“I walked into his hospital room, and he glared at me through glittering yellow eyes. The tumor in his belly had grown so large that he looked pregnant. ‘Giving birth to death,’ I thought.”
The therapist put her pencil down and laid her notebook aside. I stopped the monologue, suspicious that she had stepped outside her role. She smiled at my nonverbal question and nodded for me to continue. I relaxed and allowed the unrehearsed monologue to continue. I hadn’t heard this before.
“I was afraid of his dying, afraid of the finality and ugliness of death. I clung to the door frame, wanting to race from the room. Then my father talked to me. He needed me. He was scared. I had never heard him say those words before.
“My father took ten days to die. He did most things in his own time. For the first time in my life, I gave to him, offering him sips of water, rubbing lotion on his body. When he died, his hand was in mine.
“I understood then that my father was even wiser than I had thought. He knew that I needed to watch him die. I had always worshipped my father as though he were a god. At the moment of his death, I finally loved him as a person.”
I shook myself from the telling. I felt wrung out. There was a strength, an intensity that I had not before experienced when I let my inside out.
Lynn Wilson looked touched, her eyes misty. “Well,” she said, “that’s quite a story.”
The word “story” was jarring. “Does she think I’m making this up? Am I?” I hadn’t known what I was going to say until I heard it. Was my description of his death accurate? I realized suddenly that I didn’t feel too much about him alive or dead.
I pushed my confusion aside, too threatened to relax again yet not knowing what I’d say if the therapist asked a direct question. My session time was almost up anyway.
“See you later,” I said as I stood; stretching and smiling, I tried to be nonchalant as I made for the door.
“Wait, what about getting through the weekend?” the therapist asked.
“Oh, that’s right,” I said, but made no move to return to the chair.
“It sounds as though you need to do something for yourself, something that would make you feel good,” she said.
I smiled, nodded, and said, “What a great idea. Why didn’t I think of that?”
I was no longer worried; the pressure was already subsiding. I knew that I’d be safe this weekend. There’d be no suicidal thoughts or gestures now. That was all the help I really needed.
CASE NOTE March 6, 1981
Ms. Casey called me for an appointment at the suggestion of the nurse practitioner on our team. She was seen the same day because of her apparent high degree of anxiety.
Ms. Casey is a small-boned, thin, tall, fragile-looking young woman with large eyes, wearing glasses and no makeup. She has long brown curly hair, is well groomed, neatly and unobtrusively dressed.
On first entering the room, she shook hands firmly, looked me directly in the eye, and spoke clearly and rationally. However, from the start of the interview, she appeared limp, her shoulders drooped, and she looked away or down at her clasped hands.
Ms. Casey engaged very quickly.
However, at the end of the interview, she seemed uneasy about her disclosures—limited and offered with little affect—and I told her she had done “just fine.” I said that she has a right to take time for herself on the weekends and gave her permission to do so.
Ms. Casey is a bright, articulate young woman, introspective and insightful to a degree. She has a number of ego strengths and coping skills but is currently overwhelmed by an extremely stressful life situation in which she does not have any unconflicted supportive relationships. She has difficulty expressing and owning her anger and tends to turn it inward, accepting blame and behaving self-destructively—tends to separate intellect and feeling. Could profit from long-term treatment.
PLAN: 1. Appointment at least weekly to provide support. 2. Attempt to foster corrective emotional relationship. 3. Insight development.
3.
I had a second appointment the following week. All I wanted was the “fix” I needed to feel a better balance, but I realized too that an electric anticipation flowed through me at the prospect of seeing Lynn again. The feeling was mine, but not mine.
“That’s not so strange,” I thought. It was like keeping my mind on some office activity while looking forward to going out to dinner. It was OK to feel two things at once. And I had to admit that there was something intriguing about Lynn Wilson.
I knew Lynn was a “professional.” Like all of the therapists I had seen before her, she was talking to me because she was getting paid to do so. But she was better at pretending that she cared. Her body language and sympathetic “umm” suggested that she really listened. I decided that this visit I’d talk with Lynn directly instead of letting the drowsiness take over so that I didn’t care what was said.
“I really want to find a way to get my husband back,” I said at the beginning of the hour. She nodded and asked me why and how I planned to do so.
Lynn was easy to talk to, so easy that I found myself telling her about the internal urge to jump. “I don’t want to die,” I assured her, “but I guess I wouldn’t mind if I got hurt a little. So Keith would understand how much I need him.”
“That won’t work!” Lynn said sharply. Then her voice softened. “I don’t want you hurt for any reason,” she said.
I felt humiliated and tricked into admitting my real feelings, and stepped back into the drowsiness, not wanting to invest myself again.
I heard myself stumble and stammer in confusion and left the office in that state. “So what,” I thought.
CASE NOTE March 9, 1981
Ms. Casey came in saying that things had gone well over the weekend. She discussed her marriage and feelings concerning her husband, Keith. She admitted thinking that if she hurts herself Keith will know how much the divorce pains her. She became very withdrawn when I told her this would not work. She closed her eyes. Became silent. Seemed dazed when she left and did not make new appointment.
