Rabu, 15 Agustus 2007

About Case Study in Psychoanalysis

Psychoanalytical casuistry is the most exciting domain of psychoanalysis. And that is because when reading a case analysis, we are usually inclined to apply psychic investigation methods upon ourselves and ponder on the conclusions.

case analysisThe casuistry published for the use of our readers, nevertheless, is no easy job. For lay audiences personally inexperienced with psychoanalysis, many of its statements may seem risky. That is why case reporting requires a lot of skill, the more so as the unconditional discretion rule must also be met!

In addition, the conditions for web publication impose a limitation of editing space and no comprehensive account of the analyzed individual' personal history will therefore be available. Everything is limited to a few hints the author of the article (and of the analysis too) provides hoping to render an as complete image as possible of the analyzed individual's psychic background. AROPA

A Case with a Legacy

The best method to acquire the psychoanalytical technique is to allow yourself to be psychoanalyzed. Just as with swimming, there's nothing you can do unless you go beyond theoretical information and dare dive to see the why and the how for yourself...

No matter how much we tried to simplify things, when the uninitiated are introduced to psychoanalyzed cases, we have to keep in mind that eloquence alone cannot replace the live experience of self-analysis. Our readers will certainly understand the impediment.

An example of successful analysis in record time will get us somewhat acquainted with the psychoanalytical technique. Several other illustrations will follow, without pretending to bring the subject to a close…

Ours is the case of a lady we shall call Amelia, about 35, married and the mother of a 10-year old; she works for an important company in X. The woman complains of a troublesome symptom: persistent insomnia. "persistent", as it defies any kind of conventional treatment. "Night after night, I make desperate efforts to sleep". She succeeds towards dawn, when, actually exhausted, she finally falls asleep.

To her sleeplessness, there adds a weird mood of apprehension, an uneasiness psychoanalysts use to call anxiety. My question is:
- What brings about this condition?
- Something like an anticipation; as if I were expecting something and were not sure what...
- Would you please try to remember some circumstance when you experienced the same thing? I insist.
- Exams, maybe, when I was at school? Or, Christmas Eve rather, when I used to wait for Santa. Or, why not, when I would plan a trip or a celebration and would eagerly count every minute to it...
- Any trouble at work, I ask, any tests, exams for a higher position or things like that?
- None, came the unwavering reply, nothing special.

I then inquire about Amelia's economic standing. I find both she and her husband earn enough to make a decent living. There would be room for some additional income, though. "You know how it goes", she adds, " the more you have, the more you want".

I consider the associations Amelia has made concerning her anxiety. Exams, Christmas, Santa, family celebrations and reunions with friends etc. Anxiety is obviously a state of anticipation, just like when you are looking forward to an extremely important event you crave for. But what could that event be? Let us also keep in mind her insomnia, suggesting the same powerful, irrepressible experience. Sleeplessness and anxiety go hand in hand. Both are indicative of an intense concentration of emotions towards a certain direction we expect a lot from...

Psychoanalysts often need moments of insight, more precisely the feeling they know what a certain case is about. Theirs is an intuitive job (which we also call empathy ). That "clairvoyance" urges us to articulate it and, obviously, ask patients the key question giving instant clarification to the nature of their disturbance. In this case, the question I asked was:
- Do you happen to have a dying relative, are you looking ahead to some inheritance?
The answer was immediate, betraying Amelia's bewilderment:
- Yes! It's my uncle, she assured me, he's over 80 and he's awfully rich!
- Are you his heiress?
- His one and only heir!, she specified.
- Your case is solved then, I replied. Your eagerness to get the inheritance is to blame for both your insomnia and your anxiety. Given your uncle's age, you think the long dreamed-of moment for getting your heritage is drawing nearer by the day. Hence your anxious anticipation and sleeplessness, betraying your wish for this moment to arrive as soon as possible, just as you used to eagerly wait for your Christmas presents.

NB: Not all psychoanalyzed cases are solved on the first session. The case above was a "fortunate case", which is a rare occasion. But let us keep one thing in mind: although aware of her own wish (to lay hands on the inheritance), the patient was unable to relate it to her symptoms; hence her concern for her own health. The meaning of her symptoms clarified, Amelia was reassured (the enigma of the disease itself is reason for concern) and she was finally able to get back her wholesome sleep.

Translation by Mihaela Cristea

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