A Narcissistic Neurosis with Hypochondriac Symptoms

The following case is one of a young man whom I had the opportunity to have in psychoanalytic treatment during the “suicidal” wave of last year.* He was on the verge of suicide, at any rate, that was the strongest reason for his coming to analysis. He had been diagnosed as manic-depressive psychosis, and when he came to me, at the age of twenty, he had been in that condition for three years. He was a college student, and had lost one year of his course because of his sickness. When analysis was begun, he was suffering from a strong depersonalization feeling in addition to his other symptoms. The depersonalization brought up suicidal tendencies, which increased in strength as he read about suicides of other students in the daily paper. He had tried all kinds of treatment for his trouble, but instead of improving, he had become worse, and was convinced that after so many attempts only one way was left for him—to end his life. There was still another way out, to become psychotic and to be admitted to a hospital. Of this the patient thought quite often and the wish became powerful during the middle of analysis. Prior to the analysis that wish had been present in the form of a fear of becoming psychotic. He had a tremendous fear of death which was not so much a fear of death as of what comes afterward. Since he believed that life does not end with earthly death, he used to imagine himself lying in his grave, the earth pressing him so that he was choking, rats and snakes biting him, and his whole body being pierced with knives. He saw himself being cut to pieces and his head being cracked open. There were many hypochondriac complaints centered around his stomach, bowels, throat, eyes. The strongest was the fear of choking. He considered most of these symptoms derivatives of his masturbation.

The most outstanding symptom of his neurosis was the severe depression which made him try to escape his surroundings and filled him with pessimistic ideas and a lack of interest in the