Psychotherapy > Case Study

A Case with a Legacy

By I.D. Hora

The best method to acquire the psychoanalytical technique is to allow yourself to be psychoanalyzed. Just as with swimming, there's nothing you can do unless you go beyond theoretical information and dare dive to see the why and the how for  yourself...

No matter how much we tried to simplify things, when the uninitiated are introduced to psychoanalyzed cases, we have to keep in mind that eloquence alone cannot replace the live experience of  self-analysis. Our readers will certainly understand the impediment. 

An example of successful analysis in record time will get us somewhat acquainted with the psychoanalytical technique. Several  other illustrations will follow, without pretending to bring the subject to a close. 

Ours is the case of a lady we shall call Amelia, about 35, married and the mother of a 10-year old; she works for  an important company in X. The woman complains of a troublesome symptom: persistent insomnia. "persistent", as it defies any kind of conventional treatment. "Night after night, I make desperate efforts to sleep". She succeeds towards dawn, when, actually exhausted, she finally falls asleep.

To her sleeplessness, there adds a weird mood of apprehension, an uneasiness psychoanalysts use to call anxiety. My question is:
- What brings about this condition?
- Something like an anticipation; as if I were expecting something and were not sure what...
- Would you please try to remember some circumstance when you experienced the  same thing? I insist.
- Exams, maybe, when I was at school? Or, Christmas Eve rather, when I used to wait for Santa. Or, why not, when I would plan a trip or a celebration and would eagerly count every minute to it...
- Any trouble at work, I ask, any tests, exams for a higher position or things like that?
- None, came the unwavering reply, nothing special.

I then inquire about Amelia's economic standing. I find both she and her husband earn enough to make a decent living. There would be room for some additional income, though. "You know how it goes", she adds, " the more you have, the more you want".

I consider the associations Amelia has made concerning her anxiety. Exams, Christmas, Santa, family celebrations and reunions with friends etc. Anxiety is obviously a state of anticipation, just like when  you are looking forward to an extremely important event you crave for. But what could that event be? Let us also keep in mind her insomnia, suggesting the same powerful, irrepressible experience. Sleeplessness and  anxiety go hand in hand. Both are indicative of an intense concentration of emotions towards a certain direction we expect a lot from...

Psychoanalysts often need moments of insight, more precisely the  feeling they know what a certain case is about. Theirs is an intuitive job (which we also call empathy). That "clairvoyance" urges us to articulate it and, obviously, ask patients the key question giving instant clarification to the nature of their disturbance. In this case, the question I asked was:
- Do you happen to have a dying relative, are you looking ahead to some inheritance?
The answer was immediate, betraying Amelia's bewilderment:
- Yes! It's my uncle, she assured me, he's over 80 and he's awfully rich!
- Are you his heiress?
- His one and only heir!, she specified.
- Your case is solved then, I replied. Your eagerness to get the inheritance is to blame for both your insomnia and your anxiety. Given your uncle's age, you think the long dreamed-of moment for getting your heritage is drawing nearer by the day. Hence your anxious anticipation and sleeplessness, betraying your wish for this moment to arrive as soon as possible, just as you used to eagerly wait for your Christmas presents.

Please notice that this case procedure didn't include the
free association method. The explanation is the entire dialogue was centred on a specific symptom.

- Not all cases are solved on the first session. The case above was a "fortunate one", which is a rare occasion. But let us keep one thing in mind: although aware of her own wish (to lay hands on the inheritance), the patient was unable to relate it to her symptoms; hence her concern for her own health.

The meaning of her symptoms clarified, Amelia was reassured (the enigma of the disease itself is reason for concern) and she was finally able to get back her wholesome sleep.

This paper has been first published in OMEN - the psychoanalytic journal edited by the Romanian Association for Psychoanalysis Promotion - AROPA.
English translation by Mihaela Cristea.


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