Selfhood and Consciousness: A Non-Philosopher's Guide to Epistemology, Noemics, and Semiotics (and Other Important Things Besides) [Entries Beginning with "Case"]

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First published online 09:00 GMT 21st December 2006, Copyright Derek J. Smith (Chartered Engineer). This version [2.0 - copyright] 09:00 BST 7th July 2018

BUT UNDER CONSTANT EXTENSION AND CORRECTION, SO CHECK AGAIN SOON

G.3 - The Glossary Proper (Entries Case)

Case, Adrienne: This case was offered by Bollas (1987) as a demonstration of an imbalance of true self versus false self following exposure as an infant to a defective holding environment. Here are some of the details [a long extract, heavily abridged] .....

"[Adrienne] has been in analysis for two years. In her mid-twenties, she has managed, in spite of her good looks, intelligence, and giftedness, to ensure that she is unapproachable. [.....] Although a considerable amount of progress has been achieved in her analysis I have always been aware of a silent and secretive relation that Adrienne possesses to herself as her own object [.....] When she talks to me about herself, she does so in such an odd way that for a long time I have struggled to try to identify this strange quality. [.....] Eventually I understood that I felt she was talking to me as if I were an object that she had always possessed. [.....] Adrienne had provided me with details of her parents, and I believe that her relation to herself was partly a continuation of her mother's relation to her as the mother's object. In short, her mother was totally absorbed in the care of Adrienne throughout her childhood, constantly fussing over her, [etc.]. It was clear to me that Adrienne somatised conflict in order to regress into a mother-child relation, where she was the object of a mothering part of her that was always presenting herself with medicines and comforting words. I also came to realise that Adrienne's relation to herself was so comprehensive that it formed an intense resistance in the transference. Any insightful moment in the analysis was inevitably processed through 'mother' who spoke to her as a child [making her] quite angry with me" (Bollas, 1987, pp56-58).

[Contrast case, Marianne, where the effects of under-mothering are explored.]

Case, Ali Hassan: This case was reported in Sökefeld (1999) to illustrate the complexities of the interaction of self and identity. The extracts provided below should be read as supporting the entry for identity, comparative approaches to. Here are the passages which most concisely tell the story ..... 

"Ali Hassan was a Shiite, a member of the Yeśkun qōm and within it of the Catōrē clan. He was a respected elder of his qōm and of the town as a whole. He possessed considerable agricultural land both in the part of Gilgit where he lived and in a more distant place on the edge of town. [.....] At the age of 15 he had married a girl of another Yeśkun clan. When I met him, he was in his sixties and still versatile and innovative. [.....] His conception of 'relatives' was very inclusive. If it suited his purposes, he could conceive of a relation with almost anyone. He spent a considerable part of his life attending to relationships. Being a very pious Shiite, Ali Hassan visited the main mosque every day to offer the midday prayer. He was completely convinced that his sect was right in the religious conflict [..... and] very much against sectarian violence. [.....] Conscious of many contradictions between riwāj (local custom) and sharī'a, Ali Hassan preferred many norms of the former [..... and o]nly if forced by an explicit judgment would he have complied with the norms of sharī'a in these matters. Although in his opinion the conflict between Shiites and Sunnis was the Sunnis' fault, he did not condemn them indiscriminately. The guilty parties [.....] were the 'new' Sunnis [..... and i]n his estimation, the real, righteous, traditional Sunnis [.....] disapproved of the conflict as much as the Shiites. [.....] The separation established by differential religious affiliation could in his view be at least partially erased by some other relation. All the relations established by religion, descent, kinship, etc., were possible bases of community. [..... Against this backdrop, ] Ali Hassan and other respected Yeśkun from Gilgit and other places were endeavouring to organise a meeting of their qōm in order to overcome the religious cleavage within their group [.....] For Ali Hassan, the benefit of an assembly of Yeśkun was self-evident. It was a value in itself to promote the solidarity of one's qōm. He told me several times that he was Shiite in the first place and that religion was most important for him, but in the situation described here this was obviously not the case. The aim of the whole endeavour was precisely to subordinate religion to qōm" (Sökefeld, 1999, pp420-421).

This brings Sökefeld to his central issue, which is whether these three "contradictory basic identities", that is to say qōm, kinship, and religion, created "separate 'compartments' of the person" (p421). He sought the answer in the material Ali Hassan provided concerning the wedding of one of his older sister's great grand-daughters [i.e., Ali Hassan's first cousin, twice removed downwards (I think)]. This, it turned out, was a match he did not approve of .....

"Ali Hassan did not approve of this marriage, but he invited me to accompany him to the wedding. He told me, 'I am very angry that she is to marry a Panjābī, but Malik Amman [the bride's grand-father, and principal host] did not ask me. There are plenty of suitable boys in Gilgit!'" (op. cit., p421).

The party of guests duly set off for the bride's village, where to start with they were made welcome. Then frictions started to develop concerning matters of religious protocol, and they came away again. As for the critical relationship between self and identity, Sökefeld invokes Derrida's (1982) construct of différance, as follows .....

"Ali Hassan embraced and enacted a number of different identities. In the context presented here, only his religious affiliation, his qōm, and his kin relations were significant, but in other circumstances identities derived from speaking Shina or coming from Gilgit and from a particular neighbourhood could have assumed importance. These identities are markers of difference, but this difference is not all-embracing. The differences are not separate and do not compartmentalise the person. [.....] Identities are structures of signification that are subject to différance, that is, to the play of differences. The concept of différance introduces a strong impulse of deconstruction into conceptualisations of identity. Identity, then, is not foundational. The identities embraced by a person do not remain the same, identical. Their meaning is constantly being transformed because they refer to each other. [.....] Ali Hassan cannot simply visit his relatives in Napura on the occasion of a wedding because he has to take into account that they are not only relatives but also Sunnis [..... so he] struggles through the visit and ends up with relatives with whom he cannot share a meal" (op. cit., pp422-423).

 And again .....

"The fact of sharing kinship with Sunnis reflects upon Shiite identity and transforms its meaning (and vice versa). Différance transforming the meaning of identities works within the self and contributes to the sense of distinction between the self and everything else. One's ongoing experiences are subject to this sense of self. The self, then, is an instance superordinate to (though not detached from) the plurality of identities" (op. cit., p424; bold emphasis added)

The critical point in all this is, of course, that the self "is not passive" (p424). Ali Hassan went ahead with the visit because he felt he had to - in other words, he used his powers of agency. This in turn requires the sort of self which can "reflexively monitor" (p430) the resulting situation and re-plan things in real-time accordingly, should conflicts start to develop.

Case, Allan Menzies: [See online coverage] We mention this case merely as an example of the sort of lack of remorse noted in the entry for guilt.

Case, Angela Cannings: Angela Cannings was the victim in 2000 of a tragic miscarriage of the UK criminal justice system, due in large part to subsequently-judged-as-flawed expert testimony by the paediatrician Sir Roy Meadow. Heavily influenced by Meadow's evidence, she was initially convicted of the murders of her seven-week-old son Jason in 1991 and of her 18-week-old son Matthew in 1999. She was not accused of any involvement in the earlier death of her first child, Gemma, in 1989. Following the original guilty verdicts, Mrs Cannings was sentenced to life imprisonment. In 2003, however, following case, Sally Clark, in which Meadow's line of argument had been scientifically discredited, she was given leave to appeal. When the appeal judges studied the evidence, they ruled that it failed to take account of the possibility that an as-yet-undiscovered genetic disorder might have been responsible for the childrens' deaths. To reinforce this point, the defence revealed that Mrs Cannings' great-grandmother and grandmother had also both lost babies in unexplained circumstances. The conviction was accordingly overturned. [For more on the often unhappy interplay of the medical and scientific decision making systems, see case, Sir Roy Meadow, and the onward links.]

Case, Anna O: [Real name Bertha Pappenheim (1859-1936).] [Click for external biography] Between 1880 and 1882, Anna O was a patient of Josef Breuer in his clinic in Vienna, displaying many of the signs routinely associated with hysteria. For want of a better treatment, Breuer engaged her in his experimental "talking cure" (the patient's own description of the treatment), an early form of hypnosis-assisted psychoanalysis. What he did was note down recurring thoughts from the patient's ramblings during a hysterical attack, and then give her the opportunity after the attack had subsided to explore the deeper memory structures those themes might happen to be associated with. For example, after a period in which she refused to drink normally, a memory surfaced of an occasion when she had been sickened at the sight of a lapdog being allowed to drink from its mistress' glass. This mere act of recollection then seemed to dissolve the behavioural block. Anna O was eventually written up over a decade later as "Case 1 (Breuer)" in the chapters which Breuer contributed to the collaborative "Studies in Hysteria" (Freud and Breuer, 1895/1955). Here is Breuer's assessment of his case's significance .....

"A number of extremely obstinate whims were simultaneously removed after she descibed the experiences which had given rise to them. [.....] These feelings - that in the case of this patient the hysterical phenomena disappeared as soon as the event which had given rise to them was reproduced in her hypnosis - made it possible to arrive at a therapeutic technical procedure [.....]. In this way, her paralytic contractures and anaesthesias, disorders of vision and hearing of every sort, neuralgias, coughing, tremors, etc., and finally her disturbances of speech were 'talked away'" (Breuer, 1895/1955, pp88-89)

Interesting though the case was in its own right, Anna O's true fame came only once Freud traced his methods of "free association" and catharsis back to her, and many of his critics have claimed over the years that the conclusions he reached exceeded the scope of the available data. [See now association (Freudian).]

Case, Anne Grigg-Booth: [See firstly toxic caring.] Anne Grigg-Booth was a nurse in a Yorkshire hospital who was accused in 2004 of having murdered three ailing female patients between June 2000 and July 2004 (but who was also suspected of killing up to a further 20). The truth will never fully be known, however, because she died before the trial began. Here is an indicative extract from the press coverage at the time .....

"West Yorkshire police [said] that the nurse, who was said by colleagues to have had a 'God complex', might have killed others. [..... Ex-colleagues] described her as eccentric and bossy but popular and well-respected. She was known for taking in stray dogs and had a 'house full of animals'. One nurse said: 'She was totally in control but did have a bit of a God complex. She thought she could do little wrong, even though it went against hospital rules" (The Times, 31st August 2005).

Case, Augustine: Augustine was one of the many thousands of patients who passed through Charcot's hands in the hysteria wards at the Salpêtrière Psychiatric Hospital, Paris, between 1862 and 1893. She was one of Charcot's favourite patients, however, because she seems to have fitted his theoretical expectations of what a good hysteric ought to look like. As a result she was selected to participate in person as a demonstration case at his lectures, and to provide carefully staged photographic images to support his research papers. Didi-Huberman (1982/2003; Chapter 8) reproduces many of these images, and a few have even made it online [image]. More recently, the Charcot-Augustine story has inspired both the play "Augustine: Big Hysteria" (Furse, 2002) [see review] and the movie "Augustine" (2003) [see review (French)].

Case, Balderstone: See external report, and then aggression, hearing voices and.

Case, Benjamin Geen: [See firstly toxic caring.] Benjamin Geen, accident and emergency nurse at Horton General Hospital, Banbury, was convicted in April 2006 of murdering two of the patients in his charge by illegally administering sedatives. Here are some summary details from the press coverage at the time .....

"Over a nine-week period Mr Geen interfered with the treatment of patients to cause their condition to deteriorate rapidly so that he could enjoy the drama that followed, [the prosecution] said. He was said to administer the drugs secretly either with a syringe or by interfering with the patients' drips, oxygen supply, or cannula" (The Times, 15th February 2006).

"[Geen] injected his victims with potentially deadly unprescribed drugs to stop them breathing so he could 'enjoy the excitement' of helping to revive them. [.....] During the two-month trial, the jury of six men and six women heard how Geen 'came alive' and looked 'elated' as his patients went into respiratory arrest. Geen even 'boasted' about the regular action during his shifts and told one doctor: 'There is always a resuscitation when I'm on duty'" (The Independent, 18th April 2006).

It emerged during the trial that as soon as hospital staff had detected the surge in incidents of unexplained respiratory arrest, they carried out a forensic analysis of the casenotes, in which the common denominator was that Geen had been involved.

Case, Bobby: This is Levine's (1996/2006 online) illustration of the first signs of emerging Asperger's disorder. Here is an indicative extract .....

"Bobby, now 2-and-one-half years old, was born to his healthy young parents after a perfect pregnancy. He had been an "easy" baby who was content to play alone in his crib for long periods. He had smiled and laughed at 2 months, walked at a year, always loved music, and his parents felt he was a happy baby. He seemed very smart, showing an early interest in numbers and letters, and was able to recite the alphabet, count to 20, do difficult puzzles, make great designs with his blocks, and had many tunes and some story books memorized by 2 years. He was fascinated by certain videos which he watched over and over. His parents became concerned though, around a year, that he often didn't respond when they called his name, and that while he had a large vocabulary and used some sentences, he didn't use the words to communicate the way other children did. He sometimes recited lines from his videos, or the alphabet, rather than answering a question."

Case, Butrimonys: [See firstly atrocity.] The village of Butrimonys, Lithuania, was the scene on 9th September 1941 of an atrocity in which the Jewish element amongst the villagers, totalling 67 men, 370 women, and 303 children, were shot by Nazi-organised Lithuanian Special Police units, and dumped in a communal grave. The incident is notable because there exists rare videotaped testimony from of one of the perpetrators, one Petras Zelionka, then aged 20 years. Having served 20 years years for war crimes, he was interviewed in the mid-1990s for the TV documentary "The Nazis - A Warning from History" (Samuel West, 1997). The conversation, via a translator, went like this .....

Interviewer: "You soldiers who used to do the shooting - you were volunteers."

Zelionka: "Maybe you could call them volunteers - they were certainly given more vodka. [.....] They drank it, and then everyone becomes braver. We would shoot them, give them up as lost, and that was it."

Interviewer: "Didn't you ever think you ought to refuse to shoot them?"

Zelionka: "Today all this is very difficult to explain. Whether to shoot or not to shoot. I do not know. The others did it because of their anger - they thought the Jews were very selfish. What can I say."

Interviewer: "Let's say there's a Jew in front of you - not a man, but a woman or a child. A child has never been a Communist and yet you shoot the child. What had he done?"

Zelionka: "This is a tragedy, a big tragedy. How should I put it to you? How can I explain? It's a kind of curiosity. You just pull the trigger, he falls, and that's it."

Interviewer: "My colleague, an Englishman, asked me to ask you this question. People watching this film will not understand how somebody used to shoot other people like this and does not feel guilty."

Zelionka: "They can accuse me if they want. I was given a 20-year sentence for that, short and clear, and I served 20 years."

Interviewer: "Imprisonment. That was an official punishment. What does your conscience say?"

Zelionka: "I do not know. I am not going to answer such questions. You can ask me or not. I am not going to explain or tell you any more."

