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Presenter: The patient is a twenty-four-year-old man, a hospital physician. He arrived ten minutes late for the session. He started by saying, “I was downstairs. I hesitated to come up to the consulting room. I went to buy some cigarettes. I came to the consulting room but I stopped. I couldn't stay here. I took the elevator, not feeling well I thought it would be too difficult for me to come to the session. I thought that if I stayed here I would die. I almost went away. I really thought it was going to be too hard for me”. He kept on talking but changed the subject. “As I told you on Thursday (the previous session – this session was on Saturday) I was afraid of being on duty on Friday – it was a twelve-hour job. When I finally went on duty it was too hard for me”. This was the first duty he had been on for four months – it was impossible for him owing to his anxiety.
Bion: Was he physically ill?
P: He thought so but in fact he was suffering an anxiety crisis. He said that while he was talking with the other doctors he had the feeling that he was going to be ill.
M: Would it not be interesting to interrupt the patient at this point? I feel there is too much material.
B: Yes, you often get a patient who, in contrast to saying nothing at all, floods you with information. I gather that this is happening here. Ordinarily one expects there to be some kind of structure to which the total communication conforms. But if the patient is always changing the subject he isn't really conversing; he is flooding you with free associations, not assisting you, not keeping you informed so much as keeping you unable to give an interpretation. But I don't think I would be inclined to stop him until I got a clearer idea of what
he was up to. I suspect – I don't know of course; it's just a suspicion working in my mind – that this patient is one of those people who take up medicine because they are so frightened of some catastrophe or disaster. He can then converse with other doctors and th