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Multiple sclerosis is a neurological disorder of unknown aetiology characterized by an erratic course of relapses and remissions. The psychoanalytic treatment of one patient for seven and a half years, during a very active stage of the disease, will be reported, suggesting the existence of a specific psychological trigger mechanism associated with the onset of each acute episode of the disease.
Current developments in research on multiple sclerosis most strongly support the possibility of a combined infectious (slow viral) and auto-immune response acting together to stimulate the lesions of multiple sclerosis (Asbury, 1972) ; (Paterson, 1969). It may be that a virus infection causes a release of certain protein derivatives of the invaded nervous tissue so that an auto-immune response is secondarily initiated. If this is so, psychological factors may lead to alterations in the cellular environment that stimulate the onset of the pathological responses that are recognized clinically as acute episodes of multiple sclerosis.
From the time that Charcot (1872–87) noted a possible psychological cause of the disease, reports have continued to appear furthering this speculation, based on anamnestic studies, psychological testing, observations during supportive psychotherapy, and reviews of hospital records.1
The only report of formal psychoanalytic investigation that I have been able to find was by Jelliffe (1921), who reported observations on two multiple sclerosis patients whom he treated psychoanalytically 'for several months'.
Although the later developments in psychoanalytic theory and treatment derived from Freud's work on ego psychology were not available to him, Jelliffe made some interesting observations regarding these two patients and suggested a psychosomatic factor. He noted: (1) the use of archaic symbols in dreams; (2) extremely violent hate material held under the most forced repressions; (3) very marked sister and brother fixations were present; (4) sadisti