Ms. C: A Clinical Vignette

A thirty-five-year-old professional woman sought psychoanalysis because of chronic feelings of depression, characterized by poor self-esteem, low energy, social isolation, and weight fluctuations of 20 to 30 pounds. She had difficulty in dating men and felt hopeless about ever having a family of her own. A few years before she began analysis, a serious relationship with a man had ended. It had been marked by power struggles and growing frustration over what she felt to be his self-involvement and failure to respond to her needs. She had a successful career and functioned well at work; however, she did not feel close to people and her friendships were limited.

The patient's childhood was remarkably unhappy. She suffered at the hands of a very disturbed, controlling mother. According to the patient, mother consistently ignored her childrens' needs while gratifving her own. She was a strict disciplinarian, frequently screaming at or hitting the patient and her sibling. On occasion she deprived them of food. As a young child the patient reacted to mother's rigid authoritarianism by throwing tantrums and refusing to comply. Later she became obedient and submissive to keep mother from screaming. As an adolescent she developed medical problems which her mother dismissed as mental fabrications. During adolescence she felt ugly and depressed and occasionally had suicidal thoughts, although she never made any suicide attempts.

A particularly significant occurrence during adolescence was the patient's discovery that she was an illegitimate child. She confronted mother with this discovery and learned from her the identity of her biological father. Mother made the patient promise to keep it a secret. Her father was a family friend who had treated the patient in very special ways when she was a child, giving her money and other presents. Mother's husband was experienced as weak, ineffective, and dominated by his wife.