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Presenter: The patient came in, greeted me, and lay down on the couch. Her speech was interspersed with sighs and weeping. She complained that she woke up several times during the night. During the day she is unable to take care of her house; she has to stay in bed most of the time and needs her mother with her all the time to comfort her. Although this calms her down, it has been a cause of worry and annoyance to her husband.
Bion: Do you get the impression that she suffers from insomnia?
P: Yes. During the three years she has been coming to me she has had alternating states of insomnia and sleeping well.
B: I don't know what all these sighs and tears are about, but supposedly the patient is in a state of mind in which people are when they are awake. The fact that a person is what we call ‘asleep’ could also be described as being ‘in a different state of mind’. Patients say they had a dream and did this, that or the other; it is quite useful if we can interpret these ‘remains’, but suppose the patient doesn't have any dreams. Why does this patient not want to ‘go to sleep’? Where does she go? And where does she go when she apparently sleeps well?
P: She continued with her complaints, telling me that her husband wants her to look after the house without her mother's interference. I pointed out that her mother's presence had not resolved her feelings of despair and abandonment. I said, “I think your despair is based on the need to know what this despair is about.”
B: This crops up with some frequency. It is quite often necessary to point out to patients that they can have feelings of despair about despair, and they can be very angry about it. Putting it as a more general principle: patients hate having feelings at all; whether
they are feelings of anger or despair or depression, they are all hated. They would like the analyst to ‘cure’ them or make them incapable of having feelings.
P: She changed her position on the couch and sat up facing me. She said that during the