We find this testimony noteworthy in the context of the present glossary because in its own way it addresses nothing less than the relationship between mind and body. Was it, for example, Zelionka's will which did the killing, or just his body? And were both those facets of his self equally punished by his 20 years in prison? And can his conceptualising self - even now - engage fully with his body's memories, or are they in certain key respects still carefully repressed? The big problem in all this is whether "will power" really exists, or whether our attitudes and beliefs are merely post-hoc rationalisations of the things we find ourselves doing ["OK, we shot an innocent person, but what the heck (s)he had it coming!"]. For a more sustained discussion of the ego as a post-hoc rationaliser of whatever the id gets up to, see the entry for Lange, Carl Georg.

Case, Cameron West: [American psychologist, 24-alter multiple personality, and media celebrity.] [Homepage] Cameron West is noteworthy in the context of the present glossary for both being a multiple personality and helping to publicise the condition. His autobiography, "First Person Plural" (West, 1999), presents a fascinating insight into the introspected consciousness of one's own multiplicity. Here is a selection of the alters - he calls them "my guys" (even though some are female) - he has discovered within himself over the years .....

"Soul": Soul is/was "an ageless alter who emerged early on and whose job it was to give me hope so I could survive" (vii).

"Sharky": Sharky is/was "a primitive alter who at first couldn't form words at all [but had] a huge toothy mouth" (vii).

"Davy": Davy is/was "sweet and sad". He was the first alter to emerge, "but he doesn't come out much any more" (vii).

"Clay": This alter "comes out frequently", used to have "an awful stutter" and be "unable to look people in the eye", but is much more relaxed now. 

"Switch": This alter "held incredible rage" for being abused, but at the same time was not averse to turning that rage "toward me and some of the others" (viii).  Switch was the self-abusing alter: "He didn't want to cut, but he coudn't stand to be ignored" (p266).

"Wyatt": This alter is bright, "likes to talk to people", and is "almost perpetually in motion" (viii). 

"Bart": This alter is "easygoing" and "funny", and helps protect the younger alters. "Along with Per, he takes control when crises arise" (ix).

"Sky": This alter appeared early on "to help regulate the flow of emotions and memories" (ix). Sky was "the gatekeeper" (p115). He had no feelings of his own, but was blessed with "two strong hands on one big wheel" (ibid.), which he used to control the pain. He no longer comes out.

"Stroll": This alter is "a serpentine sexual tool, existing solely for the pleasure of women, emerging any time a woman of my age showed me any kindness at all" (x). 

"Per": This alter is "a gentle spiritual soul" (x), and acts as the "father figure" to all the other alters.

West reports from introspection that some of his alters are best treated as members of a "core group". Of the selection listed above, these are Clay, Switch, Wyatt, and Per. As to their role in West's slow recovery from childhood sexual abuse at the hands of his mother, reference should be made to the original work. 

EXERCISES: Try these for fun and edification .....

(1) Remind yourself of Freud's classic "structural" distinction between ego, id, and superego, and then decide for yourself how different alters cross-map onto different structures. [Hint: You might decide, for example, that Sharky is part of West's id, but, if so, you will also have to decide if Sharky is alone in so being.]

(2) Remind yourself of Freud's classic developmental stages, namely anal, oral, phallic, latency, and genital, and then decide for yourself how these stages cross-map onto the alter system set out above.

(3) A persona is an actor's mask, either literally (as in the classical Greek theatre) or figuratively (as one of the roles we are motivated to "adopt" now and then in our dealings with life). It is accordingly possible that some of West's alters are personas rather than personalities (if indeed there is a legitimate difference between those two terms), and that they are used in the same way that a non-multiple might protect or promote his/her self and conceal his/her personality by adopting particular personas in particular situations. It follows that if West has (at least) two genuine personalities they might each be able to adopt concealing personas, either different or - potentially - the same. The issue here is therefore whether the relationship between personality and persona is one-to-one or one-to-many, so try the following exercise. Firstly, mark out two columns on a sheet of paper, heading one "Personalities" and the other "Masks". Now enter "West #1" in the left-hand column and enter alongside it in the right-hand column as many of the "guys" from the list above that you think make sense together. Then enter "West #2" in the left-hand column and enter any of the remaining guys which make sense together. Continue until all the guys have been accounted for, and reflect upon what you then see. 

Case, Cheryl James: See case, Deepcut Barracks.

Case, Christine Sizemore: See case, Eve. 

Case, Christopher Clunis: See external report, and then aggression, hearing voices and.

Case, Cindy: Riley and Mead (1988) report the case of Cindy, a three year old girl, who presented from about age 30 months with signs of a two-alter multiple personality, making her, the authors suggested, "the youngest thus far reported in the literature" (p41). Here are some of the key points in the case [a long extract, heavily abridged] .....

"[Cindy] was first seen [] at the age of 14 months [following] a custody dispute between the custody parents [.....] and the biologic mother. In the initial evaluation, Cindy projected a very positive air. She was intelligent, explored the office, and was obviously happy and secure. [.....] When Cindy was seen again at 16 months of age, the biologic mother had been visiting Cindy for a few hours twice weekly in her guardians' home. Cindy was reported to be sleeping poorly. Her appetite had decreased and she was having fits of anger. In contrast to her previous behaviour, she was agitated, and clung to her guardian mother, becoming highly anxious when she was left alone with the examiner. [..... Nevertheless,] the custody of the child was awarded to the biologic mother [..... it only later being] learned that during this period the biologic mother had given birth to another female child who had died of sudden infant death syndrome at three months of age. [.....] Seen at 23 months with her guardian mother, she was very frightened and clinging. [.....] Over the next few months, Cindy deteriorated emotionally. She was withdrawn, insisted on being held, and cried if she was not touching her guardian mother. [.....] Also, she said that she was being called 'Lila' (the name that was eventually given to her alter) by the genetic family members. Also, she repeatedly stated that her genetic half brothers were touching her genitals and/or inserting objects into her vagina. [.....] Because of these complaints, the court curtailed overnight visitation when Cindy was 30 months of age. Cindy's mood improved and her anxiety diminished, but she became overtly angry, threw tantrums, and would not let her guardian mother out of her sight. [.....] The guardian mother also reported that she would talk in her sleep, and say 'My name is Cindy R' (her guardian surname) over and over again. [.....] The first videotaped sessions occurred when Cindy was 35 months old. [.....] When she talked about members of the biologic family, her speech and mannerisms were quite different. Her speech was more immature and her body postures and mannerisms were puppet like. [.....] The alter personality, Lila, presented herself directly in a second session with the biologic mother. [..... As Lila, s]he either did not answer questions about the guardian family or responded with 'I don't know'. [.....] Then Cindy would emerge. [.....] Lila seemed to be younger, and her fund of knowledge more limited. When Lila made mistakes, Cindy would come out and correct them. [.....] Lila did not seem to know Cindy. Cindy, on the other hand, was quick to respond to questions that did not relate to the genetic family. [.....] Cindy was assertive and commanding when she did not feel threatened. She acknowledged her anger and was, at times, overtly hostile" (Riley and Mead, 1988, pp41-43).

Case, Clare: This is the first of three cases offered by Hopkins (1991) when discussing possible pathologies of the holding environment during childrearing. Here is a summary of the case report .....

"Clare was referred for psychotherapy at the age of six years on account of nightmares. Her mother reported that she had resented the child's arrival and found her physically repellant as a baby, though she had gradually come to enjoy talking and playing with her. She had always propped Clare's bottle and kept her in a playpen all day until she started nursery school. She thought that Clare had always resisted being cuddled. As soon as Clare could walk she walked away from her mother and was liable to get lost. She had always been stoically independent, never asking for help except when she had hurt herself. [.....] The psychiatrist who assessed Clare described her as having a false personality (Winnicott, 1960). She was strongly identified with her mother whose phrases and gestures she accurately produced. It seemed that she did not need her mother because she had become her. Similarly, in therapy, Clare took over my capacity to make interpretations and gave them to herself so that she would not need to depend on me. [.....] Clare often spoke of [a] worry about lepers which gave her bad dreams. [.....] As therapy proceeded Clare became aware that she felt herself to be a leper whom no-one wanted to touch because she would kill them, and she became aware of her longing to cry and to be comforted" (Hopkins, 1991, pp189-190; emphasis added).

[Compare case, Laura and case, Paddy. The case also seems to be a good example of identification (2).]

Case, Dora: [Real name Ida Bauer (1882-1945).] [See firstly hysteria.] Freud offers us this case in Fragments of an Analysis of a Case of Hysteria (Freud, 1905) to illustrate the organisation of cognition in hysterics [thus adding to the four detailed cases presented in Studies on Hysteria (Freud and Breuer, 1893-1895). Here is how he introduces the case .....

"[Dora] had even at the age of eight begun to develop neurotic symptoms. She became subject at that time to chronic dyspnoea [= "difficult or laboured respiration" (Free Dictionary)][.....] The family doctor seems to have had not a moment's hesitation in diagnosing the disorder as purely nervous [.....] When she was about twelve she began to suffer from unilateral headaches in the nature of a migraine, and from attacks of nervous coughing. [.....] It was in such circumstances as these that the child had developed into a mature young woman of very independent judgment [.....] I first saw her when she was sixteen [and] proposed giving her psychological treatment. My proposal was not adopted" (Freud, 1905/1953, Fragments [Standard Edition (Volume 7)], pp21-22).

A couple of years went by, until, following her threatening suicide and an incident of lost consciousness, the girl's father insisted on her undertaking psychoanalysis. Freud then simply put two and two together. To start with, he had been working with cases of hysteria since the mid-1880s, so he instantly judged Dora to be a case of "petite hystérie" on the grounds that her clinical presentation - dyspnoea, tussis nervosa [= a nervous cough], aphonia [= absence of voice (regardless of aetiology)], migraines, depression, hysterical unsociability, and taedium vitae [= an air of boredom with life] (especially if "put on") - were all commonplace in that condition. Furthermore, as an adherent to the classical and still prevailing theory of hysteria, Freud was already looking for "a disturbance in the sphere of sexuality" (p24), and Dora's father immediately confirmed that she had indeed suffered unwelcome sexual attentions from a male family friend, Herr K., thus [a long extract, heavily abridged] .....

"Her father told me that he and his family [had] formed an intimate friendship with a married couple [Frau and Herr K.]. Herr K. had always been most kind to Dora. He had gone walks with her [and] had made her small presents; but no one had thought any harm of that. [In the end, however, she] told her mother - intending that what she said should be passed on to her father - that Herr K. had had the audacity to make her a proposal while they were on a walk after a trip upon the lake. Herr K. had been called to account [.....] but he had denied in the most emphatic terms having on his side made any advances [.....]. 'I have no doubt', continued her father, 'that this incident is responsible for Dora's depression and irritability and suicidal ideas" (op. cit., pp25-26).

Freud was pleased at the initial "fit" between Dora's symptoms and his own views on the causes of hysteria, thus .....

"The experience with Herr K. [.....] seems to provide in Dora's case the psychical trauma which Breuer and I declared long ago [in Breuer and Freud (1893)] to be the indispensable prerequisite for the production of a hysterical disorder. But this new case also presents all the difficulties which have since led me to go beyond that theory, besides an additional difficulty of a special kind. For, as so often happens in histories of cases of hysteria, the trauma that we know of as having occurred in the patient's past life is insufficient to explain or to determine the particular character of the symptoms [..... the fact, for example,] that some of the symptoms (the cough and the loss of voice) had been produced by the patient years before the time of the trauma, and that their earliest appearances belong to her childhood, since they occurred in her eighth year" (op. cit., pp26-27).

 Sure enough, as the analysis proceeded Dora gradually revealed new details .....

"When the first difficulties of the treatment had been overcome, Dora told me of an earlier episode with Herr K., which was even better calculated to act as a sexual trauma. She was fourteen years old at the time. Herr K. had [contrived to get her alone and] had suddenly clasped the girl to him and pressed a kiss upon her lips. [.....] In this scene - second in order of mention, but first in order of time - the behaviour of this child of fourteen was already entirely and completely hysterical. I should without question consider a person hysterical in whom an occasion for sexual excitement elicited feelings that were preponderantly or exclusively unpleasurable; and I should do so whether or no the person were capable of producing somatic symptoms. The elucidation of the mechanism of this reversal of affect is one of the most important and at the same time one of the most difficult problems in the psychology of the neuroses" (op. cit., pp27-28; bold emphasis added).

 The interpretation was now as follows .....

"I believe that during the man's passionate embrace she felt not merely his kiss upon her lips but also the pressure of his erect member against her body. This perception was revolting to her; it was dismissed from her memory, repressed, and replaced by the innocent sensation of pressure upon her thorax, which in turn derived an excessive intensity from its repressed source. [.....] It is worth remarking that we have here three symptoms - the disgust, the sensation of pressure on the upper part of the body, and the avoidance of men engaged in affectionate conversation - all of them derived from a single experience [.....]. The disgust is the symptom of repression in the erotogenic oral zone, which, as we shall hear, had been over-indulged in Dora's infancy by the habit of sensual sucking. The pressure of the erect member probably led to an analogous change in the corresponding female organ, the clitoris; and by the excitation of this second erotogenic zone was referred by a process of displacement to the simultaneous pressure against the thorax and became fixed there. Her avoidance of men who might possibly be in a state of sexual excitement follows the mechanism of a phobia, its purpose being to safeguard her against any revival of the repressed perception" (op. cit., pp30-31).

Dora's father was, however, unwilling to cease the association between the two families, a fact which seems to have irritated Dora and led her to conclude that her father and Frau K. had also been having an affair.

ASIDE: In matters of her father's love life, Freud notes, rather pointedly, that Dora's powers of recollection were "pitilessly sharp" (p32), and free of the gaps which so conveniently appeared in self-referenced narrative. At the same time, Freud implicitly congratulates the father on his prowess as a lover by noting how Frau K.'s own mental condition had miraculously improved during their illicit affair!

Dora even started to suspect that she had been "handed over" to Herr K. as the price of his silence concerning her father's dalliance with Frau K.! Freud doubted that this was precisely true, but was able, after much discussion, to conclude that Dora's underlying disease motivation was "to touch her father's heart and to detach him from Frau K." (p46). With that conviction in mind, he then turned to the matter of ultimate cause ..... 

"If we have rightly guessed the nature of the imaginary sexual situation which underlay her cough [the thought of oral sex having taken place between her father and Frau K. - Ed.], in that phantasy she must have been putting herself in Frau K.'s place. She was therefore identifying herself both with the woman her father had once loved and with the woman he loved now. [.....] I have learned to look upon unconscious love relations like this (which are marked by their abnormal consequences) - between a father and a daughter, or between a mother and a son - as a revival of germs of feeling in infancy. I have shown at length elsewhere at what an early age sexual attraction makes itself felt between parents and children, and I have explained that the legend of Oedipus is probably to be regarded as a poetical rendering of what is typical in these relations. [.....] When I told Dora that I could not avoid supposing that her affection for her father must at a very early moment have amounted to her being completely in love with him, she of course gave me her usual reply: 'I don't remember that' [although she had a young female cousin who had once confided in Dora that she hated her mother so much that] 'when she's dead I shall marry Daddy'. [.....] No other kind of 'Yes' can be extracted from the unconscious; there is no such thing at all as an unconscious 'No'" (op. cit., pp56-57).

