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Dr. Pearson was a resident in psychiatry when she treated Mrs. X, a fifty-year-old married mother of two teenage children, for one year in an inpatient setting. This was Mrs. X's first hospitalization and came after ten years of psychotherapy with Dr. Z. Mrs. X, although externally accomplished, experienced an overwhelming sense of emptiness, had chaotic interpersonal relationships, and engaged in secret, self-mutilating behavior. She first came to Dr. Z after ending a dependent relationship with a nun, which caused longstanding difficulties to flare up. She became very dependent on Dr. Z over the course of ten years treatment. She hid the depths of her involvement for six years, which Dr. Z overlooked because of Dr. Z's own needs. When Dr. Z tried to work on the problem, Mrs. X became anxious and fragmented. She revealed other secrets, including an image of herself as split between a helpless undernourished infant who was slowly dying (the "real self") and an outwardly capable, dependable, but punitive gorilla (the "false self"). The gorilla self included behaviors such as abuse of alcohol and medications, self-mutilation with cigarettes and sharp objects, and ingestion of insecticides.
Dr. Pearson documents this same "split" in the patient's early life: an externally successful, wealthy family and the dependable structure of Catholic schools covering a chaotic family life and an alcoholic, impulse-ridden, sexually provocative father. Mrs. X found refuge in the church, in her intellect, in her identity as a teacher, and