Meeting of the Psychoanalytic Association of New York

October 18, 1982. TEMPORARY DISORGANIZATION FACILITATING RECALL AND MASTERY: AN ANALYSIS OF A SYMPTOM. Austin Silber, M.D.

Dr. Silber described a woman who experienced intense anxiety attacks during the middle phase of a ten-year analysis. The analysis of these events led to recall, reconstruction, and integration of previously unrecognized facets of her mental life. Dr. Silber viewed the anxiety attacks as manifestations of the patient's repressed past, as "attempts to remember," in addition to seeing the more usual compromise formations embodied in the symptom. This facilitating view of her symptom enabled analyst and patient to better understand its meaning. The patient was married, in her thirties, and had recently moved from a midwestern town, a move necessitated by her husband's career. She was uncomfortable in the city and was left feeling like an "outsider," a feeling she was familiar with since her family had moved several times when she was a child. When the patient was thirteen her mother had undergone a mastectomy, and she had died seven years later. Her father remarried two years after the mother's death and succumbed to a heart attack a few years after that. The patient married shortly after her father's death and was now working part time, in addition to caring for her children and husband.

The analysis was conducted without significant modifications, but was "punctuated by dramatic regressive episodes … full-blown anxiety attacks." During these attacks the patient would sit up or stand up and stare at the analyst, looking terrified, vulnerable, and "curiously childlike." These attacks spanned five years of her treatment, and all but the first occurred within the analytic setting. The attacks began as the transference neurosis was intensifying and the working alliance had been solidified. Each attack seemed to carry the work of the working alliance had been solidified. Each attack seemed to carry the work of the analysis further back int