some women, rather in all women to different degrees, their birthing and having a baby over which one has complete possession is not felt as adequate compensation. The original penis envy and continued search for it through direct competition with men, which is manifested in all kinds of inexplicable behaviors which puzzles us to no extent, like entering into relationship to trick/cheat him into giving what he has to her (the woman's attitude on this matter is best explained by the saying, "What is mine is mine and what is yours is mine too", or through destroying him out of jealousy, often after falling in love with them and then once he becomes her life partner turning the relationship into a constant criticism of all his behaviors, or making his life miserable, governed by the illusion - unconscious of course - that this will hasten his destruction which will be equivalent to her getting what she has always envied and desired.
Girls who are into wild partying instead of settling down with a mate and seeing the purpose of life in having and raising children are really into this alternate lifestyle. The motive being to steal from some unsuspecting man - in the chaos of wild relationship - the penis that is so badly desired. Women's love for clutter, confusion and goofiness in conversation also owes to the same complex: in the disorder and turmoil to steal what one so badly wants. The tumultuous relationships, the modern generations are having, prior to settling down - for they are brought up with so much indulgence with all their desires immediately satisfied so they want everything - also owes to the young girls not giving up the desire to have the penis directly by stealing from a man through a deceptive relationship than through having a child by him and postponing that wish to the next generation.
And behind postpartum depression lies the same complex. "Let me kill this baby for it has not gotten me true parity with men and let me seek what I want not through marriage and playing with my child (the penis substitute) but through indulging in wild chaotic existence and changing places with a man. Even when these women come from socioeconomic backgrounds in which leading a wild sexual lifestyle is out of question just the fantasy of indulging in polymorphous perversions may act as sufficient counter motive to not take care of the baby to the point of even killing it; done under the delusional cloak of protecting him from evil (the evil itself being mother's own infanticidal tendencies).
Does a lack of instinctive understanding of the aggressive tendencies of the child who has disposition to develop autism on part of the mother also arises from some counter motive?
It is interesting that in the modern times as more and more information is being fed to people on how to be ideal parents paradoxically we are producing more and more obsessive/autistic children. It appears that more full of education, sophistication, and upper class one gets, greater is the chances for the child to turn autistic.
Why this paradox?
Perhaps all this acquiring of knowledge happens at a cerebral level and perhaps much of it as  an overcompensation for lack of feeling of natural motherly bond between oneself and one's child. In olden times women had children  in their teens and  twenties, when they were nearer to being child themselves and thus instinctively understood their babies and could instinctively identify with their children's drives. They did not need any Dr. Spock's books or Child Protective Services manuals and parenting classes on how to be a good parent. They did take care of the child instinctively and did not see themselves as separate from the baby. Mother and child were a unit. Of course, they neglected and ignored the child much more than they do today and the child was exposed to dangers and harm  far more than nowadays. Today the child is infinitely more protected and safe from physical dangers. But in earlier times while they had little time for their children, the time they did spend had far more emotional warmth and understanding than nowadays. And what the mother could not give emotionally, there were always siblings around picking up the slack, and acting as surrogate parents. Now with only one or two children in household, this substitute parenting role of siblings has disappeared.
Nowadays the parents are full of knowledge of how to raise a child but the counter motive to be drawn by other demands of life: their career, their friendships, their hobbies, their need to excel with peers, their social obligations which are far more ingrained in them for these distractions were practiced late into their twenties and thirties, with childbearing postponed to the limits of one's biological clock,  they all act against bonding with the child as the unsophisticated mothers of the past could instinctively do.
Once I was severely castigated by a neurologist for suggesting that inadequate parenting may be responsible for autistic children not finding proper outlets for their aggression. She insisted that of what she see of the parents of autistic children they are more attentive, more concerned, and more devoted to their child than ordinary parents.
I agreed with her but added that they may be more devoted and may be spending more time and may be doing everything as the book says they should do. But it is done more cerebrally than instinctively and spontaneously. Trying to heal problem of the heart with the carefully thought out solutions by the head often fail. These older aged mothers, who often become quite narcissistic, by postponing marriage and becoming androgynous for living by themselves rather than with a partner, try to bring up their children through doing everything right by the book instead of feeling emotionally one with the child.  

Sunday, June 11, 2017

Further dreams of escaping death

The patient whose dream of trying to pass his own aggressive illness upon the friend of his son - see blog entry of April 25 - in his next session reported further dreams of escaping death which may be of some interest to aficionado of psychoanalysis, especially since the dreamwork used typical dream symbols to cobble together the manifest content.

