You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
June 2, 1986. FURTHER REFLECTIONS ON A "A TURTLE'S PROGRESS" FROM Psychoanalysis and Its Discontents. John E. Gedo, M.D.
Dr. Gedo laid the groundwork for this open forum by elaborating on the case described in "A Turtle's Progress," from his book, Psychoanalysis and Its Discontents. He stated that the case is representative of analyses with severely disturbed patients who require early, frequent, and active intervention on the part of the analyst in order to get beyond the character armor and paranoia. Dr. Gedo emphasized that he has accumulated sufficient experience to feel confident that such an approach is necessary with these patients and that it does not diminish subsequent opportunities to interpret the developing transference in all its customary manifestations. Referring to "A Turtle's Progress" as an illustrative example, he described the patient's extreme narcissistic fragility, limited communication skills, intense feelings of humiliation, paranoid reactions, and peculiar cognitive deficit. The patient was symbiotically dependent upon his wife to interpret many social realities, even the essential meaning of a narrative or the story lines and motivations of characters in motion pictures they would see together. In extra-analytic situations, the patient was reasonably successful at hiding this cognitive deficit from others, including supervisors. Nevertheless, his occupational and social relationships were hindered, and he was constantly afraid of being discovered and revealed as a fraud.
For the first two years of treatment, he would become acutely anxious and rageful whenever the analyst made any comments that touched upon his deficits. During this time, the patient clung to his wife's view of the world. Gradually, he became able to acknowledge his deficits, and to depend less upon his wife, more upon the analyst, and eventually more upon himself as he acquired some of the cognitive tools he had been missing. Only after the patient's symbiotic n