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I have read R. Dennis Shelby's rich and interesting case report as both a histocan of psychoanalysis and a psychoanalyst, a dual role that I especially enjoy when a case report sparks in me an association to a locus classicus in our literature. This is what happened when I read Shelby's paper, and the text that came to mind was Riviere's (1936) “A Contribution to the Analysis of the Negative Therapeutic Reaction.”
This text rose into my consciousness for several reasons. First, Shelby's patient. Capt. B, is a man who has not been able, in many therapies, to get well, or even to make progress—he is a serial patient—and he makes it clear to Shelby that he does not think he can get well. Second, he is in mourning for his first lover, lost to AIDS, and presents his world, and his inner world, as a scene of devastation, a holocaust, the kind of scene Riviere invoked in her paper. Third, I suspected that Capt. B held himself responsible for a crime, the deterioration into alcoholism and madness of his mother, so that he could not get well himself until he had paid for this crime and redeemed the damaged mother as she existed in his internal world, an inner world where all the objects were, to one degree or another, damaged, deathly, blighted in the plague. She and the others have to be cured before he can be cured, the imperative Riviere studied. But it is just that redemption that feels impossible, for allowing depressive anxieties to become activated in treatment feels to this patient—as Riviere put it—like bringing about the death and disaster he fears. He fears his own suicide or madness will ensue.
Riviere's paper was, of course, one of the key ones in our literature for delineating the internal world of objects and for developing Melanie Klein's notion of the depressive position. In a famous passage. Riviere (1936) wrote:
The content of the depressive position (as Melanie Klein has shown) is the situation in which all ones loved ones within are dead and destroyed, all