Most of the dreams were chaotic and only a few fragments he could recall with reasonable accuracy. But since they all followed the same theme we could figure out what the dreams were trying to convey.

The following dream  he could recall with good amount of manifest material.

He was out in a business area, running from one place to another doing errands, even though it was like 2 am and no businesses would have been open. [The dream had disregarded this anomaly.] He felt an urgent need to urinate while driving from one spot to another and stopped to relieve himself at a house which he had recently purchased but had still not closed upon. He had the keys to the house or knew the keycode of the lockbox. He assumed it would be empty so there should be no problem in his slipping in and out and relieving himself. To his surprise he found a hobo living there with two of his family members. They were squatters. They had eased themselves into the house illegally.  In fact they were cooking something on the stove at that weird hour as if it was quite natural to do so with no concern the house did not belong to them and it was so late in night. He went out to find some legal authority to help him throw them out. A middle aged police woman happened to be around and came to his rescue. She ordered the hobo and his family out of there which, to his surprise, they agreed to without any protest. 

The house, where enroute, he had stopped, was his own body. Though he does possess many properties he had none in the area where the dream shows he had one. This falsehood conveyed the wish to deny his having the deadly disease. The occupied house/his body was taken over by the hobos (disease) but only in dream. But since dreams are fiction and do not exist in reality, the illness was fiction too and the disease did not exist. It was all a bad dream
The hobo and his family were obviously the illness that were occupying his body illegally and needed to be gotten rid of.
When he had the dream, it was actually around 2 am, and he did have an urgent need to urinate at that hour of the night. This need to urinate which was real need had been woven into the structure of the dream to escape getting up and getting rid of the need by actually going to the bathroom by dreaming of doing so in that house.
Having a lot of unfinished business was an attempt to postpone death. "I have so many things to take care of that there is no way I am dying." One of the unfinished business was to find the hobo (the disease) in his property (body) and throw him out. The police woman stood for his mother who had got rid of all the childhood ailments successfully, whose image he was now invoking to do the same with the current disease. She had been transformed into a police woman to symbolize the legal system whose help he was taking to get rid of the disease. For the disease had no legitimate right to invade his body and he was getting  the law enforcement to get the illegal aliens out of his body..
The hobo and his family departed so easily was another wish fulfillment. The disease had gotten rid of in a hurry without any difficulty.

In another dream he saw himself in a bright and sunny day on a road which had a row of shops from one end to the other. He was supposed to catch a train after he went through those shops, primarily to find a restaurant to eat.  Each restaurant he entered, he felt like he had been there before and the food  in the past had not been bad.  It looked like at every restaurant he stopped he could not make up his mind whether to eat there or not and kept on finding himself in the next restaurant doing the same thing. All this indetermination about eating and moving from one restaurant to the next was accompanied by anxiety that he will miss the train if he does not hurry up.

The train symbolized the last journey and exit from the world. Going to the row of restaurants was an attempt to go back to all the women from the past with whom he had had relationship and to get a fresh lease on life by impregnating one of them and starting a new family, which, because of the obligations incurred, would postpone taking the last journey (dying).  Restaurants symbolized the girls from the past and eating there for having intercourse with them. But just like all these relationships had not ended in his having a child with any of them when he actually was having relationship with them, even in the dream this reality was preventing him from indulging in the fantasy that he was getting a fresh lease on life through having a family with one of them. The anxiety/fear of dying was shifted, for lessening its impact, from fear of dying (getting on the train) to just its opposite, missing the train (not dying); a reversal.

Another dream a short one was of confronting death itself which came in form of a hoodlum/animal dressed in black hoodie, that was challenging him in front of Burger King. Fear and darkness was the ambiance.

Entering the Burger King restaurant was to eat food. Consuming food symbolized having intercouse, which would have given fresh lease on life through rebirth (having a child). But death, in the form of a frightening animal, was preventing it from happening. The  animal also symbolized the Oedipal father, the deathly fear of whom had first appeared during the Oedipal phase for having sexual attraction towards the mother the pursual of which would have led to castration and death.

There were a lot of other dreams, all vague, the common theme of which was that he was breaking the law and would get into trouble if caught. All of these dreams originated from the wish (which his conscience deemed illegal) to give his disease/fate to others. In one dream he had invited somebody to one of his houses for some educational instructions. He noticed the invited person had parked his car illegally. It was facing the wrong way. He felt the anxiety (guilt) of that man's wrongful action. The man then began entering the house. He was watching this from a distance. But while the man was crossing the threshold of the door, its wooden frame suddenly developed gaping splits,  giving it an eerie dilapidated look.

