Discussion

First I would like to say that this is an unusually interesting case, clearly written and deeply thought out, with rich clinical material that makes the patient come alive on the page. It is also gratifying to read a case in which there is such a sense of analytic momentum and therapeutic benefit.

As a framework for my remarks I will begin with the dynamics of the case. I agree with Dr. Wright that the childhood history and the analytic material indicate strong oral dependent needs, problems in separating from mother, and derivatives of the oral triad. Feelings of damage, low self-esteem, and her masochistic trends may well have been reinforced by the burn in childhood. I also suspect that her anger toward mother was powerfully reinforced by fantasies that mother had made her defective, or had not protected her adequately from harm. The prominent derivatives of anality, in references to shit, dirt, and diarrhea suggest to me the strength of her repressed anger. Her preoccupation with contaminants that get trapped within one's body causing deterioration and death suggests fantasies of incorporated internal persecutors for her oral-sadistic fantasies concerning mother's breasts. Significantly after interpretation, in the first nine months of the analysis, of her defenses against grieving for mother, and of her conflicts surrounding separation and loss, frank oedipal material emerged. Now fantasies of deterioration and death, originally based on oral-sadistic wishes, could be seen to be reinforced by hysterical identifications with her dying mother, as talion punishment for the oedipal crime. I think this is an important component in the nocturnal anxiety attacks that, along with her depression, were so prominent when she began treatment. So I agree with Dr. Wright that in this patient we see an oedipal constellation strongly colored by preoedipal issues.