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This is a clinical report based on the analysis of an adult male engineer who initially presented a profusion of symptoms, a pan-neurosis with marked ego constriction. Developmental phases and their transference manifestations were comingled in a shifting pattern, reconstructed as due to the traumatic situation of rheumatic fever at age 4½. The disease persisted for five to six months, resolving without physical sequelae. This brief communication will focus on the profound personality disturbance enduring after somatic recovery, and the later understanding of the disorder through the atypical adult transference.
The patient's disturbed object relations were reflected in his unusually childish behaviour at the outset of treatment. There was such dependent and incestuous fixation to the still available original objects, especially his mother and his sister, that at first only transference reactions were discerned with frequent acting out at home, as might be seen in child analysis. The patient would treat his wife and mother-in-law like his sister and mother, developing jealous rages in relation to any separation or withholding of gratification. He had numerous somatic complaints, was unable to work or play effectively, and avoided mature sexual activity. He pleaded for ceaseless attendance and reassurance; he demanded that the therapist pick him up and take him to the office to receive extra time, gifts, and feeding. He was fearful of both injury and exploitation in the analysis and would test the therapist with requests for direct advice, joint financial ventures, and homosexual relations. The analysis of his primitive defences and his acting out of transference fantasies was concurrent with the gradual formation of a therapeutic alliance. This led to the increasing intensification and concentration of transference with the amelioration of external symptoms and the development towards transference neurosis.
The transference recapitulated the childhood illnes