Doing something illegal was pushing somebody else into the jaws of death through transferring his own bad fate on to that person. Which his conscience was deeming illegal. However, the dream was pushing the blame for this unacceptable (illegal) wish by making the person who was getting pushed into death as the one who was doing the wrongful act (parking the car facing the wrong way). The dream however could not succeed in projecting the feelings of anxiety/guilt upon the victim and he still felt it, even though in the manifest dream it was not him but the victim who was doing the illegal parking. This proves Freud's rule that it is easier to reverse and change the visual content of the dream to suit one's wishes but the affect associated with it is much harder to block out.
The house as well as the wood frame symbolized woman. Wood is a typical symbol of woman (matter/material). But as he entered inside her (house/wooden frame) instead of deriving pleasure from the act he met the fate of death. The gaps (gaping splits) that appeared in the wooden frame were symbol of the frightening aspect of female genitals (reminders of castration and death).

Another set of dreams were about being poisoned. While in a hospital the nurse is trying to poison him through the IV, or a waitress is trying to poison through the food she is serving, or there is a bitter debate going on between him and the waitress over a credit card error. In all these the wish to poison the other person or put them on the wrong through giving them the disease and through such an action getting rid of it from one's own self is projected, reversed, and experienced as they are poisoning or harming him.


Tuesday, April 25, 2017

A dream of escaping death by passing it to somebody else

A man getting up in age after a long healthy life, in which he hardly ever was sick, came down with a very aggressive illness and when told he may not live for too long, dreamt the following:

He is in a house where a friend of his son is in great trouble. Some kind of legal trouble.  A  policewoman and a policeman are standing next to him to take him away. But the son's friend does not have proper black pants to wear which once he gets and puts it on they can take him away. The dreamer is offering the young man to take his black trousers - quite a few of which the son's friend is trying - but none of them are quite fitting him. It looks like he is purposely not trying on the right pants and in addition is doing some purposeless wasteful actions delaying everything instead of putting on those pants the way he should and leave with the police.  This is making the dreamer angry that the kid is incompetent and will not amount to anything.

The day before the dreamer had been going through his closet and had noticed how many of his black pants which were just lying there, never worn, because they were too tight, were now fitting him well and as an irony the ones which had been fitting him well, were now too baggy because of the weight loss and it had taken him some time to decide which pants to wear and while he was sifting through those black trousers the thought had passed through his mind that soon he will be wearing none of them.
In the dream this process of deciding upon which black trousers to wear had been projected upon his son's friend and had been made a ground for accusing him of being incompetent and someone who will amount to nothing. Since black, as much as white, shroud/cloth often symbolizes death, the black trousers symbolized death, which the dreamer was trying to escape by pushing it from himself upon the young lad and getting angry and accusing him of incompetence for not readily accepting it.
The two police were death itself, which had come to take him away but which the wish fulfillment had shifted it from himself to the young man. It is he who is in trouble with the police (death) not me. The accusation of incompetence was actually reversal of the realization, in service of the wish fulfillment, that the young kid is too smart to be pressured into accepting the fate of the dying old man upon himself.

Saturday, January 28, 2017

Psychogenic Impotency due to Misogyny

A patient brought the following dream which he labelled as "A dream of hidden erection." 

"The dream lasted almost all night long, or perhaps not,  but it certainly felt that way. Every now and then I woke out of it, startled, to check if my penis was erect or not and then fell back into sleep and resumed the dream."  

The dream:

In am on a long motorcycle ride. A cousin of mine is my companion. She is driving while I am in the sidecar. She is reaching out with her hand to my penis as if it is the motorcycle's pistol (accelerator) grip. There is a great effort going on my part for my not wanting her to know that I am having an erection. I do want to have an erection but not because of her.  The whole emphasis on the dream is to have an erection but for her not to know that it is there. I think when she reaches out to grip the pistol she does not find erection.

The patient has a huge number of cousins so I asked why this particular one was chosen by the dreamwork to take the ride with. The way he talked about the long ride - something that went forever, it left little doubt that it symbolized life journey, in which, by the way, he has been unsuccessful in that he is 38, unmarried, still lives with his mother, has no lasting relationship, has paranoid delusions and hallucinations when off Abilify (a dopamine blocking agent), and has great difficulties in consummating the sexual act if he does find a woman willing to sleep with him (he is good looking, but women after initial attraction can sense that he is not altogether there and break off with him) and has to resort to indirect and deviant fantasies and sexual positions to manage erection and emission. 

