In my article Time Out of Mind (Toronto, Ellen L. K. (2009). Time Out of Mind: Dissociation in the Virtual World. Psychoanalytic Psychology. 26 (2) 117-133) I also present the case of a young woman who has cordoned off her own terrifying experiences by creating a collection of “actors” in her mind who direct her affairs but never communicate with one another.
Casey is a single professional woman in her mid-thirties whose work involves apprehending internet sexual predators. She came into treatment feeling that she was under-performing at work and socially isolated. She wanted to be in a long-term relationship with a man and eventually marry and have a family. She had to force herself to go out and meet men and she didn’t understand why.
Early in treatment Casey expressed unremitting anger toward her mother from whom she is partially estranged. She described her mother as a self-centered woman who was seldom able to focus on her daughter’s feelings without making her aware of what a burden she was. The father left their family when the patient was two years old and after that her mother dated a number of men. Casey recalls instances in which the mother would bring men home and engage in sexual activity so that the patient could hear them from a nearby bedroom. The mother married two more times, the second husband being an alcoholic. She is currently living with her third husband.
Casey portrays her father as a child-like man who married too young and was unprepared to be a parent. She visited her father sporadically throughout her childhood but does not regard him as a father figure. She has memories of waiting for him by the window and then having him not show up. He didn’t pay child support on a regular basis so her mother was compelled to support the children on her own as best she could. Casey also has an older sister who is married with two children. She has a half-sister who is her mother’s child and a half-brother who is her father’s child. Her half-brother is also married with two children. The patient maintains close relationships with all of her siblings.
An “Ideal” Patient
In many ways Casey presents as an ideal patient. She appears cooperative and cordial and is intelligent, psychological-minded and insightful. Though moderately over-weight she is attractive and well-groomed. She pays her bill on time, seldom cancels and consistently greets me pleasantly at the beginning and end of each session. She began treatment with once-weekly sessions and quickly agreed to meet twice weekly. She has been on the couch at three times a week for about three years. Her productions are colorful, humorous and sometimes brilliant but progress has been slow. She will characteristically assent to an interpretation but then meticulously dissect every word of it. She has actually asked for a dictionary to check on the specific meaning of words. If one is not available she tells me that she goes home to look up a word if she is not exactly certain of its meaning. My response has been to allow her the absolute freedom to explore every nuance of every word and to resist the impulse to force an interpretation on her. I consider her careful reactions to be a protection of an extremely vulnerable self-state of which we have been able to catch only brief glimpses.
Meeting the “House People”
In an atmosphere in which her autonomy has been acknowledged and respected the patient has come to know that her verbal productions and outer air of congeniality are only a small part of her total being. Over time she has introduced me to a whole internal cast of characters whom we have named the “house people.” There is the “housekeeper” who is the administrator and most closely aligned with the patient, the “me that is me.” There is the “pathetic one”, whining and complaining and barely able to get anything done. There is the “smart aleck”, a domineering, aggressive and somewhat sadistic character who constantly berates the pathetic one. There is a little girl who sits quietly and says nothing but watches. Later we have learned of a little boy who hides behind the couch and is bad and angry. This motley crew maintained an ongoing conversation/argument in Casey’s head in a way that tortured her. The smart-aleck continually nagged the pathetic one. The housekeeper tried to maintain order. The little girl watched, seemingly stunned into silence and the little boy, who only occasionally made an appearance, disrupted the whole proceeding. When Casey was at work or with people she could keep the conversations at bay. But when she was alone they dominated her life. In fact, she had to be alone some portion of the time to satisfy them and let them out. They could communicate with each other but not directly with her and not with me. So she could not be with other people and in their presence at the same time.