Some Notes on a Dying Patient

A few years ago I wrote a paper about an obsessional man who needed to be 'kept' (5). The paper dealt with certain aspects of the first four years of his analysis, leading up to his first tentative attempts to earn his living—the only attempts (except for some months during the war) for sixteen years. This paper is the sequel.

Fairly early on in his analysis I formed the opinion that this man's development would inevitably follow one of two lines: he would either become a business magnate, and probably local mayor, or he would end in a mental hospital. He did end in a hospital, though not a mental hospital. After achieving his heart's desire as the highly successful owner-manager of a hardware store for nearly a year he developed cancer of the lung and died.

I am writing this paper because his death and the manner of it seem to me to raise a whole host of queries to which as yet we have no answer. It would, I think, be better if I tell my story first and put my queries afterwards, and I will therefore try to give a brief sketch of his case up to the time of the outbreak of his physical illness, stressing in particular the aspects which are pertinent to my theme. I will then describe in more detail the last few sessions which I had with him shortly before he died.

Mr. A. came to me for analysis in 1946 with a severe neurosis of such long standing that it seemed to have become part of his total personality. It was very doubtful whether analysis could do much for a chronic case of this type. To give all his symptoms would take up far too much time, and I have already described them in the first paper ('An Obsessional Man's Need to be Kept'). Suffice it to say that, when he first came to me, he was a very ill man mentally, suffering not only from every type of obsessional ritual—continuous handwashing, etc.—but also from delusions of a paranoid nature. When he started analysis, he was spending his time shut up in his bedroom, leaving it only to come to analysis.