"This question has puzzled me too," the patient replied. "But actually I know the answer.  You will recall I have related to you a recurrent dream that I have been having for the last six months or so of another cousin in which I am trying to have sex with her. The most surprising thing about those dreams, which but for some minor details portray the same theme, is that the cousin who I lead into sexual intercourse is someone towards whom I have not a shade of sexual interest, for she is not attractive at all. From our youngest years I never thought of her as attractive. And even the sex in the dream never progresses beyond going through the motions of making love, for I have no feelings for her, and it is done without even taking our clothes off. 

"So this new dream may be just a new version of that recurrent dream. For this cousin is the sister of the cousin with whom I have been making love to, without having any attraction towards, for the last six months." 

Now this recurrent dream we had subjected to analysis in a previous session and had concluded that it expressed hostility towards women, with the cousin representing his mother. The sexual act in it was less an expression of union (eros) and more an assertion of aggressive masculinity, with an intent to humiliate, the essence of which could be summed up in the phrase "I am screwing you." However the fear of getting too aggressive had watered down (repressed) the act by limiting it to just going through the motions of sex, without any feelings, and doing it without taking off clothes. 

We could not solve in the analysis of that earlier recurrent dream as to why this particular cousin was chosen by the dream-work to express his hostility towards women.  

The patient now claimed it was really the cousin in the current dream that was the object of his hostility and her sister had been replacing her because he must have been scared of expressing his hostility towards the one with whom he really had an ax to grind. 

"And what was your beef with her?"

"This cousin is 44 years old now. And I am 38 so she is 6 years older than me. Now when we were young, I was about 10, for almost a year I had to sleep in the same bed with her, because we were living with my aunt, her mother and there was not enough space in their house. I was afraid of the dark. I am afraid of the dark even now. As tough as I am, and fear nothing, I am still afraid of the dark. Even now I cannot fall asleep without the TV on, and my mother hates that - patient lives with his mother - and she comes to my room and cuts it off as soon as I fall asleep. 

"My cousin had a similar attitude towards me when we were sharing the bed. She would not let me keep the light on. And I would be so afraid of the dark I would go and be up against her and she would not like it. She thought so little of me she never faced me so it would always be like ever increasing 'spooning' as night would progress. I would often get erection and she would then push me away.    

"And that would make me so mad. Especially since I had no interest in her, for she was as ugly as her sister, so full of acne that I thought of her as pizza-face."

"Then why would you get erection?"

"Thats a good question. It must have been that I would fall asleep and then the erection would occur not because of her but because of the things I was exposed to during the day. I had access to playboy magazines, a lot of them, they were hidden in a closet, and Marvel Comics and there was one particular comic character, Linda Carter, the wonder woman, whose tight clothes and semi-nude body in pictures would get me so aroused.  So the excitement from those sexually exciting objects from the day I must have been transferring to the cousin who I found not at all unattractive because of sheer physical closeness as I would drift into sleep, where distinctions between one person and another kind of melts.

"In fact in the dream I do want to have an erection but not because of her and that is what I want her to know when she reaches out to check for erection that it is not for her but for others. Yet in my attempt for her not to feel my erection I think I am sabotaging my ability to have erection altogether and ruining my ability to make love normally. I grew up getting put down by my mother and all the women and girls that were always around me. I have so many cousins and aunts. And my inability to perform well as a man with women arises from this anger at them for treating me badly."

"How do you know this is the cause of your sexual difficulties?"

"I have been reading a lot lately about misogynists and there they tell you that they hate women because of bad relationships with their mothers. Verbally or physically abusive mother will turn you off towards all women."

    

Saturday, January 7, 2017

An exhibitionistic dream

A prolific dreamer brought this dream to the session.

I went to Susan and Gary's house. Gary was alive [In reality he passed away last part of the year]. I was surprised that he was alive. Gary said he would show Susan around and then left me alone. I put on one of his t-shirt and I was going to put on some underpants, but it was a pillowcase. Larry then said "Can't we leave you alone" and I said "probably not". Susan then came in. I felt embarrassed and humiliated.  I said I will wash everything and bring it back.