Because of Ms. Casey’s apparent confusion, I will ask the clerk to call and confirm next appointment. It seems obvious to me that this patient is in a great deal of pain (e.g., allusions to self-destructive behavior and sudden periods of confusion). I will suggest twice-weekly appointments.
—
LATER THAT AFTERNOON, the clinic clerk called to say that the therapist wanted an additional appointment later in the week. I was too surprised to do anything but comply. This wasn’t the way professionals were supposed to act. Lynn wasn’t supposed to care if I came back.
Anyway, the extra appointment seemed like a gift. You’re supposed to accept gifts graciously. I wouldn’t hurt her feelings by refusing.
CASE NOTE March 12, 1981
Looked very well—less frightened, less suspicious. Still subject to strong mood shifts during sessions and presented many contradictions concerning present and past relationships. For example, she said, “My mother says that my sister is just like my father”—negative connotation. Yet she told me with pride that she is like her father. She reported feeling manipulated by her mother yet also occasionally mentioned their “close supportive relationship….We’re like friends.”
She boasted that she’s “good with people—I know how to please them,” but also said, “People always stop liking me; they stop loving me”—referring to Keith, Mother, high-school and college friends. Ms. Casey did not seem aware of these contradictions.
PLAN: Encourage her to identify and explore feelings of ambivalence as a lead to helping her deal with these contradictory feelings.
—
I WAS EMBARRASSED WHEN I thought about how obvious the contradictions must have been. Before the drowsiness took over, I told Lynn how wonderful Keith was and how important it was to me to fight the divorce, and then later in the session I heard myself saying that the marriage had never been quite right. Keith wanted
a fun-loving wife and ridiculed me when I said that there was more meaning to life and that other people’s feelings really mattered.
I heard myself tell Lynn about my current relationship with Steve, and about how inadequate I felt when I compared myself with his beautiful, brilliant wife, who had recently died of a chronic heart disease. I couldn’t overcome my trancelike apathy to keep from saying this. But early in another session I told Lynn the truth: Steve was an old drag. He never wanted to go to bars or dances. I couldn’t be what he wanted, and, as far as I was concerned, Steve was just someone to fill the time until Keith realized that he wanted me back.
Lynn didn’t mention the contradictions—she must not be paying close enough attention. No matter, in a few weeks I’d stop seeing her.
The thought of not seeing Lynn brought a flash of pain and then the familiar panic of swaying, being off balance. “Damn it. That’s always my problem,” I thought. “I get attached to people, but they have their own lives, their own problems, and really don’t give a shit about anyone else.” I knew that was true, and it didn’t bother me most of the time. I had learned to be a friend without expecting anything in return. I had learned not to be surprised when people decided that I no longer fit into their lives.
I was furious with myself for letting this Lynn Wilson get to me. “She’s not even pretending to be your friend,” I reminded myself. “She’s just a professional, just listening because that’s her job.”
4.
I continued to go twice weekly to see Lynn. The suicidal urges had ended, but the more I listened as the inside part of me talked, the more intrigued I became. The part of me who spoke without my input felt special, validated by Lynn’s attention. Lynn’s questions often made that inside part uncomfortable, because there seemed to be so much that that part didn’t really remember. But for the first time I heard that part of me sound safe in saying, “I don’t know.” Lynn didn’t call me a liar, as so many other people had, and she didn’t laugh when that part of me who liked being called Jo admitted not knowing what clothes I was wearing without looking down to see.
I listened attentively but apathetically—interested but with no desire to act—and thought that Lynn must be incredibly naïve. She acted as though she believed me. And her belief in me made me feel confused. After I left Lynn’s office, I felt guilty about not doing a better job to control what I was saying.
Surely I was playing an elaborate game of make-believe with Lynn. Surely I could stop anytime I wanted to, but in Lynn’s office I often felt too drowsy to stop anything.
Effortlessly I was presenting Lynn with characterizations unlike the real me, characterizations that I thought of as “them,” not me. With other therapists I had quickly begun to feel so foolish that I couldn’t let my inside out. I realized, only after the sessions, that Lynn touched different nerves at different times, called forth varied responses, even as I watched, uncaring, from my internal perch.
Sometimes I saw myself react as a little girl who peered out at this lady through half-closed eyes. Curling up in the big chair was the only way to respond when Lynn reached out and said, “It hurts so bad, doesn’t it?”
Sometimes I heard myself defending the mother who never felt like mine.
“Your mother doesn’t sound like a very supportive person to me,” Lynn observed one day.
I heard myself saying unequivocally, “My mother knows that there isn’t anything wrong with me. There never is. I’m a very, very lucky girl, and I can’t let myself get caught up in self-pity. My mother is a lab technician. She spends her time helping sick people who really need her. She knows what’s best for me.”
