Not Waving But Drowning

This paper describes the first two years' treatment of a young man in his midtwenties whom I shall call John. He was referred within days of my mentioning to a GP that I was looking for a training patient, the speed of the referral reflecting the level of desperation both in patient and referrer.

John's complaint on assessment was that he felt really ill most of the time. When pressed for more detail, all he could describe was ‘this terrible tension’. He often feared he was about to die. Although his history gave rise to grave reservations about his suitability as a training patient, he managed to convince me that I had no choice but to take him on, that he was indeed ‘not waving but drowning’ (Stevie Smith) - the first of many strong counter-transference responses I was to have to this patient.

History

One of the most significant aspects of John's story took place on the day he was due to be born, when his two-year-old sister died in his mother's arms and his mother ‘went funny’ (John's words). John was born some three weeks later. It was a difficult birth and he was born with the cord around his neck. He believes that his father never forgave him for not being a girl to replace the one who died (there were four older brothers), and that this accounted for his sadistic violence being particularly directed towards John. A seventh child, a girl, was born two years after John. This was a working-class family with drink and violence featuring large. It is a bleak picture and not surprising that he also wet the bed until his midteens.

In his late teens he formed a relationship with a girl, which resulted in a pregnancy. They lived together for a few years, and it was the impending birth of his son, combined with a trip to Holland to find work (he is a builder), which gave rise to an acute anxiety attack, the start of his ‘illness’. Attempts to escape from this included binge-drinking, tranquilliser abuse (both largely under control by the time he started treatme