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Dr Martindale has offered us an interesting and stimulating presentation which has given an engaging flavour of his work with his patient.
A number of issues have been stirred up by this paper and it was at first difficult to know which to single out as leading to a productive debate on this sad and complicated, but fascinating young adult. I then decided to begin by taking a closer look at her background, in the hope of detecting some developmental signs which might help to account for B's presenting problem, i.e. the homosexual conflicts leading to severe anxiety, escalating to panic, with its physical concomitants.
The portrait of her parents, as depicted by B, may already give us a glimpse into her inner world. It would be plausible to postulate an unconscious identification with an incomplete (which I take as a synonym for castrated) father, albeit consciously repudiated, and an idealization of a powerful, ostensibly altruistic mother, who is yet unable to relinquish her daughters. As though to rub salt in the wound, her mother had no qualms in continuing to vilify the father in the picture she gave of him to her daughter(s).
To complicate matters, B's two early memories of being usurped by the younger sister, in addition to the sister's physical endowment and special closeness to mother, seem to have paved the way for the development of a distorted body image coupled to a deep sense of self-consciousness and worthlessness. It was not surprising, therefore, to discover a fierce competition with women who, in her view, have the perfect body and get a better deal: exactly those things she has been deprived of and longs for.
B's conscious unhappiness, however, appears to have begun when she was about ten, coinciding with her turning away and rebelling against father; and the subsequent adolescent years have been marred by body preoccupations and a gradual decline in her academic standards.
From what we have learnt so far, it is not easy to speculate as to the quality o