When asked for associations it turned out that the patient thirty years ago had dated Susan, but only a few times. His mother, whose strong influence had prevented him, despite being an exceptionally good artist and a highly intelligent man, from ever getting married, had put a block to his budding love for Susan through making a statement that one should go out only with someone who has a lot in common with oneself. Since Susan is Jewish and he a Catholic, he had given up on her.
He did admit, after some reflection, that this explanation is a superficial one and the real reason he did not pursue Susan further was because she was very popular when young and was going out with a number of boyfriends at the same time that she was dating him, and it was his fear of competition that had held him back. He rather defer in favor of others than face the dread of defeat. He was bullied as a child and has deep fear of other men who he rather placate than fight when confronted.  He has very little confidence in himself and admitted that his dreams are often about his bungling and making other mistakes at work and elsewhere inviting wrath of others. These inadequacies and lack of self confidence were interpreted to be symbolic representation of his lack of confidence in performing sexaully, turning him into a man who had never made love to anybody. "I am not good enough for anybody," is how he put it.
"You think you are at their house to resume your relationship with Susan now that Gary has passed away?"
"I no longer have interest in her. Yes I was interested in her when she was 18 but now I feel no attraction towards her. But you are the doctor."
The last sentence confirmed that my conjecture was right. The repressed wish could not be acknowledged but indirectly; imputing that he is not conscious of this rekindling of interest but I, as his doctor and with my superior medical knowledge, had guessed it correctly.
Gary said he would show Susan around and then left me alone could only be interpreted as wish fulfillment that Gary was exhibiting Susan and making her available. Leaving him alone perhaps alluded to his being permitted by Gary to pursue her but only in onanism not in actual physical contact.
Wearing of Gary's t-shirt and attempting to wear his underpants by pulling them up was interpreted to be his taking Gary's place with Susan.
"But why pillowcase?"
Patient said it was perhaps a wish to sleep in Gary's bed putting his head on his pillow.
I wondered if pillow was symbol of  female genitals, a place to rest head (penis) not unlike how the man's most restful place is inside the vagina (when making love) and finally in mother earth's womb (eternal rest).
Patient said the interpretation was quite likely correct and then added, "You know why I am pulling up the pillow case, because it is the opposite of pulling down the underpants."
Was it then 'reversal', a technique so often used by dreamwork to distort the true state of affairs, in this case to hide his pulling down the underpants, a preliminary step one must take before intercourse.
"Where is the humiliation part coming in from?"
Patient then confessed that he had hid this part of the dream when first telling it to me for it was so ridiculous.
The pillowcase came into the dream because it has no opening at the other end and so his legs could not go through and he was unable to pull it up higher than his knees and was thus forced to expose himself. It was this exposure/exhibitionism which was giving rise to the embarrassment and humiliation.
"How do the exchange of dialogues 'I cannot leave you alone' and 'probably not' add to the meaning of the dream?"
It is accusation by Gary that I cannot be trusted with his wife and I am agreeing with him. It is no different than how when I get really paranoid the security guards start appearing at the windows of my house  and how black cars follow me when I am on the road to keep a tab on me."
Patient all his life has slipped in and out of paranoia.
"Why are you promising them that you will wash the clothes and bring them back?"
"It is washing away the guilt of wishing to have sex with Susan. Though it hardly goes beyond my exposing myself." patient concluded the analysis of the dream.



Monday, October 31, 2016

Conflict between "Sweet Release of Death" and "The Continuing Lure of this Wonderful World"

A divorced man in his forties,who lives a secluded lifestyle after he readily and truthfully cooperated over his marijuana use with the law enforcement, instead of refusing to answer questions and getting a lawyer to lie about it, which caused him to go to jail, leaving him with a deep distrust of society's way of conducting its affairs with honest people, especially by those who are in charge of arresting, prosecuting and judging, and spends most of his waking hours tending after his business, of which he is the owner, and who comes to me primarily to pick up a prescription of Seroquel 100 mg. for his anxiety, insomnia and bouts of depression, for he rather be working than be in my office, suddenly volunteered, which is quite unusual for his reticent self, that he has recurring dreams, and since he has nothing better to report he might as well tell them to me, not because any good will come out of doing so but to fill up the 45-minute session.

