Clinical Communications Turning Points in the Analysis of a Case of Alcoholism

The analysis from which I wish to quote a brief fragment is that of an unmarried man of thirty-three years. His social adjustment had been outwardly satisfactory; he had made a brilliant record in college, held responsible positions after graduation, and was liked by members of both sexes. In college he had indulged in an occasional drinking bout, and during his last year and following graduation, he had had transient depressions. This latter tendency was increased following the death of his mother several years later, but neither drinking nor depression became serious problems until the suicide of his younger sister two years before the beginning of his analysis. At this time he became deeply depressed and began to drink heavily. The drinking, mostly solitary, became a daily habit and continued without any interruption. Depression also continued as a persistent symptom.

Nine months before coming for treatment, attacks of anxiety began to manifest themselves. There were several attacks, with generalized tremor and palpitation, and one with purely mental content of fear of going insane. Besides these, there had been numerous attacks of slight fibrillary twitchings in the muscles of the back of the neck and about the mouth. He became alarmed that these symptoms might herald the onset of organic nervous deterioration, and it was this fear, rather than any real desire to rid himself of his neurosis, that drove him to seek the help of an analyst. The attacks of anxiety and isolated tremors were, for the most part, elicited by stimulation of the oral zone. The first and severest attack, as well as a subsequent one, occurred as he was about to drink a milkshake. Most of the others occurred in relation to meals. The recurrence of attacks after breakfast, as he was lighting a cigarette, led to his total abstinence from coffee and tobacco on the theory that they were responsible for this phenomenon.

Radó, in his discussion of alcoholism, stresses the need of instit