Case, Elena F: We have mentioned Morselli's (1930) case, Elena F, one of the classic cases of incestuous sexual abuse, in the entries for abreaction and multiple personality.

Case, Elisabeth von R.: In his contribution to Studies on Hysteria (Freud and Breuer, 1893-1895), Freud offers us the 54-page case of "Fräulein Elisabeth von R." as one of four typical hysteria patients [the other three being case, Emmy von N., case, Lucy R., and case, Katharina]. Here is how he introduces the case .....

"In the autumn of 1892 I was asked by a doctor I knew to examine a young lady who had been suffering for more than two years from pains in her legs and who had difficulties in walking. When making this request he added that he thought the case was one of hysteria, though there was no trace of the usual indications of that neurosis. [.....] She seemed intelligent and mentally normal and bore her troubles [.....] with a cheerful air - the belle indifférence of a hysteric [.....]. She walked with the upper part of her body bent forward [and] complained of great pain in walking and of being quickly overcome by fatigue both in walking and in standing [.....] The pain was of an indefinite character [centred on a] fairly large, ill-defined area of the anterior surface of the right thigh [.....] The disorder had developed gradually during the previous two years and varied greatly in intensity" (Freud, 1893-1895, Studies on Hysteria [Case History #5], pp202-203).

During several weeks' preliminary treatment, Freud formed the impression that the material which mattered was not so much repressed unconscious memories as deep personal secrets and the like. This allowed him to depart, for once, from the heavy reliance on hypnosis which had characterised his earlier clinical years, and to relegate that technique instead to a secondary role, thus .....

"In the first instance, therefore, I was able to do without hypnosis [and] arrived at a procedure which I later developed into a regular method and employed deliberately. This procedure was one of clearing away the pathogenic psychical material layer by layer, and we liked to compare it with the technique of excavating a buried city. I would begin by getting the patient to tell me what was known to her and I would carefully note the points at which some train of thought remained obscure or some link in the causal chain seemed to be missing. And afterwards I would penetrate into deeper layers of her memories at these points by carrying out an investigation under hypnosis or by the use of some similar technique" (op. cit., pp206-207; bold emphasis added).

A complex SH [= "social history", the background facts of a case in such potentially relevant areas as family structure and habits, class, education, religion, employment, and the like, and relationship issues of all kinds] slowly emerged, including the following .....

"..... during the last few years [the family] had met with many misfortunes and not much happiness. First the patient's father had died, then her mother had had to undergo a serious eye operation and soon afterwards a married sister had [died during pregnancy]. In all these troubles and in all the sick-nursing involved, the largest share had fallen to our patient" (op. cit., p202).

"[Elisabeth had been] the youngest of three daughters, she was tenderly attached to her parents and spent her youth on their estate in Hungary. Her mother's health was frequently troubled by an affection of the eyes as well as by nervous states. Thus it came about that she found herself drawn into especially intimate contact with her father, a vivacious man of the world, who used to say that this daughter of his took the place of a son and a friend with whom he could exchange thoughts. [..... Perhaps as a result, s]he was full of ambitious plans. She wanted to study or to have a musical training, and she was indignant at the idea of having to sacrifice her inclinations and her freedom of judgment by marriage" (op. cit., pp207-208).

"Here, then, was the unhappy story of this proud girl with her longing for love. Unreconciled to her fate, embittered by the failure of all her little schemes for re-establishing the family's former glories, with those she loved dead or gone away or estranged, unready to take refuge in the love of some unknown man - she had lived for eighteen months in almost complete seclusion, with nothing to occupy her but the care of her mother and her own pains" (op. cit., p212). [Readers are reminded at this juncture of the classical opinion on the aetiology of hysteria, as set out in the quotation from Bromberg (1954) at the beginning of the entry for hysteria.]

Yet despite the hardships imposed by her familial duties, Freud observed that the circumstances were actually rather "commonplace" (p212), and certainly not, in themselves, a good enough cause for hysteria. Determined to dig more deeply, and suspecting that the woman in question might be toying with him in his role as analyst, Freud resolved to try a session of full hypnosis, only to find that the patient was strongly resistant to the technique, even to the point of "triumphantly protesting: I'm not asleep, you know" (p213). He therefore asked her instead to faithfully report "whatever appeared before her inner eye or passed through her memory" whenever he applied light pressure to her head. Using this new method brought about what was to turn out to be an important breakthrough .....

"She remained silent for a long time and then, on my insistence, admitted that she had thought of an evening on which a young man had seen her home after a party, of the conversation that had taken place between them, and of the feelings with which she had returned home to her father's sick-bed. The first mention of the young man opened up a new vein of ideas the contents of which I now gradually extracted. It was a question here of a secret, for she had initiated no one, apart from a common friend, into her relations with the young man and the hopes attached to them. [Biographical details given.] After her father had fallen seriously ill [..... on one] occasion she had allowed herself to be persuaded, by the insistence of her family and of her father himself, to go to a party [with the young man]. But when she arrived home late in [a] blissful frame of mind, she found her father was worse and reproached herself most bitterly for having sacrificed so much time to her own enjoyment. This was the last time she left her sick father for a whole evening [and] after her father's death the young man seemed to keep away from her out of respect for her sorrow. [.....] It was therefore in this relationship and in the scene described above in which it culminated that I could look for the causes of her first hysterical pains" (op. cit., pp214-215; bold emphasis added).

In short, Freud detected "a situation of incompatibility" (p215) between his patient's impulses as an eligible young woman and her duties as a loyal daughter, and it was this conflict which had the power to create the observed pathology. Here is the proposed sequence of events .....

"The outcome of this conflict was that the erotic idea was repressed from association and the affect attaching to that idea was used to intensify or revive a physical pain which was present simultaneously or shortly before. Thus it was an instance of the mechanisms of conversion for the purpose of defence" (op. cit., p215; bold emphasis added).

Elisabeth herself seemed to confirm this interpretation a few days later .....

"The patient surprised me soon afterwards by announcing that she now knew why it was that the pains always radiated from that particular area of the right thigh and were at their most painful there: it was in this place that her father used to rest his leg every morning while she renewed the bandage around it, for it was badly swollen. This must have happened a good hundred times, yet she had not noticed the connection till now" (op. cit., p217).

Freud now devotes several pages of history to a detailed discussion of the location of Elisabeth's pains, and their potential relationship to the traumas of her father's and sister's deaths, before returning to the nature of the memory recall process, and the extent of her conscious access to traumatic material. The circumstances which most concerned him were occasions when she was clearly withholding recall from him, thus .....

"I could think of two motives for this concealment. Either she was applying criticism to the idea, which she had no right to do [.....] or she hesitated to produce it because she found it too disagreeable to tell. I therefore [.....] no longer accepted her declaration that nothing had occurred to her, but assured her that something must have occurred to her [..... and reminded her that] she was under an obligation to remain completely objective and say what had come into her head, whether it was appropriate or not. [.....] In the course of this difficult work I began to attach a deeper significance to the resistance offered by the patient in the reproduction of her memories and to make a careful collection of the occasions on which it was particularly marked" (op. cit., pp2230-224; bold emphasis added)

Freud describes this further change in technique as "the third period of the treatment" (p224). He had also formed, but not yet explored, a suspicion of what Elisabeth's ultimate secret might turn out to be. Fortuitously .....

"..... a chance occurrence decided the matter. One day while I was working with the patient, I heard a man's footsteps in the next room and a pleasant voice [enquiring after her]. My patient thereupon got up and asked that we might break off for the day [.....] Up to that point she had been free from pain, but after the interruption her facial expression and gait betrayed the sudden emergence of severe pains" (op. cit., p224; bold emphasis added).

Freud now directed his questioning to her relationship with the second sister, and soon found at that Elisabeth soon formed "a desire to have a husband like [hers]" (p225). A few days later .....

"..... came the scene on the morning after the departure of her sister and brother-in-law when she made her way to the place with a view, which had been a favourite object of their walks. There she sat down and dreamt once again of enjoying such happiness as her sister's and of finding a husband who would know how to capture her heart like this brother-in-law of hers. She was in pain when she stood up" (op. cit., p225).

Now shortly afterwards the sister had died, of course, only on this occasion as Elisabeth recalled her grief her recollections took her all the way .....

"At that moment of dreadful certainty that her beloved sister was dead [.....] another thought had shot through Elisabeth's mind, and now forced itself irresistibly upon her once more, like a flash of lightning in the dark: 'Now he is free again and I can be his wife'. Everything was now clear. [.....] This girl felt towards her brother-in-law a tenderness whose acceptance into consciousness was resisted by her whole moral being. She succeeded in sparing herself the painful conviction that she loved her sister's husband by inducing physical pains in herself instead" (op. cit., pp226-227; bold emphasis added).

Freud provides his own case summary .....

"The analysis, moreover, gave evidence that during the same period the patient was in a special psychical state. The connection of this state with her erotic feelings and her pains seems to make it possible to understand what happened on the lines of the conversion theory. It is, I think, safe to say that at that time the patient did not become clearly conscious of her feelings for her brother-in-law, powerful though they were, except on a few occasions, and then only momentarily. [.....] She had no recollection of any such feelings; she had avoided them. It followed that her feelings themselves did not become clear to her. At that time, as well as during the analysis, her love for her brother-in-law was present in her consciousness like a foreign body, without having entered into relationship with the rest of her ideational life. With regard to these feelings she was in the peculiar situation of knowing and at the same time not knowing [.....] We do not mean that their consciousness was of a lower quality or of a lesser degree, but that they were cut off from any free associative connection of thought with the rest of the ideational content of the mind" (op. cit., p236).

And as to the critical incidents in the development of the disorder, he notes .....

"I cannot, I must confess, give any hint of how a conversion of this kind is brought about. It is obviously not carried out in the same way as an intentional and voluntary action. [.....] I have asserted that on certain occasions, though only for the moment, the patient recognised her love for her brother-in-law consciously. [.....] I must now consider the significance of these moments in their bearing on our view of the whole neurosis. It seems to me that the concept of a 'defence hysteria' in itself implies that at least one moment of this kind must have occurred. Consciousness, plainly, does not know in advance when an incompatible idea is going to crop up. The incompatible idea, which [is] later excluded and forms a separate psychical group, must originally have been in communication with the main stream of thought. Otherwise the conflict which led to their exclusion could not have taken place. It is these moments, then, that are to be described as 'traumatic': it is at these moments that conversion takes place, of which the results are the splitting of consciousness and the hysterical symptom" (op. cit., pp237-239).

Case, Emma: Freud offers us the case of Emma in his Project for a Scientific Psychology (Freud, 1895) as part of his explanation of the organisation of cognition in hysterics. Here is how he introduces the case .....

"Now, as it happens, there is a special psychical constellation in the sexual sphere which might be of service for our purpose. I will illustrate it (it is known to us empirically) by an example. Emma is subject at the present time to a compulsion of not being able to go to the shops alone. As a reason for this [she produced] a memory from the time when she was twelve years old (shortly after puberty). She went into a shop to buy something, saw the two shop-assistants (one of whom she can remember) laughing together, and ran away in some kind of affect of fright. In connection with this, she was led to recall that the two of them were laughing at her clothes and that one of them had pleased her sexually. [..... These memories alone] explain neither the compulsion nor the determination of the symptom. Further investigation now revealed a second memory, which she denies having had in mind at the moment of Scene 1. [.....] On two occasions when she was a child of eight she had gone into a small shop to buy some sweets, and the shopkeeper had grabbed at her genitals through her clothes. In spite of the first experience she had gone there a second time [and] now reproached herself for having [done that], as though she had wanted in that way to provoke the assault. In fact a state of 'oppressive bad conscience' is to be traced back to this experience. We now understand Scene 1 (shop-assistants) if we take Scene 2 (shopkeeper) along with it. We only need an associative link between the two. She herself pointed out that [the associative link under consideration] was provided by the laughing: the laughing of the shop-assistants has reminded her of the grin with which the shopkeeper had accompanied his assault. [.....] The memory aroused what it was certainly not able to at the time, a sexual release, which was transformed into anxiety. With this anxiety, she was afraid that the shop assistants might repeat the assault, and she ran away. [.....] What happened can be represented thus: ....." (Freud, 1895/1966, Project for a Scientific Psychology [Standard Edition (Volume 1)], pp353-354),

Freud then draws an explanatory circuit diagram (Figure 16, p354), showing how an array of individual memory fragments combine to provide both conscious and unconscious influences on behaviour [this figure uses a graphical notation previously used to represent individual ideas (e.g., Figure 15), not individual neurons (e.g., Figure 14); it is therefore best to think of each fragment as divisible into neurons if only we knew how many neurons made a memory]. Here is the structure he suggests [note the use of blacked-in and unfilled circles (respectively) to illustrate the memories relevant to Scene 1 and Scene 2] .....

This diagram no longer loads automatically, but may be accessed separately at ...

http://www.smithsrisca.co.uk/PICfreud1895.gif

Here is Freud's accompanying interpretation .....

"Of these, the blacked in ideas are perceptions which are also remembered. The fact that the sexual release too entered consciousness is proved by the otherwise incomprehensible idea that the laughing shop-assistant had pleased her. The outcome - not to remain in the shop alone on account of the danger of assault - is quite rationally constructed having regard to all the pieces of the associative process. However, nothing of the process [the cluster of memories connected by the dotted lines above - Ed.] entered consciousness except the element clothes; and thought operating consciously has made two false connections in the material at its disposal (shop-assistants, laughing, clothes, sexual feeling): that she was being laughed at on account of her clothes and that one of the shop-assistants excited sexual pleasure in her. The whole complex (unblacked-in [circles]) is represented in consciousness by the one idea clothes, clearly the most innocent one. Here a repression accompanied by symbol-formation has taken place. The fact that the outcome - the symptom - is then quite rationally constructed, so that the symbol plays no part in it, is in point of fact a peculiarity of the case. It might be said that it is quite usual, as happens here, for an association to pass through unconscious intermediate links until it comes to a conscious one. In that case, the element which enters consciousness is probably the one that arouses special interest. In our example, however, it is noticeable precisely that the element which enters consciousness is not the one that arouses interest (assault) but another one, as a symbol (clothes)" (op. cit., pp354-356).

 [For further discussion of this case, see the paragraph on the proton pseudos towards the end of the entry for Freud's Project.]

Case, Eve: [Real names Christine Costner (maiden), Christine Costner Sizemore (married); nom de plume Evelyn Lancaster.]

"She did not at first appear to be an unusual or a particularly interesting patient".

