The Missing Factor: A Young Man's Search for a Masculine Identity

Patient A. was in a state of suicidal despair when I first saw him in August 1990. He had made a serious suicide attempt just after sitting his finals at Queens College Belfast the previous summer, and two subsequent attempts in the intervening year. An anxious, intense, young man of 22 with a strikingly pale complexion and wiry red hair, A. talked articulately and with urgency about his long-standing unhappiness and depression, his increasing and painful sense of self-consciousness, and his compulsion to exercise excessively and to control his diet so rigidly that he had lost quite a lot of weight. He was attracted to various dietary regimes that purported to promote health and happiness in his search for what he felt was the missing factor which, if he could find it and ingest it, would cure his depression. In a sense, he was conveying his awareness of deficiencies in himself and in his development, as well as his wish for a magical solution. He also spoke with shame and anxiety about his lack of experience with girls, about feeling very shy and frightened of the possibility of a sexual encounter, and feeling intensely sensitive to rejection.

The notion of the missing factor struck me as a rather evocative one for this young man in whom important aspects of adolescent and earlier development were ‘missing’ or incompletely negotiated. In his evident hunger to talk and to be listened to, he conveyed an absence of a sense of containment, neither feeling safely contained within his body nor feeling himself to be in a relationship with an internal containing and sustaining object. His self-consciousness, his punishing attitude towards his body and his fear of sexual relationships conveyed the sense of ‘missing factors’ in his masculine identity. It seemed, too, that his sense of himself as an autonomous adult was in a way missing or not properly developed, so that he felt himself to be very fragile and precarious - people could see through him and see nothing in him, an