A Case Report: Part I

This paper was written many years ago. Publication was considered at that time, but it was decided that it might be imprudent to proceed. Ethical issues, particularly the need to protect the confidentiality of the patient's communications, were judged at that time to be paramount.

Now, so many years later, the passing of time seems to have sufficiently dimmed the immediacy of those communications. That earlier objection to publishing this case is now less persuasive.

Nevertheless, extreme care has been taken to protect confidentiality. Identities have been meticulously disguised. Biographical material has been excised from the original paper or so modified as to become unidentifiable. Despite these modifications, I have attempted to retain the unique flavor of our work. No two analysts are alike. The way they each work reflects their individuality. The same goes for all patients. This uniqueness of each course of analytic therapy is its own reward. It is my belief that in appreciating this uniqueness, the analyst discovers the greatest satisfaction the profession can confer.

My earliest recollection of Shirley S. is that she put me on guard immediately. This, of course, says as much about me, as it does about her. She blew in like a hurricane shorn of its winds, its insides roiling and heaving, its surface frazzled and in motion, not a spectacle, but an event. There was no question about her being miserable. It was misery on a grand scale that spoke in a loud voice. It did not beg for help; it demanded attention, and it did so, incongruously, in the genteel vowels of upper-class England.

Dr. X., the referring physician, a woman analyst, had seen the patient once, after she had been sent to her by a general practitioner. There was a history of intractable vomiting that had occurred on several occasions in the course of at least ten years, and for which hospitilization in a medical