Psychoanalytic Work with Children and Adults

Meltzer in Barcelona

Donald Meltzer

• Publisher: Routledge
• Year: 2018
• Topic: Psychology
• eBook ISBN:
  9780429918124
• Subtopic: History & Theory in Psychology
• Index: Psychology

This volume is a collection of seminars and lectures the author gave to the Psychoanalytic Group of Barcelona under Dr Leon Grinberg, and later Dr Benito Lopez, during his visit to Barcelona. The clinical case studies outlined in the book address with typical variety the author's thoughts on clinical work with children and adults, and the numerous issues involved therein, including depression, jealousy, delusional omnipotence and perversion.

Chapter One
Casimiro: life in the rectum— flight towards delusion

A brief personal history

THERAPIST: The patient is a 36-year-old bachelor, the youngest of four brothers and sisters who are, respectively, four, five, and six years older than him. The second sister was diagnosed as schizophrenic and required hospital treatment. The mother, suffering from severe hypochondria, was hardly capable of attending to him as a baby as her hypochondriac state had been very much aggravated by the pregnancy. During the five years that followed his birth, she underwent several operations for cholecystectomy, laparotomy, and hysterectomy, all of which were attributed to the act of giving birth to Casimiro. As a baby he was looked after by his grandparents, with whom his parents had lived since their marriage. When the patient was 1 year old, the grandparents forced the parents to go and live elsewhere; from then on he was looked after by a woman to whose house his mother took him in the mornings and from where she collected him after work late in the evening. He didn't play with other children. At school he often hid from the other children and the teacher, or ran away complaining that the others said or did things to annoy him. He learned things by himself and on his own, rather than in the classroom. At age 12, he was sent to the city to live with an aunt and uncle and was put to work in a bar. However, he found fault with everything and changed jobs frequently, going from one bar or restaurant to another. He completed his national service, doing kitchen work. He then returned home and found employment in a textile factory. This is when he began to consult a variety of doctors, at frequent intervals and for a great diversity of physical ailments. At the hospital clinic he was diagnosed and treated for "psychasthenic syndrome". It was during the following months that delusional ideas of a self-referential and persecutory nature appeared along with the exacerbation of bodily symptoms. At the age of 24, he was admitted to hospital for a period of two months, where he was diagnosed as suffering from schizophrenia. He then continued his treatment as an outpatient, although on an irregular basis. Later, and of his own accord, he consulted other doctors, whom he afterwards accused of not wanting to cure him, and at the same time he became very aggressive, especially towards his parents. At the age of 28, he was once again admitted to a mental hospital; after that he lived at home periodically, but on very bad terms with the rest of the family. For the last six years he has been permanently in hospital.

He has been undergoing psychotherapy with me for the last five months. In the beginning we had two half-hour sessions per week, but for a fortnight now these have been increased to three sessions a week. On several occasions he has interrupted the session before time, leaving in great haste.

MELTZER: Has he been in hospital the whole time?

T: Yes, he hasn't set foot outside in six years.

MELTZER: How well has he adapted to hospital life?

T: In the last three months, when it has become possible to conduct the sessions in the office, his adaptation to it has been acceptable. Before this I saw him in his room, in which he had remained for several months after a breakdown, which involved great agitation and aggression and rejection of others.

MELTZER: So as a patient he adapted badly and was aggressive. During the course of his adaptation, were there no signs of cooperation, of helpfulness?

T: No, none at all. He is always apart from the others and never relates to them spontaneously; he accepts their presence passively.

MELTZER: Nevertheless, he never asks to be allowed out—doesn't he say that he has been imprisoned against his will?

T: No, on the contrary. Whenever he is encouraged to go out, he always complains about how bad he feels and about not being up to it.

MELTZER: He doesn't seem very schizophrenic.... He seems more of a closed personality; during his whole childhood it would seem as if he had never opened up to the world. What does he look like?

T: He's tall and thin. His main characteristic is haste, in both speech and movement. He moves very quickly and awkwardly.

MELTZER: Is he pleasant, humorous?

T: Yes, he's humorous. And also agreeable with me, as he has a pleasant expression and he gets very close to listen to me and usually closes his eyes when I talk. His face is like a caricature: angular with very pronounced features.

MELTZER: How well educated is he? Can he read and write?

T: He can read and write perfectly well. He nearly always has a book with him, and when he went home, he used to come back with a suitcase full of books.

MELTZER: Does he read them?

T: He tries to. They're complicated and technical: about physics and engines. He writes to publishing houses and buys books through the order forms that appear in newspapers and they send him the books by post.

MELTZER: Does he know anything about such subjects; does he know anything about anything? Is he intelligent or pretentious?

T: He shows a lot of interest and determination to know things. What he knows is phrases. It's clear that he has learnt them by heart, word for word. In fact, when he is reading he marks the point he has read to, and these marks can be in the middle of a sentence.

MELTZER: And the impression he gives ... is he pretentious, does he behave like a very busy man, a scientist?

T: No. He never shows off his knowledge about anything. What he does do is move about a lot, but to and fro aimlessly.

MELTZER: With his suitcase?

T: Before, yes. He hasn't done so for some time now. Every now and then he makes notes on a piece of paper, saying he does so in order not to forget what he wants to say to me.

Monday session

P: (He rushes in and starts talking before he sits down) I'm keen when I'm with you, to be at ease and to enjoy it and dare to tell you what is wrong with me ... because all of a sudden I want to think but I get stuck, I have to look at my papers and you prefer to talk about it, don't you? (He takes out some notes and is about to read them.)

