Life of the mind: Freudian truths

There is a bright moment in the process of therapy when a patient suddenly shows up. It feels like a miracle when someone so wrapped up in their own despair just looks you right in the eye and asks an ordinary question.

There is a particular patient I’ve been seeing as part of my training for over a year now. When I first saw her she always had her face hidden by her hands or her fringe, she covered every inch of her skin even in summer and had difficulty leaving her house. She was desperately lonely and couldn’t see a way out of her state of mind.

In his work On Narcissism, Sigmund Freud compares mental illness to toothache, pointing out that every aspect of the sufferer’s being becomes concentrated on the pain. This is certainly true for depression—it is acutely isolating. (Far from talking therapies being self-indulgent navel gazing, they are often the only way out of self-indulgence.) So, although my patient had got a job and moved into a flat share during our therapy, although she was no longer clinically depressed and had come off anti-depressants without a slump, I knew she was still trapped by her own nihilistic thought processes. My pragmatic supervisor told me that this might be as good as it was likely to get.

So when she showed up last week, looked me in the eye and started telling me, directly, fearlessly, how angry she’d been with her parents over the weekend, I was stunned. No guilt? No shame? No self-flagellation?

Ordinarily she would turn her rage into self-hatred, looking at her feet and telling me how responsible she felt for her parents’ awful relationship (passive mum, violent dad). This time she saw the absurdity in her dad’s wild rage at a sloppy waiter. She watched her mum’s complicity, her attempts to appease and defend her husband instead of challenging him. Seemingly out of nowhere, they had become real, separate people in my patient’s mind and she saw them and reality clearly.

“Why now?” I asked her.

“I just got so frustrated with them that something had to change. And it obviously wasn’t going to be them,” she said. She smiled at me and then raised her eyebrows. “Have you had your hair cut?” she asked. This was the first time she’d really seen me. The fascinating thing was that her development, which seemed dramatic but had actually had a long, slow build, was based in frustration. Understanding her stuckness had got her unstuck. This is exactly how Freud describes infant development—that the shift from one phase to another is spurred by frustration. I noticed in my own children how angry they’d get at not being able to speak, just before speaking, at not being able to get up and walk, just before walking. ]

This kind of parroting of theory that is not, in fact, known to the patient is astonishing. It shows me (though many disagree) that Freud’s theory is not just his opinion about the way the mind the works, not some kind of religion that requires faith to consume. It is more like Isaac Newton’s theory of gravity—a way of describing something that exists in reality. Of course, the unconscious mind in all its vast complexity was portrayed in literature and art for centuries before Freud, but facing a patient who, unknowingly, seems to quote theory directly is nonetheless amazing. It reminds me of the time my then toddler, angry at his dad during a punishingly long walk, shouted: “You can sleep in the shed tonight and I’ll sleep in Mummy’s bed and be King.” If anyone doubted the truth of the Oedipus complex… Anna Blundy is a writer training to be a psychotherapist. The situations described are composite. Confidentiality has not been breached.