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Presenter: The patient is thirty-two years old, a paediatrician, and comes from the north of Brazil. His father is violent; his mother was sickly and died when he was seven. His is a big family. As is usual in the north, one of the children was chosen to study for the priesthood, and he was that one. He left the church school in a state of revolt, was able to pay to study medicine, and became a paediatrician. While he was still living in the north he made three suicide attempts: twice by poison and once by shooting. He came here two years ago, got married, and has a baby daughter.
He first came to me three days before my vacation was due to begin, having already cancelled an arranged consultation. I had the impression that he was afraid of coming, and during the interview I understood why. He told me that when he was a little boy he returned home after a vacation and found that his mother had died. As I was due to go on vacation I think he was afraid of establishing contact with me and then being left alone. He wanted to be quite sure which day I would be back and when I would be able to see him again.
Bion: Don't you think it is very significant that although he has all the drugs of a pharmacopoeia at his disposal, he can't poison himself properly? When he has a gun, he can't even shoot himself. So he's a bungler. What reason would he have for supposing he would be any good at anything? If there is something that anybody ought to be able to do, it is to kill themselves – there isn't even any opposition – there is nothing between him and the person he wants to murder. So if this patient can't even murder himself, what do you think he could do?
P: What he can do is to blackmail.
B: One wonders if he would be any good at that either. On what grounds does he think that he can bring up a family? Why does he
think he can support a family? I am not suggesting that you can say any of these things to the patient, but I think we can consider them here. Do you consider that su