Thigpen and Cleckley's (1954, 1957) case Eve is one of the classic cases in the history of multiple personality disorder. The events described below took place in the early 1950s in and around Augusta, GA, where Doctors Corbett H. Thigpen (1913-1999 [no significant biography online]) and Hervey M. Cleckley (1903-1984 [click for external biography]) were (respectively Associate and full) Professors of Psychiatry and Neurology at the Medical College of Georgia. As is commonplace in medicine, the less experienced member of the team (Thigpen) conducted the actual consultations under the mentorship of the senior member (Cleckley), with the associated publications going out under joint names. The first such report was Thigpen and Cleckley (1954), but that paper attracted such levels of interest outside psychiatry that it was expanded for the public at large as "The Three Faces of Eve" (Thigpen and Cleckley, 1957), which was itself then the basis of the 1957 Joanna Woodward movie of the same name. The nom de client "Eve (White)" was used to protect the privacy of the patient concerned, but she later declared herself as one Christine Sizemore, so we shall take that as given from the outset.

ASIDE: A number of additional facts from Sizemore's own writings (Lancaster and Poling, 1958, Sizemore and Pittillo, 1977) have been separated out under the heading case, Christine Sizemore, but there is no need to divert to that entry at this stage.

When first seen for psychiatric consultation, Sizemore, aged 25 years, mother to "Bonnie" and wife to "Ralph", presented as "a neat, colourless, young woman" (1957, p7). She had been referred to Dr. Thigpen by her GP for recurrent attacks of severe headache and blackout, against a social history of recurrent quarreling with her husband. There was little initial indication of what was to follow, as is borne out in our opening extracts from the case details [we follow the 1957 narrative as far as possible, using the 1954 source only when it provides a better level of detail]. Here are Thigpen's first impressions .....

"This superlatively calm, utterly self-controlled little figure of propriety showed no suggestion of anything that the layman might think of as nervousness. Her hands lay still on the arms of her chair as she spoke. Her head and shoulders drooped just a little. So thorough was her quality of gentle formality that it was difficult to believe that her eyes might ever flash in merriment, that she could ever have told a joke, or that even as a child, she could have teased anyone in some spontaneous outburst of feeling" (1957, p7).

"It was almost impossible to imagine this gentle woman raising her voice in anger or participating aggressively in a personal argument. Her deep and genuine humility seemed to enforce a meekness upon her that one felt might even prove a serious handicap in what lay ahead. [.....] This was a woman, it seemed, not lacking in spirit, but who would not be likely to assert herself actively in opposition to another. Surely it must be an unusual man who would lose his temper with this unprovocative, unvengeful woman. What were the grounds for his anger? 'He must have his reasons,' she granted thoughtfully. 'I am not quite sure what it is I do that aggravates him so'" (1957, p9; emphasis added).

ASIDE: Note the curiously self-effacing closing sentence above. At several points in the 1957 account, the authors either mention directly the fact that Sizemore often "took pains to defend" (1957, p9) her husband, or else included in their account/transcript comments which fall clearly into that category. 

And yet Sizemore did provoke anger in her husband, and the marriage was clearly already in deep trouble. She recorded never having been able to reach orgasm in their sexual life together, that there remained "little closeness or sharing of interests and personal feelings" (1957, p10), and that he had on one occasion struck her in the heat of one of their arguments. It was noted that Sizemore had been brought up a Baptist, but had married a "faithful and serious" (1957, p8) Catholic, and had been experiencing conflict with her husband over the religious education of their daughter once she got old enough for Sunday School. Probing the husband for his side of the story, Thigpen noted two interestingly dark undertones in his description of his wife's behaviour, namely a certain "erratic streak" and some "occasional forgetfulness", thus .....

"'It's hard to believe, doctor, that such a sweet, steady woman could ever aggravate anybody. Maybe she is too good. Maybe that is why I lost my temper once in a while. You get accustomed to what she's like and you don't know what to make of ..... of anything different ..... when it comes'. When asked to elaborate, Ralph White spoke of rare occasions when Eve had showed something less than her customary forbearance and calm. 'It must be a sort of little erratic streak that comes out just every now and then', he suggested. He spoke also of occasional forgetfulness that had caused misunderstandings between them. 'I know it's the right thing to try to talk over misunderstandings,' he said, 'but I can't usually get Eve to go into such things.' In retrospect it seems remarkable how little emphasis Ralph White put on these points, how little detail he gave" (1957, pp14-15; bold emphasis added).

One day, after one of her headaches, Sizemore complained to Thigpen of a recurrent nightmare, as follows .....

"'I am in a tremendous room,' she said. 'Its outline seems vague and dim because of its size. Toward the centre of this room is a pool of stagnant green water. On the edge of the pool stand my husband and my uncle. I am in the water with Bonnie. I am trying to get her out for we both seem to be drowning, but I must not take her out where she will be near my husband or my uncle. Despite all I can do to the contrary, I put her directly into my husband's hands. Then my uncle, whom I love dearly, tries to push my head under the slimy water. I can remember nothing more" (1957, p15; emphasis added).

ASIDE: It may or may not be relevant to the forming of this dream that Sizemore had, as a child, witnessed the last-minute rescue of a neighbour who had fallen, while drunk, into a ditch. In fact, Sizemore and Pottillo's 1977 narrative opens with this very recollection, and claims it as the first time Sizemore was conscious of an imaginary playmate [see case, Christine Sizemore]. Note in the sentence emphasised the inability to control one's own actions (a common feature of dreams) and the detached observing consciousness. Readers interested in the Freudian interpretation of the <water-drowning> dream symbolism may divert to Freud, dreams and and follow the onward links

Thigpen suggested that hypnosis might help Sizemore interpret the dream, and she consented to the treatment. She was duly hypnotised and required to recollect the dream while in the hypnotic state. Upon being reawakened, she suggested that the room must represent her existence, that the stagnant pool probably represented her husband's religious affiliation, that she was struggling to prevent her daughter becoming overly indoctrinated, and that she saw both her husband and her uncle as standing against her in this. This realisation, together with the opportunity to talk through her tensions in this matter, seemed to help her. Her headaches ceased, and there were no further major consultations for almost a year. Then Ralph White reported a relapse. There had been a serious argument and Sizemore was now contemplating divorce. Ralph thought that one more attempt at therapy would be worthwhile, because strange discontinuities in his wife's behaviour were becoming apparent, as if she were suffering from periods of amnesia. He had, for example, found her planning a visit to her cousin which in fact she had already made! Indeed, it was as if another person had taken that trip.

ASIDE: Readers unfamiliar with the notion of "fugues" in neurological conditions should consult that entry in the companion Neuropsychology Glossary before proceeding.

So Thigpen now had his patient's headaches and her amnesias to worry about. At the ensuing consultation, Eve still had no accessible memory of the visit she had undertaken, but under hypnosis was immediately able to bring it all back - shopping trips, the cinema, card games, and the like. And, curiously, the memories remained once she had re-awakened.

ASIDE: Readers interested in the cognitive science of the biological memory trace may find value in diverting briefly to the entry for eye movement desensitisation and reprocessing (EMDR), a technique for desensitising traumatic memory fragments by retrieving them individually in rapid succession. There is certainly a strong theoretical possibility that many unavailable memories reflect relatively straightforward "indexing" or "access" problems. 

A few days later Thigpen received a strange letter, consisting of 34 lines in Sizemore's familiar handwriting, followed by a further four lines in a different hand tagged on at the end. The body of the letter was to thank Thigpen for retrieving the memory of the visit, but it also contains some clear insights on the part of the patient into the relationship between memory and self. Here is the full text .....

"Dear Doctor, [//] Remembering my visit to [NAME WITHHELD] brought me a great deal of relief, to begin with. [//] Just being able to recall the trip seemed enough, but now that I've had time to think about it and all that occurred, it's more painful than I ever thought possible. [//] How can I be sure that I remember all that happened, even now? How can I know that it won't happen again? I wonder if I'll ever be sure of anything again. [//] While I was there with you it seemed different. Somehow it didn't matter to [sic] much, to have forgotten; but now it does matter. I know it's something that doesn't happen ev [sic - this paragraph ends abruptly, and without a full stop] [//] I can't even recall [NAME WITHHELD] colour scheme and I know that would probably be the first thing I'd notice. [//] My head hurts right on top. It has ever since the day I was down there to see you. I think it must be my eyes - I see little red & [sic] green specks - and I'm covered with some kind of rash.  

[NAME WITHHELD] baby please be quiet dear lord don't let me lose patience with her she's too sweet and innocent and my self-control

" (1957, pp19-20 as transcription and pp 21-22 as facsimile).

ASIDE: Note the curious lack of phrase punctuation in the inset.

Then came news of yet another of Sizemore's "erratic" episodes. Ralph White reported that his wife had gone into town and had returned with a great array of expensive clothes. When challenged, however, she had claimed yet another memory loss, her headaches had returned, and he wanted her to be seen urgently. It was to be a pivotal consultation. To begin with, Sizemore was asked about the mystery letter. She expressed confusion. She had started to compose a letter, yes, but had decided not to send it, could hardly remember what it had been about, and believed that she had destroyed the draft. As for the clothes, she continued to deny any knowledge of them. At this point, however, she started to become distressed, clearly wanting to raise something else, but not sure whether or how to go about it. Sensing that it was going to be important, Thigpen coaxed her gently, whereupon the barrier suddenly came down and she came straight to the point. Sizemore had been hearing voices, and was seriously concerned for her sanity .....

"'If you hear voices ..... what does it mean? Oh, no ..... If you really hear it ....., with no one there?' She sobbed briefly, very quietly. 'I know what it means'. Her posture tightened. 'Madness!'" (1957, p24).

ASIDE: The hearing of voices is, indeed, a relatively serious symptom of psychiatric illness (although perhaps not quite as serious as Sizemore seems then to have believed). It is also just one facet of one of the most fascinating issues within cognitive science, namely that of the role of "inner speech" in phenomenal consciousness and the higher cognitive functions. We introduce the topic proper in the entry for inner speech, and discuss the issue of "voices" in the entry for aggression, hearing voices and.  Readers for whom it is an everyday experience to conduct silent conversations with themselves while problem solving or idle daydreaming will already know what inner speech is, and need not divert at this juncture. All others should.

Questions suddenly flooded into Thigpen's mind. How long had his patient been hearing these voices? Were they always the same? How often did they come? To use the more modern terminology, what "speech acts" were they delivering - advice, insults, instructions, or what? And, if instructions, were they encouraging harm, to self or other, or what? The narrative continues ....

"'For several months', she finally admitted, 'I've heard it on rare occasions'. During the last few days it had become frequent; now she could not escape it. It was always a woman's voice. Though she could not recognise this voice, at times it seemed somehow familiar. It spoke in a jaunty tone, often using vulgar phrases" (1957, p24).

Thigpen was pleased to be able to reassure Sizemore that she had none of the other signs of a psychotic disorder, and decided to stabilise his patient by focusing on the positive aspects of the situation. This strategy was not put to the test, however, because Sizemore herself returned the discussion to the issue of the dresses. She explained that she had tried to return these to the stores concerned, only to discover that the shop assistants were adamant that it had most definitely been she who had made the purchases. So perhaps the voices and the amnesias were somehow related. Then came the first personality transition ever knowingly witnessed. Sizemore's narrative trailed away, and after a short silence "Eve White" became "Eve Black" before Thigpen's very eyes .....

"The brooding look in her eyes became almost a stare. Eve seemed momentarily dazed. Suddenly her posture began to change. Her body slowly stiffened until she sat rigidly erect. An alien, inexplicable expression then came over her face. This was suddenly erased into utter blankness. [.....] Closing her eyes, she winced as she put her hands to her temples, pressed hard, and twisted them as if to combat sudden pain. A slight shudder passed over her entire body. Then the hands lightly dropped. She relaxed easily into an attitude of comfort the physician had never before seen in this patient. A pair of blue eyes popped open. There was a quick reckless smile. In a bright unfamiliar voice that sparkled, the woman said, 'Hi there, Doc!'" (1957, p26).

ASIDE: From this point onward, we refer to the physical, factual, individual as Sizemore, but to the active personality within that individual as either "Eve White" or "Eve Black" as appropriate. Thigpen and Cleckley report using the case-name "Eve Black" whenever Sizemore used her own maiden name, which was Christine Costner. This may or may not indicate that Sizemore's preferred self was the one she had had before marrying.

Momentarily, Thigpen was at a loss to know either what had just happened or what to ask next. It was Eve - still as Eve Black, remember - who took advantage of the silence, remarking concernfully (but not entirely so) of Eve White, the woman-soul with whom she shared a body .....

"She's been having a real tough time [.....] I feel right sorry for her sometimes. She's such a damn dope though ..... What she puts up with from that sorry Ralph White - and all her mooning over the little brat...! To hell with it, I say!'" (1957, p27; emphasis added)

ASIDE: We have highlighted all the pronouns used in the sentence emphasised above. The three occurrences of "she" and the two occurrences of "her" are without a doubt referring to Eve White, but the sentence is spoken by Sizemore as Eve Black, in which persona she takes the first person "I/me" role. The physical person (Sizemore) thus presents with both an "I" and a "her" simultaneously on board. This confusion of first and third person within a single body is entirely impossible in everyday normal conversation, although something close to it can be seen in self-recriminatory phrases such as "Derek, that was a silly thing to do" or in self-directed admonishments such as "You silly old fool".

TEST YOURSELF NOW: Do you use such phrases? If so, do you use your full name, or "you", or both? And do you speak (a) silently, (b) out loud but only when alone, or (c) out loud even when in company?

In fact, accurate pronoun resolution is vitally important to the accurate comprehension of another person's discourse. It may or may not be relevant that pronoun resolution happens to be one of the main barriers to the development of competent machine translation software.

Thigpen and Cleckley then decided that Ralph White ought to be introduced to his wife's alter ego, since it was potentially the secret instigator of many of their disagreements. Thigpen therefore summoned up Eve Black at the next consultation and asked her if she would speak with him. She agreed, and Ralph White was led in. He later reported that Sizemore looked like his wife, of course, but that "the brash unfamiliar voice" (1957, p42), and the fact that Eve Black denied ever marrying him, took him aback. He knew the face, "but all that it expressed was alien" (ibid.). So, too, the mannerisms and the body language. Eve Black even denied that Bonnie meant anything to her - that she was Eve White's daughter, not hers. Subsequent cross-questioning soon confirmed that Eve White knew nothing of Eve Black, experiencing Black's periods of control as her own "blackouts" [the pun is marvellously coincidental]. Black, however, was fully aware that she was dualled with another, and spoke of Eve White as someone else, thus .....

