Open Door Review III

/647#)2*2<4($7!(%02(90*(!):!2!12($0*(!Z$(#!2!*0B%)($7!&01%066$)*>!=! 646(092($7!7<$*$72

F%B*6_!S>![+,,.^?!pZ0$:0<*!29!O260$*>!=B6!&0%!F0#2*&!L%)9! (#0!(%02(90*(!):!2!&01%066$Y0!12($0*(^>!/647#0!h!p0$(67#%$:(!:T%!/647#)2*2<460_!.\_!b-gEb]+>! >-001(3! The article describes the psychoanalytic treatment of a male patient suffering from a neurotic depression with symptoms of a desperate, depressive mood, conscious and unconscious self- destructive tendencies (suicidality, somatic and psychosomatic diseases, overly ascetical and self- restricted style of living) and sexual symptoms of erectile and libidinal disorder. The depression dates back to childhood and was exacerbated in adulthood by a separation and the psychic conflict connected with it. In the course of the analysis the etiological background emerges more clearly ! between the age of 0,5 and 1,5 years of the patient his mother lost her husband, her only daughter, her father and a brother by dead and became depressive. A constellation of the kind described with the concept of the dead mother by André Green showed up. The emotional absence of the mother was made more severe by the complete absence of the father. The patient felt that his mother most intensely suffered from the loss of her daughter and that he had the unspoken and unconscious task to replace his dead elder sister together with comforting his mother. In this constellation he experienced doubts whether he was recognized by his mother as own person and whether he was seen by her at all. These early doubts laid the foundations for persisting doubts if he had the right to live and to follow own wishes or if he had to live for the benefit of another person, especially his mother or another woman substituting her in his mind. In order to understand these existential doubts of the patient the author draws substantially on an interaction model taken from developmental psychology. In analysis the existential doubt manifested itself as hunger for contact and confirmation. The psychosomatic symptoms played a special role for these needs: on the one hand they demanded care and attention from doctors, they reduced dependency from the analyst because there were more doctors than one, and they were an unconscious recapitulation of experiences of illness-conditioned abandonment in early childhood. In the course of treatment over five years, the patient was able to gradually overcome his symptoms and to establish a more mature and stable form of self/object differentiation. @)15-1.*$#! The sessions were recorded and based on the records evaluated with regard to the unconscious conflicts which changed during treatment, to transference and countertransference. The evaluation was done with a group of clinically working psychoanalysts in fixed intervals. Based on clinical data and the analyst's countertransference it was examined which psychoanalytical theory of depression and of mental functioning seemed to be most appropriate to understand the patient's symptoms and the intersubjective processes during treatment. During four years after termination there were follow up meetings with the patient once or twice per year which showed the stability of the development during treatment. G$#.1/.!"''(&22\! !

Prof. Dr. Georg Bruns, Schubertstr. 54, 28209 Bremen. E-mail: gj.bruns@t-online.de

POL

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