“That Darkness—Is About to Pass”: The Treatment of a Dying Patient

This paper describes the psychoanalytic psychotherapy of a middle-aged woman ill with cancer. The patient entered treatment frightened, depressed, and feeling unable to endure the narcissistic humiliation of chemotherapy. She wished actively to abandon the struggle for life, in spite of the real possibility of a significant remission. Passive longings dominated her thoughts, but a good family situation mobilized a wish to continue the struggle. It was the immediate goal of the treatment to strengthen that wish by mobilizing healthy narcissistic cathexes that would facilitate feelings of self-esteem, personal pride, and pleasure in living.

Treatment was conducted on a twice-weekly basis for almost three years. After two years it was determined that the illness was terminal, and the patient expressed the wish to be helped to “let go,” precisely the reverse of the goal toward which we had previously been working.

The paper describes the processes by which the patient was able to use the two stages of her treatment to accomplish her goals: to feel greater pride in life and then, with the help of a physician, to die as she had wished. Her final messages reflected her feeling that her suicide was a loving and estimable act.