Other Psychotic Treatment and Posttreatment Reactions

Under the subtitle, “Those Wrecked by Success,” Freud (1916) called attention to a particular character type met with in psychoanalytic work, those people who “occasionally fall ill precisely when a deeply-rooted and long-cherished wish has come to fulfillment” (p. 316). He accounted for this “surprising, and, indeed bewildering” (p. 316) turn of events—at least in terms of the dictates of ordinary common sense—as follows: “[O]n closer examination we shall reflect that it is not at all unusual for the ego to tolerate a wish as harmless so long as it exists in phantasy alone and seems remote from fulfillment, whereas the ego will defend itself hotly against such a wish as soon as it approaches fulfillment and threatens to become a reality” (pp. 317-318). Freud's case illustrations consisted of two very brief vignettes from individuals who had consulted with him, plus more extended examples from literature—Shakespeare's Lady Macbeth and Ibsen's Rebecca Gamvik from Rosmersholm. In the concluding sentence of his discussion, Freud linked this phenomenon to the Oedipal dynamic: “Psychoanalytic work teaches that the forces of conscience which induce illness in consequence of success, instead of, as normally, in consequence of frustration, are closely connected with the Oedipus complex, the relation to father and mother—as perhaps, indeed, is our sense of guilt in general” (p. 331).

It is perhaps because of this last statement—the close tying of this phenomenon of being wrecked by success to the vicissitudes of Oedipal, higher-level conflict-that such patients have often been given favorable prognoses for psychoanalytic treatment, despite the total shambles that their illness may have made of their lives. Within our project sample, we had two patients, the Alcoholic Heir and the Bitter Spinster, who seemed quite clearly of this type. Though the one was severely alcoholic, and both were seen as individuals with paranoid potential and