The dreams have the same theme though their form changes.  I have to be somewhere for something important, like to take an examination, or go to do a difficult job, but I cannot reach there because of obstacles like I cannot remember where I parked the car, or the car itself is missing if I do find the place where I had left it, or if the car is not missing the keys are. I may even visualize where I had left the keys but don't quite know how to get to them. As for taking the test, I make it to the school but I cannot find my way to the classroom. Or I am on the dock for family vacation but there is no boat. I wait and wait for it to show up. Or my body itself fails upon me. My feet get heavy and my body feels so tired I can hardly move. Or I fall down with no strength to get up. I crawl on all fours to be at the spot where I have to be but without success. 
All of these dreams are very scary. My heart beats real fast. I feel all amped up, confused and clenched. My body feels like it is ready to fight. It usually happens in early morning. Especially if I have been waking up through the night.  

The patient always inhibited did not volunteer any associations.
So with nothing to go on I decided to tell him the psychoanalytic theory as to why we dream of being back in school and being examined and not doing well on it and how it is classified as a typical dream (typical dreams are those that uniformly occur in all of us). We dream of being back in school and dreading to take a test lest we fail when we have something important to do the next day, the worry of which tries to wake us out of sleep. The aim of the dream is to reassure the dreamer - so he can continue to sleep - that don't worry about tomorrow's important thing that you are all hyped up about. Don't lose sleep over it, For you did same kind of worrying over facing examinations in school which the next day you would do quite well on. So just like in the past all that worrying was for naught, your fear over tomorrow's difficult situation will be over nothing too. Freud pointed out that one always dreams of getting tested on a subject that one did quite well in the school not on a subject in which one failed, or at least on one which was not one's favorite.
But patient rejected the interpretation and claimed that nothing about next day's job, or other challenges of life, bother him anymore, for he is too old for all that, and that could not be causing him to go back to school and worry about taking tests in his dreams.
But, then, after a hiatus of time, he said, may be as a young man he did get quite uptight over situations he had to face the next day and would worry whether he will be able to get the job done right or not. "But as I have aged, I can talk myself out of being anxious by telling myself that you have always succeeded in whatever difficulty you have had in the past so why worry about tomorrow today."
So he now talks himself out of the worrying instead of letting the dream do it after falling asleep.
So he did confirm the correctness of Freud's theory of "examination dreams".
When pressed to try and scour in his mind for more associations however faint or far fetched they may seem to him to the other elements of the dream, the only one that came up was to his being stranded on the dock and how his family would go to St. Clair Shores (part of the Great Lakes) every weekend and how they were the happiest days of his life. But in the dream the dock is on a ocean not where the family dock was. And in the dream the family is not around, or was there before but no longer, or they have already left for vacation and waiting for him to join them or they keep coming in and out of the dream picture but so faintly that he cannot be sure what role they are playing.  "It is all very hazy."
With no associations emerging, I fell upon the psychoanalytic theory once again, and conjectured that all these dreams have the same theme: not being able to reach somewhere you want to be so badly because of  obstacles. That place could only be the final resting place, the mother earth's bowel, your mother's womb where you felt safe and happy. It is a wish to be dead and free from life's tensions.
However, this greatest wish of all is naturally accompanied with such fear that you recoil from it and start thinking of all the other less fearful things in life that you rather face than die. These are counter-wishes, the wishes that will be fulfilled by staying alive, the pull of life (moh/maya), the enticement to be eternally entangled in life's obstacles and frustrations instead of dying. And the fear of dying in torn out of context and displaced upon the fear of living (life's vexing and frightening problems) exaggerating its strength, making them look insurmountable, waking you out of sleep in panic.
Patient said this makes lot of sense but proudly declared that he has no fear of dying. and then added, "It is injury that I fear." Obviously the fear of death had been displaced, to lessen its terror, to fear of getting injured. And then further confirmed that we were on right track by saying, "On the other hand my father has great fear of death. He is a very tough man. Hard as a nail, always on task. But whenever he has an ailment he gets very worried. If it is a cough it got to be lung cancer. For me death holds no fear. For I reason if death comes you won't know it, you won't be aware that you are dead. Death is not being in pain anymore, no longer to worry about anything, the final checkout. So I have no fear of death. My feet will no longer hurt from neuropathy that wakes me out of sleep. No suffering will affect me because I will already be dead.
And I must confess doctor that when I have real bad day, a real tough day, I calm myself that 'sweet release of death' will fix it. And it is on those nights that I have these dreams from which I wake up in such a panic. And by the way these dreams are very very vivid. I see everything in color. I see every detail. All the surroundings of whatever I am dreaming of, the trees, the building, they are all so vibrant, the car is brilliantly red, the key shines like silver. Why everything becomes so life like, so colorful? "
"Because they are temptations to lure you back to living. They seem to say when it is such a vibrant, wonderful world why you want to die?"