"This new and apparently carefree girl spoke casually of Eve White and her problems, always using she or her in every reference, always respecting the strict bounds of a separate identity. When asked her own name she immediately replied, 'Oh, I'm Eve Black' [..... and] a thousand minute alterations of manner, gesture, expression, posture, of nuances in reflex or instinctive reaction, of glance, or eyebrow tilting and eye movement, all argued that this could only be another woman. [.....] Eve Black, so far as we can tell, has enjoyed an independent life since Mrs White's early childhood. She is not a product of disruptive emotional stresses which the patient has suffered during recent years. Eve White apparently had no knowledge or suspicion of the other's existence until some time after she appeared [.....]. Though Mrs White has learned that there is a Miss Black during the course of therapy, she does not have access to the latter's awareness. When Eve Black is 'out', Eve White remains functionally in abeyance, quite oblivious of what the cohabitant of her body does, and apparently unconscious. On the contrary, Eve Black preserves awareness while absent. Invisibly alert at some unmapped post of observation, she is able to follow the actions and the thoughts of her spiritually antithetical twin. [.....] Eve Black 'knows' and can report what the other does and thinks, and describes her feelings" (1954, pp137-138; emphasis added).

Eve Black also took advantage of this convenient disguise to snipe in a rather cowardly way at her other self's husband, as is borne out in the following extracts .....

"This lively Eve told of several [occasions] when, being out, she had pursued mischievous or injudicious ways and then, as trouble loomed ahead, had slipped back into retirement, leaving the other conscientious and innocent Eve to face various puzzling and unpleasant consequences. [..... Once] when Ralph White called up and told her to come home, this capricious Eve, owning no obligation or attachment to this man whom she disliked, not only refused, but tore into him with scurrilous abuse [.....] Little wonder then, the physician now told himself, that Ralph White sometimes lost his temper" (1957, p35; emphasis added). "She can live it up as Eve Black and then return to her status as the innocent wife and mother without troubling her conscience" (1957, p160; emphasis added).

This element of secretiveness was perhaps what lay behind the team's failure ever to hypnotise Sizemore while in her Eve Black state .....

"We never succeeded in hypnotising Eve Black. About all matters past and present her emotions were utterly free. [.....] Despite her access to Eve White's thoughts and her technical knowledge of this mother's grief in the separation from her child, the playful Eve showed little or no compassion for her. [.....] Neutral or immune to major affective events in human relations, an unparticipating onlooker, she was apparently [] free of hatefulness, or of mercy, or of comprehension" (1957, p114).

Yet even though her Eve Black disguise was a convenient way for Sizemore to escape the demands of motherhood and the marital home, and to get out to have a good time, there seem, perhaps surprisingly, to have been no other men involved. When Eve Black went out on the town, it was as a decidedly innocent rebel - it was for a dance and the bright lights, nothing more. Thus .....

"She responded to the glitter of bright lights automatically, as a trout rises to a flashing spinner. The major considerations of ordinary life never curbed her irresponsibility; but she seemed immune to the strong urges toward serious misconduct that sometimes spring from a genuine personal attachment, or, fleetingly, from the simpler bare sexual impulse. Giddy and outlandish as was her demeanour in sober surroundings, she apparently remained free from the customary temptations that sometimes lure even conscientious people into disaster. As time passed it became steadily clear to us that she was attracted not by sin or depravity but rather by the trappings with which they are so often garnished. [.....] Eve Black, as a manifestation of personality, as a functional entity, seemed to be without the emotional components of full, normal, human response to any major issue. With no serious goals to distract her, it seemed only natural to romp and play. Free of personal attachments, entirely without the conscious experience of any profound emotion, she apparently evaluated possible consequences and risks in her career with little more sober foresight and apprehension than the squirrel in his game with the terrier. Like the squirrel [..... a] scamplike zeal, an untroubled insouciance [= "carefreeness"] possessed both figures" (1957, pp126-127; emphasis added).

So what sort of woman were Sizemore, and why? Was she the result of a traumatised childhood or some subtle cognitive deficit (or conceivably both, in subtle interaction)? Or was she just a devious fraud, manipulating the world at large in an attempt to wriggle free from a marriage which no longer amused her? As diligent psychiatrists, Thigpen and Cleckley were rightly eager to exclude the possibility of malingering ..... 

"It has been mentioned that Eve Black's career has been traced back to early childhood. She herself freely tells us of episodes when she emerged, usually to engage in acts of mischief or disobedience. She lies glibly and without compunction, so her account alone can never be taken as reliable evidence. Since Eve White, whose word on any matter has always proved good, still has no access to the other's current awareness or her memory and, indeed, did not until recently even faintly suspect her existence, it has been impossible through her to check fully and immediately on Eve Black's stories. [.....] Irresponsibility and a shallowly hedonistic grasping for ephemeral excitements or pleasures characterise Eve Black's adult behaviour. She succeeded in concealing her identity not only from the other Eve but also from her parents and the husband [..... and] her wayward behaviour, ill will, harshness, and occasional acts of violence [.....] were attributed to unaccountable fits of temper in a woman habitually gentle and considerate. During her longer periods 'out', when she expresses herself more freely in behaviour so unlike that of Eve White, she avoids her family and close friends, and seeks the company of strangers [.....]. [..... And] when it suits her, she deliberately and skilfully acts so as to pass herself off as Eve White, imitating her habitual tone of voice, her gestures, and attitudes. Let us not forget that she is shrewd" (1954, pp138-140; emphasis added).

ASIDE: The DSM-IV includes copious advice on how to exclude malingering in the differential diagnosis of mental health disorders.

At this point in the 1957 narrative, Thigpen and Cleckley divert into the theory of multiple personality, noting the historical roots in 19th century fictional works such as "Dr Jekyll and Mr. Hyde". In fact, they argued, there is nothing particularly surprising about inner conflicts in human beings, or about people maintaining a social presence which belies their true nature. This, after all, is what is implied in everyday phrases such as "wolf in sheep's clothing". But of one thing they were, for the time being, convinced .....

"Whatever one might choose to call what we witnessed - hysterical dissociation, dual personality, return of the repressed, somnambulism, role-taking, legerdemain, play-acting, or deliberate pretence - it was a performance or manifestation that plainly demanded attention and study" (1957, p54).

TO BE CONTINUED

Case, Figan: See impulsivity.

Case, Geoff Gray: See case, Deepcut Barracks.

Case, Hank: For details of Hank (Beck and Rector, 2003), an auditory hallucinator displaying a circular reasoning bias, see hyperconnectivity model.

Case, Harold Shipman: [See firstly toxic caring.] Popularly known as "Doctor Death", Dr Harold Shipman, of Hyde, Manchester, was convicted in January 2000 of murdering 15 of his elderly patients between July 1996 and November 1997, typically by overdosing them with the sedative diamorphine. He was also strongly suspected of murdering around 200 others over perhaps a 20-year period.

Case, Jade Sinclair: [See firstly battered child syndrome.] Jade Sinclair was a three-year-old girl murdered by her mother's live-in partner Steven Barton on 26th March 2003. The child's injuries included a broken nose, four fractured ribs, a broken right arm, a broken pelvis, a lacerated liver, and "bruising from head to toe". Here are some of the sordid details .....

"The court heard that the fatal attack must have included punches, kicks, and stamping to the stomach. [.....] The pathologist concluded Jade would have been in agony before passing out [and] described it as the worst case of child abuse he had seen in 30 years" (The Daily Mail, 6th April 2004).

Case, James Bulger: James Bulger, aged 2 years 11 months, was abducted [check out the last-seen-alive security camera image] from a Liverpool shopping centre on 12th February 1993 by two 10-year-old boys, and slowly beaten to death on nearby waste land. The accused were known during their trial as "Child A" and "Child B", were named as Robert Thompson and Jon Venables upon their conviction in December 2003, and were released under rehabilitative new identities in June 2001. This case is mentioned in the entry for aggression, social learning theory and.

Case, James Collinson: See case, Deepcut Barracks.

Case, Jamie Hancock: Private Jamie Hancock, 2nd Battalion, The Duke of Lancaster's Regiment, was killed by a dissident sniper in Basra, Iraq, on 6th November 2006, in his first week of operations. He was the 121st fatality to be suffered by the British armed forces in the Iraq War. See now case, Eddie Hancock.

Case, Jessie Gilbert: Jessie Gilbert was a 19-year old "chess prodigy" and gap-year medical student, who fell/jumped to her death from a hotel window on 26th July 2006. When the death was first announced in the media, the report included the following comment: "Jessie's parents recently divorced and neighbours said the family had been through a 'very difficult time'" (The Daily Mail, 28th July 2006, p5). Now the words "very difficult time" are journalistic code for "very difficult time" - they are saying that there is a deeper darker story here, so keep buying this newspaper. Sure enough, twenty four hours later the writers were able to be somewhat more explicit: "Now it has emerged that the teenager [] had been tormented by the criminal proceedings against her father [for] raping her" (The Daily Mail, 29th July 2006, p5). As it turned out, however, the press spoke in haste, for her father was subsequently cleared of that offence (14th December 2006).

Case, Karla: [See firstly dual unity] Lucente (1988) reports the case of Karla, a 14-year old babysitter accused of the theft of clothes and valuables while babysitting, whose subsequent behaviour could be interpreted as indicating a mildly dissociated identity. Here is an indicative extract .....

"Karla, age 14, was accompanied to the office by her parents who sought consultation for their daughter's recent theft of clothes and jewellery from a neighbour's house. [.....] While refusing to admit to knowledge of the stolen items [recovered from her bedroom - Ed.], Karla did consent to return them and to pay for some inexpensive earrings that could not be found" (p161).

Case, Kate: See Forward's (1989) use of this case in toxic parenting (5).

Case, Kathy Bush: This case was reported by the popular press in April 1996 as a case of Munchausen syndrome by proxy. The report came shortly after one Kathy Bush, a medical practice manager, had been formally charged with deliberately making her then seven-year old daughter, Jennifer Bush, ill, "in order to win attention for herself". Here are the key points of the case as originally reported ..... 

"After 40 operations, 200 hospital visits, $3m worth of medical treatment, and a short lifetime of pain and bewilderment, Jennifer's illness has at last been diagnosed. ccording to Florida child-abuse investigators, she was a victim of her mother's mental illness. [.....] In an extreme case of what has come to be known as Munchausen's [sic] syndrome by proxy, Bush is accused of torturing her child by contaminating with faeces the feeding tubes surgically implanted in her stomach. [.....] The accusations against Bush are so horrifying and improbable that it hardly seems surprising she allegedly duped dozens of doctors into believing Jennifer was truly ill. Yet to experts in the Munchausen syndrome last week, Bush was a perfect fit for the profile of a deeply disturbed mother who makes herself the centre of attention by secretly hurting her child" (The Sunday Times, 21st April 1996).

As to what happened next .....

here is an account of the trial .....

and here is a 2005 case update.

Case, Kay: Kay was one of the two cases featured in Meadow's (1977) class-defining paper on Munchausen syndrome by proxy. As a six-year-old child , she had been receiving hospital treatment over a long period for passing foul-smelling bloody urine. Yet her symptoms were intermittent, and she was otherwise a healthy little girl. Her parents were cooperative, and her mother always stayed with her daughter at the hospital. Upon investigation, it was concluded that the mother was contaminating her daughter's urine specimens with her own menstrual discharge.

Case, Lashuan Harris: See external report, and then aggression, hearing voices and.

Case, Laura: This is the second of three cases offered by Hopkins (1991) when discussing possible pathologies of the holding environment during childrearing. Here is a summary of the case report .....

"Laura, 16 years, suffered from depression and compulsive eating. In therapy she recounted a recurrent nightmare of finding herself alone in a desert, covered with a revolting skin disease [.....]. Laura's mother, like Clare's, could not tolerate physical contact with her throughout her infancy. However, she had been able to enjoy cuddling Laura's younger sister when she was a baby. In therapy Laura represented herself as a tortoise and her sister as a cuddly rabbit. I have found it common for physically rejected children to dramatise or draw themselves as physically repellent or unstrokeable creatures [.....]. After getting in touch with [her feelings], Laura lost the urge to eat compulsively. [.....] Winnicott (1963) has described how the toddler's need for his mother becomes 'fierce and truly terrible'. When this need is frustrated by a physically aversive mother then I believe that the pain which is aroused is also fierce and terrible, like burning or torture, stabbing or biting. It seems to me that the infant experiences the pain as a physical assault, not as a psychological rejection" (Hopkins, 1991, pp190-192).

[Compare case, Clare and case, Paddy.]

Case, Les: See Forward's (1989) use of this case in toxic parenting (1).

Case, Libby: Here is a case of Munchausen syndrome reported by Feldman (2004) .....

"A 38-year-old woman, whom I shall call Libby, travelled from town to town faking cancer and other equally dramatic illnesses and events. Although Libby's simulations became more intense and inventive as she grew older, her practice of playing sick had actually begun when she was in elementary school. The eldest of three children, this woman adored her father, a military officer, who showered affection on her younger twin brothers but totally shut her out. She became jealous and temperamental and was physically abusive to her brothers. [At school], Libby began playing sick to stay home as a way of getting extra attention from her authoritarian mother. She also used illness to try to evoke some positive emotion from her father, who remained cold and distant. Libby continued playing sick as she got older. She saw a psychiatrist who was unable to curtail her charades, which increased after her father's death. Her mother knew that Libby was faking her ailments, but didn't know how to help or stop her. Libby then created a new setting for her performances - another version of a family environment - by gravitating toward clergymen (father figures) and religious communities [..... moving] from one Catholic parish to another under the guise of a terminally ill patient, often seeking counselling and guidance from priests [.....]. When she sought financial assistance at a cancer centre, Libby exposed herself to scrutiny. She told social workers there that she had been treated several years earlier for uterine cancer, but it had now spread to her liver and she had only six months to live. They wanted to know where she had been treated so they could request her medical records, but she was vague [..... and] had convoluted answers for every question. Lies to counsellors snowballed into tales of tragic loss. She claimed that her fiance had been killed in Vietnam when she was 20, that a priest friend had been killed in Guatemala, and that her brother had died in an auto accident, which led to her mother's suicide. She exaggerated her education [and experience]. In her fantasies, the father who had shunted her aside needed her, but in reality, Libby neither nursed her father nor carried out any of the other heroic deeds for which she claimed credit. Libby's appearance and her portrayal of illness were so convincing that even highly trained therapists were completely taken in. [.....] There wasn't a dry eye in the house when Libby was finished" (Feldman, 1994, pp7-9).

Case, Lisa (1): [See firstly dissociative identity disorder.] Stern (2002) uses this case to illustrate how a child's "primary subjective experiences" put in place the cognitive structures which then control the rest of that child's life, thus .....

