About Case Study in Psychoanalysis

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-> Billy's Dream (Learn how we use dream interpretation in psychoanalytic cure)

Psychoanalytical casuistry is perhaps the most exciting domain of psychoanalysis. This is

because when reading a case analysis, we see haw and why, and are usually inclined to
apply the psychoanalytic methods of approaching the psychic disorders upon ourselves.
The casuistry published on this site, nevertheless, is no easy job. For lay persons
(beginners or others without any prior experience with the psychoanalytic statements)
much of our psychoanalytic work may seem rather uncertain. That is why case publishing
requires a lot of skill from us, the more so as the unconditional discretion rule regarding
the personal life of those subjects of such cases must also be met.
In addition, the specific conditions for website publication impose a limitation of editing
space so that no comprehensive account of the patient 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 the background of the case as complete as possible.
The following is the first case that shows how we actually approach our patients - more
cases will be published soon (see also the above one).

A Case with a Legacy

By I.D. Hora
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 10year 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.

Note.
Not all cases are solved on the first session. The case above was a "fortunate one", 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.
-This paper has been first published in the psychoanalytic journal OMEN, editated by the Romanian
Association for Psychoanalysis Promotion. The English translation is made by Mihaela Cristea.

Billy's Dream

Billy's Dream
Billy is a 25 years old young man, a skilled worker in an economic unit. He has had a
girlfriend for about 5 years and wants to marry her. He is a straight, modest man, gifted
with a native intelligence.
He approached me about a dream he wanted me to interpret. He knew I was dealing with
psychoanalysis, that I interpreted dreams and wanted my help from the bottom of his
soul. He was observing for a while some alarming changes in his life, in his way of being.
From a courageous guy, proud of his physical power, he became a coward, a depressed
and very confused person. The dream, he thought, must have something to do with this
behavioral change.
The dream, actually a short visual impression, was the following: Billy was helplessly
watching a torrent of blood flooding the room through the window. It made him all wet,
while he was just standing still, not knowing what to do!
*
We have already observed that the blocking feelings encountered at the end of the dream
are also found in the awareness state. Billy became an undecided, confused man in the
most common life situations. We conclude that the dream refers to his behavioral change.
I ask him about the wave of blood, about its meaning. (1) He does not know what to say.
He has no suggestion about this scene. It seems that our interpretation does not stand a
chance. We have no association from the real life to Billy's dream. After some free
discussions I find out that Billy has wanted, for a long while, to have a child with his
girlfriend. For him the child is a symbol of his virile force. I also find out he could not

have had this child up to now. As I insist on the subject, he tells me that he recently had
again the confirmation he was not to be a father: her girlfriend had her period.
So here is the interpretation of the dream: the wave of blood is an allusion to his
girlfriend's period, and, implicitly, to the fact that Billy did not make her pregnant.
I find out more details about his intimate problems. The fact that the blood spreads over
him emphasizes the idea that he would be to blame for the negative result. (I was to find
out later on, that Billy's girlfriend was to blame.) This imaginary guilt is at the bottom
of his behavioral change. Lucian, as many other men, associated virility with fertility.
This is the reason why he lost all his self confidence and self esteem from the moment he
had again the proof that he would not have a child. It was as he had to admit he was not a
man!
*
I published this dream with the purpose of illustrating the use of the dream analysis in the
psychoanalytical work. We thus observe that Billy's dream is determined by the feelings
of fear concerning his virility. But the object of this fear - the idea of virility - was
repressed and the anxiety related to it remained suspended and lived as a feeling without
any meaning. Unrelated to anything in particular, it is difficult, if not impossible, to
remove it. But the dream and the analysis brought us up front its cause and thus we could
work on it.
*
Conclusion: psychoanalysis approaches its cases starting from the principal of the
analysis of the unconscious. The feelings, the experiences, the ideas as well as other
repressed psychical contents can come back in the shape of neurotic symptoms and
disorders. Also, many behavioral disorders, as it is the case here, find their roots in
repression.
Psychoanalysis approaches the repressed and asks the patient to integrate consciously
what it is rejected from his conscious mind. The analysis of dreams is a big step in the
work of integration of the unconscious, repressed, material.
Notes:
1. When we work with dream in the analytical procedure, we usually collect the
associations of the dreamer. See also the article on how we deal with dream in
psychoanalysis here.
-Paper by Jean Chiriac.