Meetings of the New York Psychoanalytic Society

April 13, 1954. RECONSTRUCTION OF A TRAUMATIC CHILDHOOD EVENT IN A CASE OF DEREALIZATION. Victor H. Rosen, M.D.

A twenty-seven-year-old professional man, whose main complaint was a feeling of unreality, struggled with suicidal thoughts and had many bizarre somatic sensations, among them a feeling of choking as if the upper and lower parts of his body were being separated. These symptoms started suddenly after he broke an engagement to marry. He developed the obsessive fantasy that girls with whom he had sexual relations would be found strangled in their rooms and he would be unable to provide an alibi. His mother was an unstable woman subject to depressions. The patient accused her of incestuous feelings toward him. The father tried to dominate the patient by financial pressure.

Because of marked feelings of unreality on the couch which served the resistances, the patient was treated vis-à-vis. The turning point of the treatment, which lasted four years, came after the analyst interrupted treatment several months because the patient refused to pay his bills, claiming they had no reality. When the treatment was resumed the patient complained of wry neck, as if his head were being twisted off. He talked about Venetian blind ropes which seemed like a hangman's rope to him. In association to a dream he mentioned that his father did not allow iodine in the house and had bathroom locks removed from the door. At this point it became clear that the patient must have witnessed a suicidal attempt on his mother's part in early childhood. The patient responded to this reconstruction with very severe emotion, following which he began to improve. He then began to discuss his masturbation fantasies, acknowledging that he considered the payment of the fee as a punishment for masturbation. His father confirmed the mother's suicidal attempt which occurred when the patient was three, and which had been treated by the family as a 'bad dream' whenever he mentioned it.