"Lisa, a remarkably resilient, professionally successful woman in her 30s, was, as a child, sexually molested by her father. Later, in adolescence and as a young adult, she took on the role of the selfless responsible daughter, focusing on everyone else's welfare except her own [.....] Over the first year of treatment Lisa got more and more in touch with her resentment about this state of affairs and became determined to make a change in her responsibilities. The problem was that [every time] she would immediately feel intensely guilty, accusing herself of being selfish, irresponsible, and negative, exactly in the style of her mother. At the outset of treatment this latter voice was by far the louder and more compelling: Lisa was mostly the compliant caretaker, with occasional dissociated eruptions of anger in other, safer, arenas, such as work. [.....] I think of Lisa's resentment and defiant self-assertion at moments when she felt exploited as expressions of her primary subjective experience" (p699).

Case, Lisa (2): This from Ramsey (1994/2006 online) regarding a victim of incestuous sexual abuse .....

"Lisa is currently 27 years old. [.....] She isn't sure when exactly the abuse began but can figure out that it was after a family relocation. She can only pinpoint that the abuse began after she was eight and stopped in her mid-teens. The incest was father-daughter. [.....] She sought psychiatric treatment for [the resulting] problems but stopped the sessions due to her feelings that it was useless. She is consistently attracted sexually to older men (approximately 20 years, give or take a year, older than she) and has a hard time not being promiscuous with them. She has an almost obsessive need to get married and be in love. She has never told her mother about the abuse and lacks intention of ever doing so. She could barely talk about it with me and would not share details of what her father did to her. She continues to have strong episodes of depression and has tried to commit suicide in the past."

Case, Liz: Forward (1989) cites Liz's case in her discussion of the sexual abuse aspect of toxic parenting, as an example of maternal complicity in the wrongdoing, thus .....

"When Liz was 13, she made one desperate attempt to tell her mother about her stepfather's escalating sexual assaults: 'I really felt trapped. I thought if I told my mother she would at least talk to him. What a joke. She almost collapsed in tears and said ..... I'll never forget the words: 'Why are you telling me this, what are you trying to do to me? I've lived with your stepfather for nine years. I know he couldn't do this.' [.....] I ended up comforting her'" (Forward, 1989, p150; emphasis added).

[Compare Case, Tracy.]

Case, Louise Woodward: Louise Woodward was the British au pair convicted in 1997 of the "murder in the second degree" of her employers' eight-month-old son, Matthew Eappen, at his home in Newton, MA. Although initially sentenced to life imprisonment, a judicial review later that year commuted the conviction to the lesser one of involuntary manslaughter, and reduced the sentence to "time served". The cause of this confusion was a fine legal argument as to the admissibility of certain items of testimony. [Click for further case details. For more on the often unhappy interplay of the medical and scientific decision making systems, see case, Sir Roy Meadow, and the onward links.]

Case, M: Waska (1999/2007 online) reports case M as an example of the sort of bullying personality which can result from pathological operation of the ego defense of projective identification. Here is a selection of his clinical observations ..... 

"M was an obese and oddly dressed middle-aged woman who was ambivalent about her marriage and entered into treatment. She felt that her life was a 'major disappointment'. She wanted to find out why she couldn't be happy in her marriage and why she couldn't find a meaningful job. [.....] I disliked M immediately [.....]. She had an irritating demeanour that I later understood as the interpersonal component of projective identification. She would stomp around instead of walk, routinely slam my door, and collapse with a crash onto my couch. [.....] The intensity of my thoughts and affect were the clues that I was involved in a situation that included dimensions beyond my usual countertransference. [.....] Throughout treatment, M showed moodiness, chaotic behaviour, and feelings of entitlement. She would change the radio station in my waiting room to a rock/pop station, turn up the volume, and dance around the waiting room. She seemed surprised when I asked her to stop. [.....] M's unique style of relating left me with specific countertransference feelings. I felt I was with a robot-like imposter or with a cold and ominous 'presence'. This left me fearful and mistrusting. She seemed manic, yet internally dead. [.....] M projected her unfed and confused child parts into me and related to me as a just-out-of-reach, rude, and provocative parent"

In discussing M's case, Waska adopts Klein's and Fairbairn's view of aggression as a primary "constitutional component" of the mind. He suspects that M was projecting onto him and into him "her self loathing, her hatred towards various internal objects, and her fears of those objects' retaliation". He reports feeling overwhelmed by the resulting "atmosphere of hostility and fear" and that this only came under control after he - the therapist - had dreamed of slitting his patient's throat!

Case, Margaret: See multiple personality disorder.

Case, Marianne: This case was offered by Bollas (1987) as a demonstration of an imbalance of true self versus false self following exposure as an infant to a defective holding environment. Here are some of the details [a long extract, heavily abridged] .....

"Marianne is a twenty-five-year-old art historian who came for analysis after a spell of psychotherapy with me. She is the only child of two well-to-do parents who had several children by former marriages. Raised by seven nannies during her first five years, she describes her mother as a very arrogant woman who masked personality confusion by using the social configurations granted to her class falsely to suggest competence and assuredness. She recalls that her mother was highly critical of her behaviour and remembers that she tried to comply with her mother's wish to see her daughter as a young, brilliant socialite when she was but a child. Her father was a somewhat remote man who came to life when delivering some pompous address to the family. [.....] In spite of his pomposity, Marianne rather liked her father and can recall trying to emulate him. Marianne found it exceedingly difficult to narrate her life to me in the analysis. For years she had deposited fragments of feeling and thought into a multitude of friends [.....]. Typically she would visit a friend in one country and tell that person a bit about another friend, usually something nasty. When she sensed that she might be wearing out her welcome, she would travel to visit another friend and disclose something 'unfortunate' about herself or another friend. One result of Marianne's depositing of herself into different people was to preserve through this splitting an unintegration in herself [.....] although she was preserving a split in the self, she was also maintaining a split in her objects, each of which acted as a limited container for diverse thoughts or feelings. [.....] When the mother dismissed the nannies, she did so for no apparent good reason [.....]. She showed a passing interest in her daughter, not reflective of any mothering impulse or nurturance [.....]. She had absolutely no tolerance for her daughter's naughtiness and simply walked from the room imperiously whenever Marianne played up. In the course of her analysis it became clear that she recreated aspects of her infantile environment when she deposited feelings and thoughts into different holding persons. [.....] The lack of a stable mothering process simply facilitated the widening of ordinary splitting, the frustrations of this instability increased her destructive instincts and gave a certain urgency to the splitting process. [.....] There was another feature to her externalisations. She had a capacity to tantalise her friends with either destructive bits of gossip or by actively seducing different men. [She] would have a brief affair which in one way or another she made known to different persons. [.....] By preserving a multitude of containers all over the world to hold different bits of herself, she created an environment which handled her in much the same way that the mother's created world managed her. Her true self was to be without an other who could both bear her and nourish her out of her destructive self-cancellation. [.....] By feeling false when in the presence of any one container, she related to herself as the mother handled her in infancy: 'You are not to say what you feel, and you are to appear as if you agree with the false presentation of events.'" (Bollas, 1987, pp52-55; emphasis added).

[Contrast case, Adrienne, where the effects of over-mothering are explored.]

Case, Marianne Williams: Marianne Williams was nearly the victim in October 2006 of a tragic miscarriage of the UK criminal justice system, as a result of flawed expert testimony. In what the prosecution suspected was a case of Munchausen syndrome by proxy, Mrs Williams stood accused of force-feeding her 15-month-old son Joshua with salt, and thus bringing about a condition known as "hypernatraemia". As the story unfolded, however, it turned out that Joshua had been born with under-developed kidneys, a relatively common condition which requires the medical administration of salt to prevent dehydration. The trial jury accordingly decided that it had been unsafe to presume that the high salt level detected in Joshua's body at the post mortem could not, to the required standard of "beyond reasonable doubt", be attributed to the defendant, and she was duly acquitted. Forgiveably, her solicitor used the occasion to pass wry comment, observing that clinicians were "far too prone to point fingers of suspicion at persons who are already vulnerable" (The Times, 28th October 2006). [For more on the often unhappy interplay of the medical and scientific decision making systems, see case, Sir Roy Meadow, and the onward links.]

Case, Mark Latta: Mark Latta was nearly the victim in 2004 of a tragic miscarriage of the UK criminal justice system. He had been accused of the murder of his ten-week-old daughter Charlotte Latta, as follows ..... 

"The prosecution allege he snapped while trying to feed the fractious baby, banging her head so hard that her brain swelled. Doctors later discovered 32 separate fractures to her body which had been inflicted, it is alleged, in the weeks leading up to her death" (The Daily Mail, 11th March 2004).

However, it emerged as the trial progressed that there was conflicting and insufficient evidence that Mr Latta had been responsible for any of these injuries, and he was duly acquitted. [For more on the often unhappy interplay of the medical and scientific decision making systems, see case, Sir Roy Meadow, and the onward links.]

Case, Martin: We discuss this case from George and Main (1979) in the entry for aggression, domestic violence and.

Case, Michelle Dickinson: This case hit the headlines in January 2003 when Michelle Dickinson, a 31-year-old Seascale woman, was sentenced to life imprisonment for the attempted murder (but occasioning the subsequent death) of her seven-year-old son Michael. As can be seen from the following report, the case presents as a near-textbook instance of Munchausen syndrome by proxy. Here are some of the details .....

"At three years old, Michael Dickinson was an ordinary happy little boy. By the time he was seven, however, he had become a pitiful invalid too ill to attend school. His mother Michelle convinced increasingly suspicious doctors his plight was caused by severe epilepsy. But, in reality, she was slowly poisoning him with drugs, inflicting untold agony and misery before he eventually died. Even when Michael fell desperately ill for the last time, Dickinson tried to kill him in the ambulance taking him to hospital by pouring liquid down a tube into his lungs. [.....] Michael died in October 2000 after doctors lost a four-month battle to save him. The boy's torment started when he was three after Dickinson convinced doctors that he had epilepsy. Over the next four years, she stockpiled anti-convulsant drugs and gave him deliberate overdoses. [.....] Dickinson made her son so ill that he had to wear a protective helmet and be fed by nasal tube. She lied to GPs to get drugs Michael did not need, then reinforced his bogus illness by lying to health and school staff as well as friends and family. [.....] Doctors had grown suspicious as Michael fell more and more ill, but Dickinson manipulated the situation to stop them finding out the truth" (The Daily Mail, 14th January 2003).

Case, Miss E.: This case was offered by Jung (1918) to illustrate the use of method of free association in psychotherapy [although it also a useful illustration of obsessional neurosis]. Here is an illustrative extract from the original report .....

"Here I would present the connection between psychoanalysis and association experiments by some practical examples. I choose an ordinary case of obsessional neurosis which I treated in June 1905. Miss E. came to me for hypnotic treatment for sleeplessness of four months' duration. Besides the sleeplessness she complained of inner unrest and excitement, irritability towards her family, impatience, and quarrelsomeness. She is thirty-seven, a teacher, cultured and intelligent; has always been nervous; has a younger sister feeble-minded; her father was an alcoholic. [.....] Whilst talking she seldom looks at the doctor, as a rule not addressing him but speaking out at the window. From time to time she turns away still more, is often obliged to laugh involuntarily, frequently shrugs her shoulders as if shaking off something disagreeable, protruding the lower part of her abdomen in a peculiar manner. [.....] The illness only occurred in recent years and has gradually developed to its present pitch. She says she has been unsuccessfully treated by many doctors [and] would now like to try hypnosis, but immediately adds that she is firmly convinced that hypnotism will not succeed [and] she will go mad. She has, indeed, often thought that she [....] is already insane. It here occurred to me that the patient was obviously talking round something that she would not or could not say. On being urged she finally explained, with many gestures of resistance and constant blushing, that she could not sleep because whenever she disposed herself to sleeping the idea came to her that she would not, of course, be able to sleep, that she would never sleep again until she were dead; she would then wake right up and be unable to sleep again the whole night. [.....] She had to wrench this explanation out of herself - in such a way, and with such gestures of aversion, as almost to arouse the impression that she was telling something sexually improper which caused her to be ashamed. Again there were the movements of the abdomen. [Her disturbed state] caused me to ask if there were other ideas present which troubled her during the sleeplessness [.....]. She was unable to recall anything, made gestures of aversion, [and apologised]. She had once told a doctor and a clergyman about her thoughts and now she is always thinking that she had infected those people and they also has obsessional ideas. She was sure she had already infected me. [Further history skipped.] Any attempt at hypnotism was useless because she could not fix her attention in any way [and so] I decided first to obtain some certainty about the psychical material which was at the root of her illness. I therefore arranged an association experiment with her" (Jung, 1918, pp108-110).

Jung then presented detailed free association data [of which the first block of seven items is reproduced in the entry for free association, if interested. Here are some of the comments he passes in considering the individual response times [a long extract, heavily abridged] .....

"Reaction 3, water - drinker- drink, is verbally disturbed. Drinker has been improved to drink. Her father was a heavy drinker. The subsequent three reaction-times are all prolonged to over 2.4 seconds [indicating] a perseveration due to emotion after drinker. [.....] Reaction 16, dance, is prone to arouse erotic reminiscences. This supposition is not unjustified here, for the reaction following is disturbed. [.....] That children (reaction 36) is not reproduced but is replaced by another of erotic nature is worth mentioning.

Stimulus Word	Reaction	Reaction Time (Seconds)	Reproduction (If Not Correct)
39. Habit	ugly or bad	12.2	bad manners
40. Ride	drive	2.4
41. Wall	room	3.0
42. Stupid	clever	2.8
43. Copy-Book	book	3.0
44. Despise	disesteem	15.2	to disesteem
45. Tooth	abscess	1.4

In this series we meet various severe complex disturbances. At reaction 39, habit, and reaction 44, despise, [both very long reaction-times, note - Ed.] the patient made gestures of aversion and stamped her foot. An 'ugly or bad habit' can easily easily be understood in a sexual sense: onanism [= masturbation (strictly speaking in males)], for instance, is a bad habit. [.....] The movements accompanying the expressions are certainly not against a sexual complex. Habit might also be drinking habit, and thus have aroused the complex of her drunken father" (Jung, 1918, pp111-113).

Case, Orfeo M. Angelucci: [See firstly alien abductions.] Orfeo Angelucci (1912-1993) [click for external biography] was one of the most famous UFO "contactees" of the 20th century, having been abducted twice, by his own report, and having published his own story in "The Secret of the Saucers" (Angelucci, 1955 [unconfirmed full text]). We have drawn the following synopsis from Jung (1959) [a long passage, heavily abridged] .....

