Thursday, February 03, 2005

A Classic Case of Hysteria

I vividly remember a young patient who I first saw in the Emergency Room many years ago--I'll call her Barbara. Barbara was a 16 year old high school student who decided to skip classes at her school one afternoon and arrived home only to discover her mother in bed with a man who was not her father. Clearly upset, she ran out of the front door of the house and tripped over a potted plant, landing in the grass of the well-manicured front lawn. When she tried to get up from her fall, Barbara discovered that she was completely blind.

Barbara was brought in by her parents, and the story was related to me by the mother, who asked to see me alone. When I finally spoke to Barbara, she seemed completely indifferent to what had happened. Had she hit her head? No. She had fallen on her outstretched hands and closed her eyes and when she opened them she had been unable to see. Had she been upset, I asked. No. Was she angry at her mother? No. How did she feel about the fact that she couldn't see. What am I supposed to feel, she wanted to know and shrugged her shoulders with supreme boredom of a teenager. both of her parents were significantly more anxious and emotional about her situation than she was.

Her case was not difficult to diagnose (although we did all the necessary medical tests to make sure it was not a serious medical problem). Back then we called it "hysterical blindness"; now it is called a "Conversion Disorder". Barbara's case even had what was known as "la belle indifferance"--the notable lack of conern seen in the sufferers of a conversion disorder. You see, this was a classic Freudian case, the kind that he used to write about with all the obligatory symbolism (e.g., the blindness symbolized the fact that she didn't want to "see" or "look" at something that was too painful for her to accept). It is the kind of case that was very common in Freud's part of the century, when there was a general lack of sophistication about medicine and psychology. Hysteria become less and less frequently seen in the 70's and 80's as the public became more educated about medical and physiological matters. It is uncommon today, but still occurs occasionally.

On further questioning about what had made her come home that day, Barbara became quite animated as she described the precipitating event that lead to her unexpected decision to cut class. She had just been told by her boyfriend of several months that he was seeing another girl and wanted to break up with her. Feeling she would not be able to get through the rest of the day without crying, and not wanting her friends to see her upset, she came home. Interestingly, she was angry--extremely angry--at her ex-boyfriend and the girl he was now dating. She had no difficulty in expressing that emotion. When asked more confrontationally about what she found when she came home, she admitted it had been a shock to see her mother with another man, but what was REALLY bothering her was the deceitful, lying, ungrateful, evil boy who had broken up with her. She was able to express some decidedly homicidal rage about his behavior. About her mother's behavior, she had nothing to say.

Barbara, I submit to you, is a perfect metaphor for the Democratic Party of the 21st Century. Like Barbara, they have had a rude psychological shock, stumbled, and become blind to the serious events happening in the world around them. They feel they have been deceived and lied to --betrayed even--and have chosen to direct their rage against President Bush, the symbol of all the evil in the world. By doing so, they don't have to focus on the real evil --the horrific attacks of 9/11. They appear to be sublimely indifferent to the reality around them and choose to focus on events and incidents that are trivial in comparison. Like Barbara, their world is falling apart, but all they can do is close their eyes to it and focus ("displace") their anger onto a convenient target whose election was a blow to their narcissism.

Over the next two months, Barbara slowly became well again. In psychotherapy, we focused on trying to get her to "see" what she really couldn't bear to face--the breakup of her parent's marriage and the end of her childhood idealization of them--and come to grips with it. The loss of a fickle boyfriend she barely knew hurt also, but was not the real trauma she had to deal with. Somehow, she had to develop the necessary maturity to cope with the new reality of her world--to "see" it for what it was. And somewhere along that difficult psychological path, her vision returned.

I sincerely hope that the Democrats are able to negotiate that same path.

No comments: