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The following brief communication concerns a male patient, Mr. Z., whom I saw for two and a half years from January 1973 through August 1975 for a total of 346 sessions. He was intelligent, was highly motivated, and was making good progress. In the middle of July 1975 I went on my usual summer vacation, resuming practice the last week of August. During this week I saw Mr. Z. three times, our last appointment being on Thursday. The next morning, Friday, he suffered a cerebral hemorrhage on the right side and died at one o'clock the following morning, Saturday. I was informed that day of his death.
I was stunned by the news. His death was sudden and unexpected. I re-examined the case history in my mind. His mother was still alive, in her 70's, and in good health. His father had died of a heart attack about the age of 65. Mr. Z. had been in good health except for allergies. As far as I could recollect, he never missed a session because of illness. Aside from hay fever, he felt well most of the time. Later that day, however, I had a recollection. I remembered that during his Wednesday session he had mentioned briefly that he had been thinking of his epitaph. He repeated this on Thursday but could not associate any further. Then he elaborated on various things he would like to be remembered for when he died. He could imagine the inscription on his tombstone.
I am reporting this incident as substantiation of the hypothesis that patients may have unconscious knowledge of their bodily processes, knowledge that is not accessible to conscious thinking.3,4 We might even entertain the possibility of inferring the presence of physical pathology, even if it does not yet appear as a physical symptom. Eissler reports a case in which he inferred the presence of a malignancy.