"The author [i.e, Angelucci] is self-taught and describes himself as a nervous individual suffering from 'constitutional inadequacy'. [.....] He seems to lack any kind of mental culture, but appears to have a knowledge of science that exceeds what would be expected of a person in his circumstances. [.....] He makes his living now by preaching the gospel revealed to him by the saucers. [.....] On May 23rd 1952 he underwent the experience that gave him his calling. Towards 11 o'clock in the evening, he says, he felt unwell and had a 'prickling' sensation in the upper half of his body, as before an electrical storm. He was working nightshift, and as he was driving home in his car he saw a faintly red-glowing oval-shaped object hovering over the horizon, which nobody else seemed to see. On a lonely stretch of the road, where it rose above the level of the surrounding terrain, he saw below him the glowing red disk 'pulsating' near the ground only a short distance away. Suddenly it shot upwards with great speed at an angle of 30-40 degrees and disappeared towards the west. But before it vanished, it released two balls of green fire from which a man's voice issued, speaking 'perfect English'. He could remember the words: 'Don't be afraid, Orfeo, we are friends!' The voice bade him get out of the car. This he did, [to find] two 'pulsating' disks hovering a short distance in front of him. The voice explained to him that the lights were 'instruments of transmission and reception' [and] that he was in direct communication with 'friends from another world'. [.....] The twin disks were about three feet apart. 'Suddenly the area between them began to glow with a soft green light which gradually formed into a luminous three-dimensional screen.' In it there appeared the heads and shoulders of two persons, a man and a woman, 'being the ultimate of perfection'. They had large shining eyes, and despite their supernatural perfection they seemed strangely familiar to him. [..... the aliens explain their interest in humankind as wholly fraternal .....] After these revelations Angelucci felt exalted and strengthened. It was 'as though momentarily I had transcended mortality and was somehow related to these superior beings'" (Jung, 1959, pp154-157).

A second vision took place on 23rd July 1952 .....

"[That] evening he took a walk, and on the way back, in a lonely place, similar sensations came over him as had felt on May 23rd. Combined with them was 'the dulling of consciousness I had noted on that other occasion' [.....] a state which is a very important precondition for the occurrence of spontaneous psychic phenomena. Suddenly he saw a luminous object on the ground before him, like an 'igloo' or a 'huge misty soap bubble'. This object visibly increased in solidity, and he saw something like a doorway leading into a brightly lit interior. He stepped inside, and found himself in a vaulted room, about eighteen feet in diameter. The walls were made of some 'ethereal mother-of-pearl stuff'. [..... the object then transports him into space .....] Suddenly something like a round window opened, about nine feet in diameter. Outside he saw a planet, the earth, from a distance of over a thousand miles, as voice he recognised explained to him. He wept with emotion and the voice said: 'Weep, Orfeo ... we weep with you for earth and her children. For all its apparent beauty earth is a purgatorial world [.....]. Hate, selfishness, and cruelty rise from many parts of it like a dark mist.' [..... Angelucci is now taken deeper into space, whereupon he] saw a Ufo about 1000 feet long and 90 feet thick, consisting of a transparent, crystalline substance. Music poured from it [and] the voice informed him that every being on earth was divinely created, and 'upon your world the mortal shadows of those entities are working out their salvation from the plane of darkness.' All these entities were either on the good side or on the bad. 'We know where you stand, Orfeo.' Owing to his physical weakness he had spiritual gifts, and that was why the heavenly beings could enter into communication with him. [.....] Under the searching eye of this 'great compassionate consciousness' Orfeo felt like a 'crawling worm - unclean, filled with error and sin'. He wept once more to the accompaniment of appropriate music. The voice spoke and said: 'Beloved friend of Earth, we baptize you now in the true light of the worlds eternal.' A white flash of lightning blazed forth: his life lay clear before his eyes, and the remembrance of all his previous existences came back to him. He understood 'the mystery of life'. [.....] After this illuminative experience he came to himself again. Accompanied by the obligatory 'etheric' music he was borne back to earth. As he left the Ufo, it suddenly vanished without trace. Afterwards, on going to bed, he noticed a burning sensation on the left side of his chest, There he found a stigma the size of a 25 cent bit, and inflamed circle with a dot in the middle" (Jung, 1959, pp157-160).

A third, but comparatively uneventful, vision took place on 2nd August 1952, when the "tall handsome man with unusually large and expressive eyes" (p161) introduced himself as "Neptune", and a fourth vision, and second abduction, took place just over a year later.

Case, Paddy: This is the third of three cases offered by Hopkins (1991) when discussing possible pathologies of the holding environment during childrearing. Here is a summary of the case report .....

"[Paddy] was referred for psychiatric assessment at the age of three years by a paediatrician who wondered whether he was mentally defective or psychotic. He had no speech and was not toilet-trained. His parents reported that he had never shown signs of preferring them to anyone else; he had never greeted them on arrival or protested at their departure. He showed no awareness of danger and would wander off and get lost unless kept locked indoors. [.....] He rejected being cuddled and was a constant thumb-sucker. He did not play but wandered about 'getting into things'. [.....] In spite of the many worrying features of his development, Paddy presented at the clinic as a jolly little boy who usually made good eye contact, though there were times when his eyes glazed over and he became inaccessible. [.....] Paddy's mother was a chronically depressed and very anxious woman who had made several attempts at suicide in her teens. She suffered from severe eczema and explained that although she loved Paddy she had always avoided touching and cuddling him for fear that his germs would infect her skin" (Hopkins, 1991, pp192-193).

[Compare case, Clare and case, Laura.]

Case, Rat Man: [Real name Ernst Lanzer (1878-1914).] In A Case of Obsessional Neurosis (Freud, 1909), Freud offers us the 161-page case of "Paul" (more popularly referred to nowadays as the "Rat Man") as a typical obsessional patient. The patient in question underwent psychoanalysis between 1907 and 1908, and turned out to be deeply obsessed with fantasies about rats, torture, and the like. Here is how Freud introduces the case .....

"A youngish man of university education introduced himself to me with the statement that he had suffered from obsessions ever since his childhood, but with particular intensity for the last four years. The chief features of his disorder were fears that something might happen to two people of whom he was very fond - his father and a lady whom he admired. Besides this he was aware of compulsive impulses - such as an impulse, for instance, to cut his throat with a razor; and further he produced prohibitions, sometimes in connection with quite unimportant things. He had wasted years, he told me, in fighting against these ideas of his, and in this way had lost much ground in the course of his life. He had tried various treatments, but none had been of any use to him except a course of hydrotherapy at a sanatorium [.....] and this, he thought, had probably only been because he had made an acquaintance there which had led to regular sexual intercourse" (Freud, 1909/1955, A Case of Obsessional Neurosis [Standard Edition (Volume 10)], p158).

Freud based his treatment on his method of free association, and, taking full advantage of the freedom of expression thus offered, the patient duly free-associated himself almost at once into a discussion of infantile sexuality, thus .....

"'My sexual life began very early. I can remember a scene during my fourth or fifth year [.....]. We had a very pretty young governess called Fräulein Peter. One evening she was lying on the sofa lightly dressed, and reading. I was lying beside her, and begged her to let me creep under her skirt. She told me I might, so long as I said nothing to any one about it. She had very little on, and I fingered her genitals and the lower part of her body, which struck me as very queer. After this I was left with a burning and tormenting curiosity to see the female body. [.....] When I was six years old I already suffered from erections, and I know that once I went to my mother to complain about them. I know too that in doing so I had some misgivings to get over, for I had a feeling that there was some connection between this subject and my ideas and inquisitiveness, and at that time I used to have a morbid idea that my parents knew my thoughts; I explained this to myself by supposing that I had spoken them out loud, without having heard myself do it. I look on this as the beginning of my illness. There were certain people, girls, who pleased me very much, and I had a very strong wish to see them naked. But in wishing this I had an uncanny feeling, as though something must happen if I thought such things, and as though I must do all sorts of things to prevent it. (In reply to a question he gave an example of these fears: 'For instance, that my father might die.') 'Thoughts about my father's death occupied my mind from a very early age and for a long period of time, and greatly depressed me'" (op. cit., pp160-162).

Freud's comment at this early stage was as follows .....

"We find, accordingly, an erotic instinct and a revolt against it; a wish which has not yet become compulsive and, struggling against it, a fear which is already compulsive; a distressing affect, and an impulsion towards the performance of defensive acts. [But] something more is present, namely a kind of delusion or delirium with the strange content that his parents knew his thoughts because he spoke them out loud without his hearing himself do it. [We] suppose that in making this attempt at an explanation the child had some inkling of those remarkable mental processes which we describe as unconscious [..... indeed] it sounds like an endopsychic perception of what has been repressed" (op. cit., pp163-164).

The free-associating then moved on to an army acquaintance, whereupon there emerged the "great obsessive fear" which would later earn the patient his nickname. The acquaintance in question, "a captain with a Czech name", had a reputation for being fond of cruelty, and had explained to the patient one day how "in the East" [Freud does not specify exactly where] you had to beware "a specially horrible punishment". Now, however, the patient's narrative confidence failed him .....

"Here the patient broke off, got up from the sofa, and begged me to spare him the recital of the details. [I reminded him that] the overcoming of resistances was a law of the treatment, and on no consideration could it be dispensed with. [.....] Was he perhaps thinking of impalement? - 'No, not that; ... the criminal was tied up ...' - he expressed himself so indistinctly that I could not immediately guess in what position - '... a pot was turned upside down on his buttocks ... some rats were put into it ... and they ...' - he had again got up, and was showing every sign of horror and resistance - 'bored their way in ....' - Into his anus, I helped him out. [W]hile he was telling this story his face took on a very strange, composite expression. I could only interpret it as one of horror at pleasure of his own of which he himself was unaware. He proceeded with the greatest difficulty: 'At that moment the idea flashed through my mind that this was happening to a person who was very dear to me.' In answer to a direct question he said that it was not he himself who was carrying out the punishment, but that it was being carried out as it were impersonally. After a little prompting I learnt that the person to whom this 'idea' of his related was the lady whom he admired. [..... He subsequently admitted] that a second idea had occurred to him simultaneously, namely, the idea of the punishment also being applied to his father" (op. cit., pp166-167).

The patient's second and third sessions of analysis seem to have been taken up with a long, highly convoluted, and even-then confusing tale of the patient's obsessive attempts to repay a small debt. The fourth session went through the circumstances of the patient's father's death. This had been known to be imminent, but had nevertheless come more quickly than the nurse in attendance had predicted, with the result that the patient had been asleep in his own room when it had happened. In this respect, the patient reported being tormented ever since by the thought that he had let the old man down and been unable to say a last goodbye. This incident provides a good example of obsessional self-reproach [for more on which, see the entry for guilt], as follows .....

"One evening, thinking the condition was one which would come to a crisis, he had asked the doctor when the danger could be regarded as over. 'The evening of the day after tomorrow', had been the reply. It had never entered his head that his father might not survive that limit. At half past eleven at night he had lain down for an hour's rest. He had woken up at one o'clock, and had been told by a medical friend that his father had died. He had reproached himself with not having been present at his death [.....] It had not been until eighteen months later that the recollection of his neglect had recurred to him and begun to torment him horribly" (op. cit., pp174-175).

The scene was now set for an intellectual discussion during the fifth session on how medicine (i.e., Freud) viewed the nature of unconscious motivation, and so forth, in the working through of painful memories. The sixth session touched upon some obsessive memories from about six months before his father's death. The patient had decided that he would like to marry his lady friend, but had consciously decided that he would not be able to afford to do so while his father was still alive. The heartlessness of this calculation had then distressed him, and prompted floods of co- and counter-arguments. Freud delivered his standard psychoanalytic explanation that such fears were "former wishes", now repressed, and again took pains to explain how the underlying mechanisms might work .....

"At this I told him I thought he had now produced the answer we were waiting for, and had at the same time discovered the third great characteristic of the unconscious. The source from which his hostility to his father derived its indestructibility was evidently something in the nature of sensual desires, and in that connection he must have felt his father as in some way or other an interference. A conflict of this kind, I added, between sensuality and childish love was entirely typical. [.....] This wish (to get rid of his father as being an interference) must have originated [.....] when he was incapable of making a clear decision. It must have been in his very early childhood, therefore, before he had reached the age of six, and before the date at which his memory became continuous" (op. cit., pp182-283).

 Freud then reviewed half a dozen of the patient's specific obsessions in detail, before concluding as follows .....

"Compulsive acts like this, in two successive stages, of which the second neutralises the first [as with the issue of the inheritance above - Ed.], are a typical occurrence in obsessional neuroses. The patient's consciousness naturally misunderstands them and puts forward a set of secondary motives to account for them - rationalises them, in short. But their true significance lies in their being a representation of a conflict between two opposing impulses of approximately equal strength: and hitherto I have invariably found that this opposition has been one between love and hate. Compulsive acts of this sort are theoretically of special interest, for they show us a new type of method of constructing symptoms. What regularly occurs in hysteria is that a compromise is arrived at which enables both the opposing tendencies to find expression simultaneously [.....] whereas here each of the two opposing tendencies finds satisfaction singly, first one and then the other, though naturally an attempt is made to establish some sort of logical connection (often in defiance of all logic) between the antagonists" (op. cit., p192).

In the remainder of the paper, Freud combines additional snippets of case detail with a theoretical discussion of how the patient's "father complex" fuels the rat phobia. TO BE CONTINUED .....

Case, Rebecca Wilson: [See firstly toxic caring.] Childminder Rebecca Wilson was convicted in February 2005 of the manslaughter of Anil Joshi, a five-month-old boy entrusted to her care. Here are some of the details ..... 

"A registered childminder shook [the] boy to death after he refused to take his feed, a court heard yesterday. Rebecca Wilson, a churchgoer and an experienced childminder, became frustrated after having little sleep the night before. Wilson, who is married with two young children of her own, tried to distract the 'lively' baby with toys and his bottle. But when that failed she snapped and shook Anil Joshi for up to 30 seconds, the court heard. He died in hospital three days after the incident in January last year. [.....] Wilson is also accused of punching Anil the day before the shaking incident" (The Daily Mail, 23rd April 2004).

Case, Rhonda: Here is a case of factitious disorder reported by Feldman (2004) ..... 

"Everyone who knew Rhonda agreed that she was a woman of amazing spirit. What they didn't know was that she was a master story-teller - a woman who was remarkably and skillfully deceptive. [..... Her fellow trainee nurses] heard that only three years prior, at the age of 28, Rhonda had overcome the devastating effects of a car accident that nearly claimed her life. [.....] She claimed that she had barely recovered from the accident when another catastrophe struck. Her mother was diagnosed with an aggressive cancer. [.....] She heard about a special mentoring program for new student nurses and immediately signed up. Rhonda quickly made friends with one of the tutors [Louise], who responded to Rhonda's sharp mind and readiness to learn. Within a few visits, she [.....] began sharing secret and startling stories about her past. [.....] Louise [..... was] ill-equipped to handle Rhonda's ever-expanding need for attention. [.....] Then Rhonda revealed that she had discovered a lump under her arm and was terrified at what this might mean" (Feldman, 1994, pp2-3).

The story continues in like vein, exposing Louise to crisis after crisis in her tutee's life, until she was prompted by a colleague to insist upon some independent confirmation of the details, whereupon Rhonda immediately "broke all ties" with her, and went off to find new and unsuspecting sympathetic ears, where she repeated the entire sordid pack of lies. [Compare case, Libby.]

Case, Roger: [See firstly social skills training.] This is Hayes' (1994/2006 online) example of a learning disabled adult with social skills impairment, thus .....

