Family Role and Identity Formation

In this paper a patient will be described whose illness can be best understood as a failed attempt to establish an identity of her own as opposed to one thrust upon her by her family's need.

Miss F. came to analysis at the age of 30, having been psychiatrically ill for six years. Her main presenting symptoms were phobic, and included fears of travelling and of being poisoned. Both fears were very incapacitating and resulted in an inability to work. She lived with her mother and father, never went out except occasionally to the local library, and could not eat or drink anything that her mother had not first tasted. She attended for treatment in a taxi, accompanied by her mother.

Her greatest fear was of blindness, and she was also afraid of insanity and was unsure of the correctness of her perceptions. She had been temporarily certified once on account of an anorexia nervosa which endangered her life, and had spent several months in a mental hospital. She thought that at times she had had visual hallucinations, but remained uncertain about this.

In appearance Miss F was a tall, gaunt woman with long hair who walked in a disjointed way as though liable to fall to pieces; it was difficult to imagine her as the successful model she had once been. Her anxious and rather haggard face readily broke into a charming smile, and she talked incessantly and irrepressibly in a pleasant upper middle class voice. She was untidily dressed and her clothes were dirty.

The Family

Her parents were working-class country people who came to London soon after they were married. The husband had completed his apprenticeship as a butcher, and had the prospect of a good job, but was persuaded by his wife to abandon this and to move to London because her own brothers and sisters were migrating there. They came to live 'below stairs' in a West End house where the wife acted as housekeeper; the husband took employment as a railway porter.

One effect of this move was to instil into t