Introductory Lectures on Neuropsychoanalysis: Lecture Six Part 1 "Treatment Case Example Mr. C" Beginning Phase

BEGINNING PHASE.....................Mr. C (an imaginary patient), is a 45 year old , married, male, college professor, with 2 children. He called to make a first appointment for psychoanalytic psychotherapy after recently having an overwhelming abreaction of anger. He was driving down the road and spilled a drink on his new suit. He felt his wife would be angry at him and scold him for his carelessness. In anticipating seeing her he began saying to himself, "I wish she would just leave me alone." As he repeated this phrase in his mind, he suddenly started screaming in anger," Leave me alone!! Leave me alone!! Leave me the Hell alone!!" The anger became so intense he had to pull over to the side of the road. There in his car a rage he had never felt before, accompanied by trembling and seizure like contractions, came to his consciousness. As a result, he screamed and screamed at someone from his past to leave him the Hell alone!! It took him several hours to finally calm down and eventually relax. This experience scared Mr. C and that is why he was calling for a therapy appointment. After gathering some necessary information from Mr. C, I scheduled an initial appointment with him to see if we might work together in neuropsychoanalytic psychotherapy. According to my neuropsychoanalysis studies, Mr. C was telling me that he was suffering from the basic emotional need of RAGE (somewhat akin to the Aggression Drive in Freudian Theory.) As you will recall from my previous Blog Posts, this is one of the seven basic emotional needs that drive us as human beings. The other six are: Attachment (PANIC/GRIEF), CARE, FEAR,(Safety Need) LUST, (Sex) SEEKING, and PLAY. Rage, anger, or irritability is aroused in patients who are not able to successfully remove obstacles or impediments to getting their basic emotional needs met. So in the initial phone call and the first assessment session, Mr. C spoke of his problem of feeling this deep body trembling RAGE. I knew then that he had problems in removing people or things that were preventing him from meeting his other needs. And that the resultant RAGE he was feeling had been well defended against throughout his life. What I came to find out in the first few sessions with Mr. C was that he had a conflict between the two basic emotions of RAGE and Attachment (PANIC/GRIEF.) He had been very close to his mother growing up but at times his mother would greatly frustrate him to the point where he wanted to lash out at her-- to get rid of her--even to destroy her. But his little childhood mind feared that if he expressed such RAGE at his mother that he would destroy her and lose her, and he knew he could not live without her. This conflict between RAGE and Attachment (PANIC/GRIEF) resulted in Mr. C feeling guilt , which is a secondary emotion. Freud defined guilt as aim inhibited aggression. So Mr. C had gone through his life unable to feel RAGE, that is until that day in his car when his defense against the feeling of RAGE broke down and he felt it ( a powerful abreaction) with its full bodily force. Now neuropsychoanalytic treatment has taught me that Mr. C was clearly not getting his basic need met of removing obstacles from his life that were interfering with his meeting his other needs. The question is, "Why was Mr. C not able to do this?" The answer was this conflict between his RAGE at his Mother and his need for remaining Attached ( PANIC/GRIEF) to her for the love she also provided him. But why had Mr. C not realized that one can have loving feelings and hateful feelings toward one's Mother, and that the hateful feelings will not destroy her? Why had he not learned that ambivalent feelings toward his loved ones is what living in relationship reality is like? Why was Mr. C's ego not able to work out a workable compromise/solution/prediction with his Id? The answer is that Mr. C was not thinking like an adult. He was thinking like a child. He was acting out an unconscious, repressed, prediction (fantasy, wish, belief, faulty ego solution) of: You either love your Mother and keep her close to you, or you hate and destroy your Mother and lose her forever. This is how Mr. C's little child mind thought. His little Ego could not work out a workable solution/prediction to his Id drive demands( basic emotional needs.) So Mr. C's childhood Ego solved the problem of how not to destroy the woman whose love he so desparately needed. But the prediction was not a good one. It was not a workable prediction. It was a childish prediction. It was the best prediction he could come up with at the time, but it clearly was not working for him in his adult life. This is the problem with patients who come to us for neuropsychoanalytic psychotherapy. They are all to some extent trying to live their adult lives based on unconscious, repressed, childhood predictions. And they do not know that these childhood predictions are repressed and unconscious. They cannot know this. These early solutions have been automatized. They have been pushed deeply into the child's unconscious mind and they are now non declarative. Which means they cannot be declared. They cannot be remembered. They cannot be known. They are unconscious. Mr. C had no idea that at some point in his childhood when he was most frustrated by his mother and felt an impulse of destructive rage toward her, that his little child Ego created a solution/prediction that went like this: " Oh my, I cannot have this thought or this idea. If I have it I may act on it and I may destroy the very woman I cannot live without. So I have to push this intolerable thought into my unconscious mind where it is no longer available for me to think it, remember it, or even know I ever had it." So Mr. C's Ego repressed this thought or idea or fantasy or wish--it is called by many different names. But what Mr. C also did not know was that although he could cognitively repress this thought or fantasy, he could not affectively repress it. He would still feel the RAGE Feeling. He just had no idea why. He had no conscious awareness of the thought, wish, or solution his mind had come up with as a child. Meaning that the feeling of RAGE toward his mother was still there, and much as he wished not to feel it, he could not help doing so. So, then what was Mr. C's little child mind supposed to do with the remaining unbearable RAGE? He had to develop a defense against the RAGE. This defense would protect Mr. C from feeling the uncomfortable and unbearable RAGE. The defense mechanism Mr. C's childish mind chose was Reaction Formation. In using this defense Mr. C felt the opposite of his hateful feelings toward his Mother. He did not feel RAGE. He only felt love toward her. And as long as this defense was working for Mr. C he did fine. Matter of fact it had worked for him well into his adult life. That is until his defense began to fail and the feeling of RAGE came into his consciousness. This is called "the return of the repressed." That is when Mr. C called and asked for a therapy appointment.