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Dr. Josephine Wright, in response to a question, indicated that her write-up carried the analysis up though December 31, 1991.
Dr. Eslee Samberg clarified the total duration of treatment to be three-and-one-half years to that point.
Dr. Dorothy Lieberman expressed some question as to how we should discuss this case; there were two levels, the effects of medication and the effects of psychoanalysis.
Dr. Eslee Samberg observed that these levels were inextricably intertwined. The patient's affective illness, that is, her psychopathology, influenced decisions as to her medication, while the medication influenced her affective illness.
Dr. Renato Almansi commented on the developmental complexity of this patient. On the one hand, her orality was certainly a prominent feature. But yet her anality was equally strong; as a child, she was unable, for example, to leave the bathroom. Her fears regarding retention and loss of her mother are still expressed in anal terms, as in her frequent diarrhea dreams. Likewise on an anal level were her alternations between aggression (sadism) and her masochistic tendencies.
Dr. Herbert Wyman felt that we were here faced with the challenge of a clinical differential diagnosis. Was this patient a borderline personality with manic—depressive features who had been helped by a combination of drugs and psychotherapy, or did she also have a neurotic conflict that had been helped by analytic work?
Dr. Ernest Kafka noted that the patient seemed stalled in the adolescent reworking of her mother's death, part of which was a romanticization of her “Liebestod” in an effort to suppress her awareness of the