Sweating it out

I HAVE ENTITLED MY PAPER "SWEATING IT OUT" BECAUSE THIS PATIENT had had as one of his symptoms profuse and offensively smelling sweating—really smelling of fear—and the last few months of the analysis he again sweated a few times on the couch. And those last months one could say he was really "sweating it out." Freud once observed that at the end of the analysis patients sometimes revert temporarily to the early symptoms. This has not been frequently my experience. More often—and this was markedly the case with that patient—old themes are taken up. Anxieties are reawakened, defenses of the past remobilized in sessions, but not necessarily resulting in the reappearance of symptoms; as in this patient, termination was a time of working through, sweating it out, at times with a great deal of pain. What he had to work through was the final facing of separateness and separation with all the attendant anxieties and depression. The patient had always been exceedingly sensitive to separation. In the early years of his analysis he was regularly physically ill before or during holidays.

He was virtually symptom free over several years. When he started, his sexual life was in a mess. He was very perverse, mostly in fantasy, but also in acting out. He was, in turn, grandiose and feeling disintegrated by anxiety, occasionally transitorily hallucinating. In previously describing this patient, I emphasized his pathological and excessive use of projective identification and identified the moment when he came out of it, which was one of the turning points of his analysis. He is now very happily married with a family of two children, very successful in his profession, a very gifted and respected physicist.

He remained a fairly anxious person and is still inhibited in reading and writing, though in the last few years he started writing papers. (As a child he was so inhibited intellectually that he was discouraged from