"Roger is a brilliant designer. Some of his learning disability and AD/HD problems were overlooked because society generally is more tolerant of quirky behavior in creative artists. But Roger often failed to get important contracts in projects for which his talent and creativity seemed to make him a clear choice. It seems that among Roger's LD-AD/HD related problems was great difficulty in reading social signals and body language. He was unable to interpret the signals given in an interview or during a design presentation which signaled that the interview was over, and that he should thank the interviewer for his time and leave. In other words, Roger overstayed his welcome and often talked himself out of a job."

Case, Rose: Rose was one of R.D. Laing's schizophrenic patients, and is included here (a) as an instance of a fragmented self, and (b) as an instance of hearing voices. Here is an extract from the case description Laing gave in "The Divided Self" [a long passage, heavily abridged] .....

"I saw Rose when she was twenty-three years of age. When I saw her she said that she was frightened she was going insane, as in fact she was. She said that horrible memories had been coming back to her, which she could not forget no matter how hard she tried. But now she had discovered the answer to this. She was now trying, she said, to forget these memories by forgetting herself. She tried to do this by looking all the time at other people and hence never noticing herself. [.....] Moreover, she was frightened to do anything on her own behalf or take personal responsibility for anything she did. At the same time, she said that she was distressed by the feeling that her life was no longer hers to lead. 'My own being is in everyone else's hands than my own'. She had no life of her own, she was just existing. She had no purpose, no 'go', no point to herself. [.....] A few days later she was experiencing herself in the following way: 'These thoughts go on and on, I'm going over the border. My real self is away down - it used to be just at my throat but now it's gone further down. I'm losing myself. It's getting deeper and deeper. I want to tell you things, but I'm scared.' [.....] She maintained almost constantly that she had actually killed herself or sometimes that she had lost herself. On the occasions when she did not feel that she was entirely 'lost' or 'dead' she felt 'strange' to herself, and both she and other things no longer had the same realness about them. She was painfully aware of the loss of some capacity to experience things in a real way, and the capacity to think thoughts which were real. She was aware with equal intensity that other people had this capacity, and she described various techniques which either intentionally or unintentionally she now practised in order 'to recapture reality'. For instance, if anyone said anything to her which she classified as 'real', she would say to herself, 'I'll think that'; and she would keep repeating the word or phrase over and over again to herself in the hope that some of the realness of the expression would rub off on her. [.....] She tried to produce effects in other people such as saying something which she hoped would embarrass them. [.....] If then, looking at the other person, she saw signs of embarrassment she told herself that she must be real because she could produce a real effect in a real other person. As soon as anyone 'came into her mind', she would tell herself that she was that person. [.....] She followed behind people, imitated their walk, copied their phrases, and mimicked their gestures. In a way that was frequently infuriating to others, she agreed with absolutely everything that was said [..... and] became unable to know what anything was for. [.....] She had no future. Time had stopped moving. [.....] This paradox of being more withdrawn and at the same time more vulnerable found its clearest expression in the statement that she was murdering herself on the one hand, and her fear that her 'self' might be lost or stolen on the other. She had only other people's thoughts and could think only what other people had said. She now talked of being two. 'There are two mes'. [.....] She heard a voice telling her to murder her mother and she knew that this voice belonged to 'one of my mes'" (Laing, 1960, pp150-153; emphasis added).

Case, Sara: Sara was the victim of workplace bullying reported by Roberts (2003). Here is an indicative extract .....

"The behaviour that Sara was subjected to, by a senior female manager in the HR department where she worked, ranged from constant criticism of the way she did her job to outright personal attacks. 'This was a day-to-day wearing away of my confidence and self-esteem', Sara says. 'The worst problem was that one minute she was your best friend and the next she was snapping at you'. Other members of staff were reduced to tears or panic attacks by this manager, many leaving the department or organisation. Everyone in the team knew what she was like, but no one would address it. Sara has since been diagnosed with chronic fatigue syndrome and severe depression" (Roberts, 2003, p12).

Case, Sarah: [Chimpanzee (1962-).] [Click for external biography] Sarah, one of psychology's superchimps, is noteworthy in the context of the present glossary for her linguistic abilities and for her ground-breaking contribution to theory of mind.

Case, Sarah: This is Aston's (2005/2006 online) case illustration of an Asperger's disorder child being parented by Asperger's disorder parents. Here are the key points from the case description .....

"Sarah was seventeen when she first came to see me [with] a history of eating disorders, self-harm, and anxiety. Sarah was not the first member of her family who had found their way into my counselling room as I had been seeing Sarah's parents for almost six months. Sarah's mother had initiated counselling for herself and her husband, as she suspected that her husband was on the Autistic Spectrum but had not realised she was also affected. [There resulted] a diagnosis of Asperger syndrome (AS) for both of them. During one of my sessions with Sarah's parents I raised the issue of their only daughter []. They described her as being a 'problem'. Her father felt she did not put enough effort into what she did and could have done better in her [examinations]. He also said that she played her music too loud and made a mess everywhere. [Etc.] As I listened to Sarah's parents describe their daughter, I realised they had not told me anything about who she was, only about what she did that they found frustrating. With this in mind, I asked 'How do you think your Autism has affected Sarah?' This question was met with total silence. [.....] I explained that presuming Sarah was not on the Autistic spectrum, how would they know if they had met her needs and really understood who their daughter was. Sarah's parents struggled to understand this concept and it was becoming clear that they did not truly comprehend their daughter's world or what it consisted of" (Aston, 2005/2006 online; emphasis added; see the original for the happy ending).

Case, Sean Benton: See case, Deepcut Barracks.

Case, Strasbourg A320 Air Disaster, 1992: See companion resource.

Case, Susie Dore: Susie Dore is the 34-year-old woman whose attempted suicides in the 1990s prompted her millionaire father Wynford Dore to devise the "Dore method" of special education for dyslexia.

Case, Tamara Howard: Five-year-old Tamara Howard was headlined in the popular press in October 2006 for the dubious honour of being the youngest female schoolchild to be expelled from a British school. Her crime? "A spate of attacks on teachers and classmates" (The Daily Mail, 21st October 2006).

Case, T.C.: See Asperger's disorder.

Case, the Butcher's Wife: In his Interpretation of Dreams (Freud, 1900), Freud offers us the case of the butcher's wife as part of his explanation of the organisation of cognition in hysteria, and, within that, of the role of identification in particular. Here is how he introduces the case .....

 "'You're always saying to me,' began a clever woman patient of mine, 'that a dream is a fulfilled wish. Well, I'll tell you a dream whose subject was the exact opposite - a dream in which one of my wishes was not fulfilled. How do you fit that in with your theory?' This was the dream: 'I wanted to give a supper-party, but I had nothing in the house but a little smoked salmon. I thought I would go out and buy something, but remembered then that it was Sunday afternoon and all the shops would be shut. Next I tried to ring up some caterers, but the telephone was out of order. So I had to abandon my wish to give a supper-party'" (Freud, 1900/1958, The Interpretation of Dreams [Standard Edition (Volume 4)], pp228-229).

Now Freud was already convinced that "the instigation to a dream" was always to be found in the events of the previous day, and, sure enough, when he pursued that line of questioning with the woman in question it turned out that her husband, "an honest and capable wholesale butcher", had informed her that day that he intended going on a diet to lose weight. She also mentioned in the conversation which had ensued [i.e., with Freud] that she had dropped into the conversation with her husband an ironic remark about not wanting him to give her any caviare. This led Freud to probe further .....

"I asked her what that meant; and she explained that she had wished for a long time that she could have a caviare sandwich every morning but had grudged the expense. Of course her husband would have let her have it at once if she had asked him. But, on the contrary, she had asked him not to give her any caviare, so that she could go on teasing him about it. The explanation struck me as unconvincing. Inadequate reasons like this usually conceal unconfessed motives" (op. cit., p230).

Freud pressed the woman for further detail, whereupon .....

"After a short pause, such as would correspond to the overcoming of a resistance, she went on to tell me that the day before she had visited a woman friend of whom she confessed she felt jealous because her (my patient's) husband was continually singing her praises. Fortunately this friend of hers is very skinny and thin and her husband admires a plumper figure. I asked her what she had talked about to her thin friend. Naturally, she replied, of that lady's wish to grow a little stouter. Her friend had enquired, too: 'When are you going to ask us to another meal? You always feed one so well.' The meaning of the dream was now clear, and I was able to say to my patient: 'It is just as though when she made this suggestion you said to yourself: "A likely thing! I'm to ask you to come and eat in my house so that you may get stout and attract my husband still more! I'd rather never give another supper-party"'" (op. cit., pp230-231; bold emphasis added and discussed below).

However, Freud still found it difficult to identify the woman's true but repressed wish; that secret, and potentially quite unconscious, thought, which, if it ever became fully conscious, would cause sufficient "unpleasure" to warrant keeping it safely under wraps. Taking at face value Freud's requirement that dreams ought to fulfill otherwise unacceptable wishes, we can start to guess at what that true motivation might be. For clarity's sake we have set the sequence out in the following table: the reported facts of the dream are in the centre and right hand columns, and the presumed repressed motivation is in red in the left hand column. Here is how the colour-highlighted interpretation in the preceding quotation looks in tabular form .....

True but Repressed Motive (GUESSED AT BY ANALYST)	Dream Wish (REPORTED BY PATIENT)	Dream Outcome (REPORTED BY PATIENT)
To have no party, and thereby to obstruct any intent by the friend to make a move on her husband	"I wanted to give a supper party ....."	No party.

There are immediately two major problems. The first problem is that any analyst's guess can only ever be that - a guess. Sure, it needs to "fit" in some intuitive way with the reported facts, but it can never be empirically known [which is why psychoanalysis has traditionally been criticised as being inherently unscientific]. The second problem is that the presumed motivation also needs to be painful-if-conscious to the patient in question, because if it is not genuinely "unthinkable", then it would not have been necessary to try to dream-fulfil it in the first place! And on this occasion this scarcely seems likely, because the motivation to protect one's husband against a predatory flirt is hardly unreasonable nor intuitively likely to demand symbolic rather than direct expression.

ASIDE: One of the broader problems with the entire notion of the Freudian unconscious is that in practice the data which suggest its presence might just as easily reflect deliberate deception on the part of the patient. We discuss this possibility at length in the entry for unconscious, Freudian, but it is worth noting here that Freud had been fully aware of this problem ever since he remarked in Studies on Hysteria (Freud and Breuer, 1893-1895) that one of his patients carried "secrets" in her mind rather than fully repressed unconscious memories [for more on the case in question, see case, Elisabeth von R.].

Freud's suggestion as to an alternative repressed motive is as follows .....

"The same dream admits of another and subtler interpretation [..... I]t would not have been surprising if my patient had dreamt that her friend's wish was unfulfilled; for my patient's own wish was that her friend's wish (to put on weight) should not be fulfilled. But instead of this she had dreamt that one of her own wishes was not fulfilled. Thus the dream will acquire a new interpretation if we suppose that the person indicated in the dream was not herself but her friend, that she had put herself in her friend's place, or, as we might say, that she had 'identified' herself with her friend" (op. cit., pp231-232; bold emphasis added).

Case, Tina, McLeod: Tina McLeod was nearly the victim in February 2003 of a tragic miscarriage of the UK criminal justice system, as a result of flawed expert testimony. In what the prosecution suspected was a case of toxic caring, Mrs McLeod, a registered childminder, stood accused of having murdered 11-month-old Alexander Graham while in her care on 26th July 2001. The case was initially reported as follows .....

"Alexander Graham was repeatedly shaken to death by Tina McLeod, who was supposed to be looking after him, it was alleged. [.....] Edinburgh High Court heard how a post-mortem examination revealed the baby's brain and spine were covered in blood and his head was a mass of bruises. A pathologist said the injuries suggested the infant had been shaken to death, hit with a heavy object, or involved in a car crash" (The Daily Mail, 21st February 2003).

As the case unfolded, however, a number of gaps and inconsistencies in the evidence against her were exposed, and she was duly acquitted. [For more on the often unhappy interplay of the medical and scientific decision making systems, see case, Sir Roy Meadow, and the onward links.]

Case, Tracy: Forward (1989) cites Tracy's case in her discussion of the sexual abuse aspect of toxic parenting. Her point was that Tracy confessed to having had orgasms when being forced to have intercourse with her stepfather, and had to be reassured during therapy that this was a matter of biological programming, not of emotional commitment nor consent. Forward also notes that incest victims often become "very skilful child actors" (p147), thus .....

"..... many develop a false self with which to relate to the outside world, to act as if things were fine and normal. Tracy talked about her 'as if' self with considerable insight: 'I felt like I was two people inside one body. In front of my friends, I was very outgoing and friendly. But as soon as I was in our apartment, I became a total recluse'" (p147).

[Compare Case, Liz.] WAS THIS A SENSITIVE TOPIC FOR YOU?: If for any reason you have been emotionally affected by any of the issues dealt with in this entry, you will find suitable helpline details in the entry for toxic parenting.

Case, Unnamed (Freud [A.]'s, 1936/1966): [See firstly Freudian theory and Case, Little Hans.] This case is Anna Freud's corroboration of her father's Little Hans case, and is used to make the same general points about the Oedipus complex and what can go wrong if the underlying tensions fail to resolve in the normal way. Here are some of the details .....

"A seven-year-old boy whom I analysed used to amuse himself with the following fantasy. He owned a tame lion, which terrified everyone else and loved nobody but him. It came when he called it and followed him like a little dog, wherever he went. He looked after the lion, saw to its food and its comfort in general, and in the evening made a bed for it in his own room. [This] fantasy became the basis of a number of agreeable episodes. For example, there was a particular daydream in which he went to a fancy-dress ball and told all the people that the lion [was] a friend in disguise. [.....] He delighted in imagining how terrified the peoplre would be if they guessed his secret. At the same time he felt that there was no real reason for their anxiety, for the lion was harmless so long as he kept it under control. From the little boy's analysis it was easy to see that the lion was a substitute for the father, whom he [] hated and feared as a real rival in relation to his mother. [His] aggressiveness was transformed into anxiety and the affect was displaced from the father onto an animal" (op. cit., p74).

Freud interpreted this behaviour also as a clear expression of denial as a defense mechanism, thus .....

"..... he simply denied a painful fact and in his lion fantasy turned it into its pleasurable opposite. He called the anxiety animal his friend, and its strength, instead of being a source of terror, was now at his service" (op. cit., p75).

Case, USS Vincennes: See the companion resource on "Military Disasters" (scroll down to 1988).

Classic Study - Bandura, Ross, and Ross (1961): [Click for full text online (courtesy of York University, Toronto)]. See aggression, social learning theory and.

Classic Study - Meadow (1977): See Meadow, Sir Samuel Roy, Munchausen syndrome by proxy and, and case, Sir Roy Meadow, in that order.

See the Master References List

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