Discussion

Dr. Wright has provided us with a beautifully written account of her 3 1/2-year treatment of M, a patient with formidable psychopathology as well as impressive capacities and strengths. I admire Dr. Wright's determination and fortitude in attempting to analyze this patient who, throughout much of her treatment, must have seemed overwhelming in her intensity, urgency, and profusion of associations. Dr. Wright raises several questions in her own discussion, including the very fundamental one as to whether or not psychoanalysis is the appropriate treatment for M. Dr. Wright continues to believe that psychoanalysis is the treatment of choice, a conviction which I share. In my discussion, I will explain why I think this is so. I will also comment on M's diagnosis, the indications for medication, and explore the layering of preoedipal and oedipal material which is so prominent in this case. I will touch on what is most striking to me about M: her affective instability, her relentless need to suffer, her sensitivity to separation, and her pressure to enact with Dr. Wright the preoedipal as well as positive and negative oedipal determinants of the maternal transference.

M began treatment with Dr. Wright at the age of 25, complaining of a life-long feeling of anxiety and despair; a ten-year feeling of unconnectedness and drifting which began when her mother died of breast cancer; a two-year feeling of intensified depression dating to the loss of her college therapist and boyfriend; and more recent feelings of deterioration, growing old, being unloved, and feeling that she will soon die. The information about M's childhood is sketchy but we learn, among other details, that she felt defective, dirty, unattractive, clumsy, alienated, and disliked by other children. She clung to her mother and felt ignored by her father. There are three older siblings who remain shadowy figures. Her mother's two-year illness