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Dr. Cohen,* a 40-year-old married orthopedic surgeon, father of a son and two daughters, was sent to me for treatment by a psychiatric consultant whom he'd seen because his marital difficulties had escalated after his wife discovered that he had a mistress.
Dr. Cohen was the youngest of the four children born to a lower
middle-class Jewish family in the heart of a large city in the Midwest. His sister was eight years his senior, and his brothers were ten and twelve years older than he, respectively. He was told by his mother that he was, “a late baby,” and he learned that she had procured several abortions prior to his arrival. His mother was described as bright, filled with feeling and energy, but very self-centered, critical, and perfectionistic. She was a housewife who busied herself with friends, card games, and volunteer work. Dr. Cohen felt that his mother had tried to make up for not wanting him, and perhaps for trying to abort him, by overindulging and overstimulating him. He took advantage of that by becoming a tyrant and, even into his teens, he would demand that his mother serve him dinner by imperiously shouting, “eat.”
His father was a burly, talented tradesman, who was a partner in a small business. He was warm, but very erratic and volatile. At times, his playfulness involved pretending to grab his young son's genitals; sometimes he didn't pretend. Dr. Cohen learned, early on, always to be on guard. He admired his father who was tall, strong, and possessed giant spadelike hands. Father was no more gentle with his wife,