Discussions of the case study

Dr. Karme has given us a fascinating presentation of what appears to have been an effective and successful analysis of a young woman whom she has chosen to call Mary. Like most psychoanalytic case presentations, the emphasis of her report is primarily on the content of her interpretations and only secondarily on the nature and quality of her interpersonal interaction with the patient. Implicit in Dr. Karme's presentation is the assumption that enabling Mary to understand the infantile and early childhood roots of her personality difficulties is what led to the patient's ultimate improvement.

Now a question arises in my mind. As I have indicated, most of the interpretive comments in this case report are directed toward what happened in the first two or three years of Mary's life. Mary's mother died when she was two years old, and the major source of Mary's difficulties is assumed to be the loss of her mother and the experiences that she had prior to and immediately following her mother's death. Some emphasis is placed on the traumatic effect on her sexual development of having witnessed the primal scene prior to the age of two, with the result that her image of an “idealized sexually unfulfilled mother imago who was pure and untarnished by sexual desire and who was ‘raped’ against her wishes by Mary's father” left an indelible imprint on Mary's subsequent attitude toward sexuality and men. In addition to blaming her father for his traumatic sexual relations with her mother, Mary is assumed also to have blamed herself, at this early age, for her mother's death.

I am aware that I am not doing justice to all of the meaningful elaborations of these interpretations that Dr. Karme made to Mary, but I give the above only as an example of some of the basic concepts dealt with in Mary's analysis.

Now my question is as follows: What if Dr. Karme, within the