But, whatever turmoil might trap me mid-session, I usually managed to shake it free and feel fully in control at the end. I’d smile and stretch, telling Lynn through my cat-cozy manner that I attached no significance to the bullshit she had observed in the last hour. None of it had anything to do with me.
Lynn always smiled back and asked, “Feeling better?”
“Much,” I answered cheerfully and went on my way.
CASE NOTE March 30, 1981
Ms. Casey clearly has periods of dissociation. She described two such incidents within the past six months. One evening, her mother-in-law, who reportedly never cared for her, called to tell Ms. Casey that she was happy Keith was getting a divorce. After her mother-in-law said, “You ruined my son’s life,” Ms. Casey “woke up” at a shopping mall with no idea of how she had gotten there or what had happened in the intervening time.
Another episode occurred after her own mother called to cancel a trip to Chicago. Ms. Casey’s mother had not visited her for two years, and she was counting on her mother’s support in helping her deal with the divorce. Ms. Casey reported “waking up” in the car, parked in front of a friend’s house, uncertain as to whether she was on her way to see her friend or on her way home.
Since I suspect that Ms. Casey has also been dissociating during her sessions with me, I will continue encouraging her to talk about these incidents. The patient who bounces in and out of my office with a “what-the-hell” attitude is very different from the aspect I’m talking with during the majority of the treatment session. And that aspect is different, again, from the “scared child” and the “mother advocate.” I’m beginning to think that Ms. Casey may suffer from Multiple Personality Disorder. But this is unsettling for me. I’ve never seen a case, nor have my colleagues.
PLAN: 1. Reread Three Faces of Eve and Sybil and see if I’m on the right track. 2. Search for a knowledgeable consult. 3. Explore the possibility with Ms. Casey and continue supporting all parts of this very complex patient.
—
EARLY IN MY FIRST APPOINTMENT in April, Lynn told me that she suspected that I suffered from Multiple Personality Disorder. “Oh, brother,” I thought, “what’s this lady’s problem?” She might as well have told me that I was possessed by demons. I was more worried about her mental state than my own when she said that, but I refrained from expressing my derision. Professionals don’t like their diagnoses questioned.
I spent the evening ticking off why I wasn’t a multiple. Sure, I forgot things sometimes and failed to pay attention to everything I was doing. So did everybody else. Occasionally I heard myself saying something I didn’t believe, something that seemed to pop out of nowhere. Eric Berne’s Transactional Analysis explained it perfectly: we all have various parts—parent, adult, child—within us.
People said I had a flair for the dramatic, but what Lynn suggested was just plain weird. Multiple personality was some sort of mental illness. I certainly didn’t need psychiatric care.
I was fine unless the pressure of doing so much or being rejected put me off balance. And I had done a lot. I had completed my B.A. at the University of Virginia in three and a half years—longer than I expected because Keith and I didn’t have the money for me to take as many courses as I wanted each semester—and I worked full-time. I had interned with a state legislator, completed my teaching certification here in Chicago, was doing graduate study, again working full-time—and still pursuing my hobby of breeding, training, and showing springer spaniels. Now I was applying for high-school teaching jobs.
People called me compulsive, a workaholic, overenergized, an overachiever, too intense, but no one would call me crazy.
5.
CASE NOTE April 9, 1981
Ms. Casey is terrified at the thought that she might be a multiple. I decided not to force a discussion of the diagnosis until I am more certain myself of how to deal with this—my patient requires unquestioned support far more now than she needs debate over a particular psychiatric label—but as soon as I made that decision, Ms. Casey presented her multiplicity in a more florid way.
Ms. Casey was working on an annual fund-raiser with United Way, where her husband is employed. During our sessions, she talked of her fear of this intense involvement with Keith and the people who used to be their mutual friends. But still she felt compe
lled to meet her responsibilities.
However, in direct contrast with this “fearful” presentation at the beginning of our last session, she proceeded to talk animatedly about the event—about how much fun she would have there. Since I knew I would be out of town during the weekend of the fund-raiser, I encouraged Ms. Casey to use the on-call number, advising her that she would find somebody to talk to, and stressed that I would see her for our Monday appointment after the weekend. She said that she would be very busy with United Way and felt she probably wouldn’t need any support.
Because of poor flying conditions and airline cancellations, I was unable to get back in time on Monday and had to have the receptionist reschedule the appointment.
When I finally saw Ms. Casey today, she seemed different. Bright, gay, bouncy, and happy, she told me that she hadn’t minded missing our appointment. She inquired whether I had had a good time and said she had had a ball at the fund-raiser. She had explained to her friends there that she and Keith were having a little trouble now but that she was sure it would all work out.
I remarked on the change, and Ms. Casey insisted that Keith was just angry and that he had a right to be—“she really fucked it up.” When I asked who “she” was, Ms. Casey replied, “Jo, of course.” When I asked her name, she told me “Renee.”
—
I WAS STRONGER, more in control, than I had been before meeting Lynn, and the suicidal impulses were gone. But that inside-out part of me was stronger as well. This was not the way the game was supposed to work—before it had just gotten quiet inside.
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