T: If you think that I prefer to talk about things, and then you go and read them to me, that might make you feel uncomfortable with me.

P: No, I feel alright here; it's nice here with you. I'm the one that feels bad, here I have (he touches the right-hand side of his chest) like a black creepy-crawly that isn't quite dead, and it was hurting me a while ago. At the moment it has eased off. It's a little animal that self-generates, and since it feeds on me, it doesn't die and I need some sort of medicine that will kill it off so I can defecate it. And here, too (he touches the left-hand side of his chest), I can feel what seems like wood and plastic and that filthy slime that covers a fish's eye; do you remember? And ... I don't know if I have this written down ... (picks up his papers again).

T: You were telling me about your worries, and about what was wrong with you and that the creepy-crawly had eased off.

P: Right, well.... (He hesitates, and then goes on with determination) It's that here in my coronary artery there is also a load of black matter, and my heart aches and these bones here ... Touch these bones here (he takes my hand and places it on the right-hand side of his chest) and see how they are not healthy, hard! ... They're soft and unhealthy. They have carbonic anhydride and residues from what the cell doesn't want. And then there's the creepy-crawly, and I don't know whether there's a better medicine to do away with it, break it down into finer matter—don't you think it would be a good way if it could be managed? And all this wood and the plastic and the fish eye, break it all down into tiny little pieces ... can that be managed?

T: You are asking me to give you a kind of medicine that will do all that, and you think it's possible ...

P: Yes! Yes! What do you think? Will too much relaxation make the tension more violent or not? (Silence) It's just that at present I'm making a really big effort to relax and the valves or some or other nerve in my heart have gone all tense.... When I made the effort, as the nerve was covered in filthy slime, I felt a lot of tension.

T: Did you feel relaxed because of what I said to you?

P: I mean ... well, I don't know if you've realized ... because of ... It's that sometimes they feed us lentils that they've even put some black stuff in ... for Christ's sake, I mean how far are we going to get? And with the beans they go too fucking far. I eat lentils and beans, okay, but they should serve them right; it's that they serve them with what's like tiny bugs all covered in black stuff and when they reach my heart they go through the valves, my cardia gets all tensed up and if this goes on any longer I'm going to die, hey!

T: So, what we give you here in the hospital makes you ill.

P: Well, there are meals that I like ... and if the lentils were done in a nice sauce ... but this cook doesn't like us; she wants to kill us!

(He started off seriously and ends up laughing, amused.)

T: What the cook serves you makes you ill, and I have to remedy this with medicine.

P: Yes, yes. Make all these ills go away. (Long silence)

T: What a terrible situation! In the hospital we give you rotten food, and then you come here day after day asking me for some good medicine, and I still haven't got round to giving it to you.

T: I use the term "good medicine" because he always comes with papers; I have a whole drawer full of his papers, and he always asks me for "good medicine". As regards his case history, I remember that one of his major problems was that he consulted doctors, asking them to prescribe medicine for him and he would then accuse them of not wanting to cure him. As a result, the colleague who treated him before me was faced with a lot of aggression from the patient, who, day after day, begged him to change the treatment he was on. And he used to comply, never knowing which was worse: whether to change the medicine or not. As soon as his treatment was changed, Casimiro would almost instantly feel even worse. However, practically from the moment I started with him, I have never changed his treatment. It was a real discovery the day I said to him, "I'll think it over." Because, really, I didn't know what to do, but he took it very well. He sometimes puts a lot of pressure on me, and I ask him to let me think it over. That way he resigns himself to it That's how the psychotherapy with me started: when I proposed to him that he let me think about the medicine and that meanwhile we could talk about other things.

MELTZER: Yes. The problem here is how to make anything out of all of this. We could think of it in terms of the beta screen. It's almost like a constant flow of quasi-technical terms, which have no meaning. There is very little evidence of any emotional content, apart from the fondness he expresses for relating to the analyst, but more with the idea of being with a colleague and being able to discuss medical matters, and so on.... Although there appears to be a somatic delusion—the little animal and all that—the main point about his relationship with you is that you are clearly the good guy, and the cook is bad, and he has to get rid of all the rotten matter and obtain good matter, the more the better, otherwise he will die. This is the most evident part Therefore, in those fifteen minutes, more or less, of the session, what we observe is this outward flow of speech concerning the somatic delusion about the animal. It would be interesting to stop here and examine this.

My impression is that the process was arrested the moment the patient started saying that he had written it down and he began fiddling around with his papers. The content of his verbal expression was then transformed into a language close to anatomy and physiology. It is in this context that he took your hand and placed it on his chest And it is then that the material about the bad cook and the good medicine emerges.

In my experience, with most schizophrenic patients, during the first few minutes of a session, under the pressure of separation and resentment, there is an upsur...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• PREFACE
• INTRODUCTION
• 1 Casimiro: life in the rectum—flight towards delusion
• 2 Victor: mental pain—anger and silence
• 3 Jordi: from bi- to tridimensionality
• 4 Yolanda: vicissitudes and failures of symbolism
• 5 Herbert: a vocation for perversity
• 6 Cecilia: the end of analysis
• 7 David: sucked into projective identification
• 8 Montse: delusional omnipotence
• 9 Felipe: analytic work on the threshold of the depressive position
• 10 Julio: unborn parts of the personality?
• 11 Sylvia: the exciting servitude of jealousy
• 12 Paula: the fascination of the esoteric world
• ANALYTIC INDEXES