Otto was in rough shape, literally trembling in fear, sweating profusely, and becoming visibly more anxious as I attempted to learn about his situation. As his anxiety rose, Otto divulged a further piece of information: Fred, who had so alarmed Sally, had called Otto on the telephone and threatened him. I was able to quiet Otto's fear somewhat by noting that Fred seemed entirely in charge of himself, and that this latest manoeuver was analogous to his shaming attack on Sally. He seemed more like a bully, the kind of provocative person who stops when people do not respond to his taunts.
Otto stopped for a moment and smiled. "I understand bullies," he said, but he did not elaborate on that insight. We agreed that it was most important for him to get a good night's sleep so that he could recover his normal aplomb, and I prescribed a modest dose of clonazepan to control the fear and remaining rage. He accepted my suggestion that he call me the next morning so I could find out how well the medication worked; it made him "slightly drowsy" but did nothing for his anxiety. A higher dose let him sleep 6 hours, but now he said that he felt "depressed." Fred had filed suit against him for something to do with the altercation in the street a few days earlier. Otto said that he was torn between the desire to "beat up the guy" and to throw himself under a bus. At this time I admitted him to the hospital for emergency care. (You may be interested to know that in the 30 years I have practiced psychiatry I have only hospitalized 12 people. Otto was out of control and needed structured external support.)
I visited him there daily, and he pulled together rapidly. After 4 days he felt back in charge of his emotions and ready to resume his life. While he was in the hospital I met Sally, who might best be described as an overly made up bleached blonde dressed somewhat seductively in sharp contrast to her evident "shy little girl" presentation of self. What ran through my mind when I saw them together was that he seemed disgusted by her the way some men treat a wife or lover who has been raped.
When we resumed our sessions in my office, I took my regular history, which starts by asking for one's earliest memory--- "the earliest scene you can remember."
"The relationship between my parents was terrible. My mother had to live with a man she hated, and he hated her. My mother told me many times that she didn't want to be pregnant with me, was horrified when she found out she was pregnant, told me over and over that she didn't want me, and that she went to one of those gyms where they have a thing you stand on with a motor and a belt that goes around your fanny to jiggle it a lot so you lose weight there. Only she put the belt around her waist and faced outward rather than the correct way, and stood there for hours trying to shake me loose. I have this memory which probably isn't real that I am in a big Waring Blender being shaken up like a milkshake.
"My parents and a bunch of their friends and relatives used to take a house by the Danube in the summer. I was a baby in a carriage on the sidewalk, and the hood of the carriage collapsed on my hand causing excruciating pain and I started to cry. They say a mother should know her baby's cry. I was screaming in pain for half an hour. A passerby released me, ran upstairs to tell my mother, who said "I thought that was a cat screaming." Until her death a few years ago she told that story as if it were funny."
"Once I came home half an hour late and my father put me in a tiny closet behind the hall stairs for 2 hours. I was 9 then and terrified. Another time I bought a water pistol from the neighborhood store for a dime (we lived in America then) and just as soon as I walked out of the store I realized it was defective. I walked right back in and asked the guy to exchange it and he acused me of stealing it and told my parents. My mother beat me severly with a belt and buckle. My face was covered with blood. I looked in the mirror and vowed I would never hit a child. She never asked my side of the story, not ever."
The history continued with one after another similar story in which he had been punished and humiliated and ridiculed by a family for which he could do nothing right. From early childhood he worked to support himself, and when he developed a severe allergy from which he once almost died in anaphyllactic shock, he had to use up his entire earnings to pay the allergist. He paid his way through all his schooling, did well in college and business school, and landed a good job with a flourishing store that soon expanded to a chain and then to be traded on the stock exchange; now he is a ranking executive in the growing company.
Otto has a sister 5 years older than he, described as "an unfortunate individual who has taken on many of the characteristics of my mother. An unhappy individual. My mother felt her children could never attain." Gertrude is married, childless, and avoidant of all family events. Otto's children range in age from 17-26, all in various stages of education, all described as "just as manipulative as their mother; users."
He has few friends, devoting his time almost entirely to work. Otto married a woman he met in graduate school; their union lasted 19 years, during which he believes she became "more and more like my mother---increasingly rigid and unfriendly as she got older. About the time I left her she had developed the habit of bringing supermarket clerks into our apartment, photographing them nude, and having sex with them."
I put a lot of stock in people's response to a group of 3 proverbs, and it is from "a rolling stone gathers no moss" that I learn whether they believe there is such a thing as intimacy. Otto's response absolutely surprised me: "A person who moves about doesn't have an opportunity to set down roots and form a relationship as a person should do if he's in tune with himself and his environment." I would have expected his answer to me more in the line of moss=rot or rust, as I see with most people with histories like his.
When asked to describe himself, Otto said "I am a good person who's a nice guy, intelligent, hard working, compassionate, understanding, who likes and enjoys the work that he does."
Asked about any history of depression or previous emotional illness, he responded that "on and off during the years of my marriage I felt trapped. This mood was relieved by the divorce. A lot of minor phobias fell away---fear of flying sort of disappeared as soon as I left my wife."
My diagnosis at this point in the therapy (8 sessions) was 1) Brief Reactive Psychosis. 2) Characterologic problem with anger probably related to shame.
Throughout this prolonged anamnesis, I took care to treat him as a glue case, limiting the intensity of the powerful negative affects dredged up by my need for history. The information presented here represents about a third of what I learned in those interviews. At this point, it was clear that he was no longer concerned about the matter with Fred, which seemed to have been dropped, and was pleased to work with me in therapy on the matter of his relationship with Sally, which was the only issue about which he felt uneasy.