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Received as The Forum went to press.
The response of the unconscious to impasse is dramatic. Besides being an escape it is also a call for help. Depression, attempt at suicide, psychosis, alcoholism, and somatic illness such as coronary occlusion, status asthmaticus, etc., all represent a regression or retreat or a cry for help. Somatic illness like a suicide attempt or any other of the mechanisms of the unconscious may be overplayed and result in death.
In my thirty-three years of practice I have witnessed a number of deaths at impasse. Usually my view in retrospect as a psychopathologist like that of any pathologist is better than my early appreciation of a man's need and of how I might fill it When we recognize the urgency of the cry for help early enough we can sometimes satisfy the need and perhaps prevent death.
This past year a dependent artist of 44 was sent to me because of narcotic addiction. He had had a coronary infarction two years before and had taken morphine and Demerol in large doses ever since. His activities were grossly restricted. He complained of abdominal distress and occasionally of chest pain if he did not have adequate narcotics. I placed him in a locked ward where his choices and activities were restricted and controlled and I confronted him with his anger and greed. He promptly gave up his needs for drugs and became interested in reactivating himself. He returned home after a month of increasing activity during his confinement.
In the home situation with its increased pleasures and demands he did well until he wanted his therapist and could not get him quickly enough and became angry. He had chest pain and wanted to go back to the locked ward. I gave him extra attention and his pain abated when I was with him, only to return when I left. I placed him in an open hospital instead of the locked ward that he pleaded for and there his pain was only relieved by my presence. Heroic doses of morphine did not control it. His greedy demand for me and h