XI. On Resistance

The investigation of the possible psychological origins of illness, in general practice as elsewhere, soon runs into difficulties. The idea that an infant self survives within the adult, and that this infant suffers intense separation anxieties, can seem incomprehensible, and attempts at discussion are resisted. Patients who are puzzled but interested are very different from those who reply with irritable denial, But the respect felt for the achievements of science and for the doctor who personifies them, only carries a limited distance when it comes to the problem of inner reality.

For example, a married man of fifty-five reported four days' chest pain, typical of coronary thrombosis. He was admitted to hospital, but discharged after four days with the diagnosis of ‘anxiety state’. After this, I discussed with him the possible emotional background of his illness. As he could not think of anything that had been upsetting him, I asked if there had been a recent death in the family. He replied, somewhat bewildered, that his father had died four days ago, but that could not be relevant as it happened after his chest pain incident. But he went on to say that his father had a coronary thrombosis a year earlier and had since been an invalid, slowly declining in health with loss of weight and mobility, so that his death had not come as a surprise.

I thought that the patient would now understand that his father's illness was significant for his own anxiety state. But it was not so, and when I spoke to him again after the funeral, at which he had remained dry-eyed, he looked at me in perplexity, and confessed that he wished he could understand me, that he wanted to see it my way, but in all honesty he could see no connection, particularly as he and his father had not been on good terms. The patient was now well and grateful for the attention and the incident was concluded.

A factory worker, approaching thirty, began to attend frequently as an anxiety state intensified. At first