The hall—numerous guests, whom we were receiving
He becomes aware of himself as a multiple self .Different parts of himself are gathering together unconsciously to negotiate their existence .He is dissociated though therefore he cannot experience this multiple existence of his parts as owned by himself therefore he alleviates himself from accompanied anxiety by projecting the ownership to familiar persons with whom there are ‘unfinished businesses’.
I reproached Irma for not having accepted my solution; I said: ‘If you still get pains, it's your own fault,
He approaches first the internal saboteur self-state. The pains are substitutes of cocaine. He is aware of taking cocaine as a self -attacking procedure and is afraid of recognizing the devastating power of such a self state .He comes aware of the Winnicotian anxiety of self-fragmentation and tries to renegotiate this relationship in himself.
Irma's complaint: pains in her throat and abdomen and stomach; it was choking her
The survivor self state is taking the lead now. It complaints to himself that he was not listening to it so far. This part of himself was warning him by physical symptoms (the pain in his nose) that something was going on, it was calling for his attention and action.Throat ,abdomen and stomach are somatic areas that are used for digestion. His survivor self state warns him of not being able to digest his theory thoroughly; his theory is incomplete, in pain. He starts to feel guilty of having constituted a theory that is inadequate (this is a disguised occurrence of a narcissistic injury).
She looked pale and puffy
By visual representations he becomes aware of his vulnerable (narcissistically wounded) self. He still cannot own this part as his and he needs to project it on a wounded woman (Irma) as way to feel superior to his injury.
I was alarmed at the idea that I had missed an organic illness
He is becoming alerted on his inability to reflect properly on himself. He is becoming gradually aware that his grandiosity made him blind to experience his vulnerability. He is unconsciously aware that his internal saboteur would be able to create a physical illness that he could not cope with or/and eliminate its origins.He starts to understand that his physical problem with his nose and his solution to it(taking cocaine)could bring him into psychological death ,implying he was aware of his ‘deadly’ addiction to cocaine.
I took her to the window to look down her throat. She showed some recalcitrance, like women with false teeth. I thought to myself that really there was no need for her to do that
His addicted part of himself receives finally more attention and consequently there is a more careful glance to it. The internal saboteur initially resists such a closer relationship. The false teeth are representing the oral aggression of the internal saboteur ,the false self that is disguised under the narcissistic cocoon. He understands the vanity of his narcissistic defences though he is not ready to explore them deeper.
What I saw in her throat: a white patch and turbinal bones with scabs on them
He moves more deeply to understand his wounded self. He can now contain some pain of his traumatized self and the wounded self’s image becomes clearer.
I at once called in Dr. M., and he repeated the examination
He doubts his self image is accurate and calls for an external representation of himself . Dr.M is his disguised Mother .His mother is being put in authoritarian position, although he is in need of his mother’s representation he becomes aware of his rage against her of putting him in an inferior position. On another level Dr M is really his superior colleague and he painfully questions him of the way he represents Froyd as a medical professional.Froyd becomes aware of his dependent positioning around authoritative figures. The cocaine dependency is a self-attacking manifestation of his grandiose self-rage attacking the self of himself that is need of external mirroring.
Dr. M. was pale, had a clean-shaven chin and walked with a limp
He is fighting against the external object .His maternal representation of him cannot be internalized without pain. He is becoming furious of such a procedure and he unconsciously realizes the nature of his narcissistic injury. On another level he is aware that the closer his relationships get the more his narcissistic vulnerability (his fear of how other people perceive him) is expressed.
My friend Otto was now standing beside the patient and my friend Leopold was examining her and indicated that there was a dull area low down on the left
He is still questioning his representation in other significant authoritarian people of his circle. Leopold is one of his self-states that can see clearly his narcissistic wound. The underlying friendship with Otto and leopeold (his self-states) indicates his self becomes more cohesive.
A portion of the skin on the left shoulder was infiltrated
He understands his death anxiety issue as another narcissistic wound. He understands he is not immortal and he is connected more with the physical pain that is his disguised pain of realizing he is getting older .
In spite of her dress
The dress is the narcissistic defenses that although there are still there they cannot longer hide the narcissistic wound. However he is afraid of a possible collapse without his defences therefore the dress cannot be taken away.
Dr. M. said: ‘It's an infection, but no matter. Dysentery will supervene and the toxin will be eliminated
Dr.M becomes familiar with his injury but cannot offer more empathy. Froyd becomes aware that his theory although significant in understanding the symptom lacks proper interpersonalization and here there is another narcissistic injury .On another route his mother was able to understand his vulnerabilities though her understanding was not expressed properly for him.
We were directly aware of the origin of the infection.
The self states party reveal a coherent self. He understands now the psychodynamics of his injury and has a clearer opinion of what went wrong.
When she was feeling unwell, my friend Otto had given her an injection
He understands he needs his friends to overcome his injury; he can now let them become closer to him. On another level he understands there are parts of himself that are healthy and can really help him if he sustain a better internal relationship with them.
A preparation of propyl… propyls … propionic acid
He needs to smell the perfume of closer relationships but still he gets in the paranoid position .The perfume is perceived as contaminating acid, that is closeness is still threatening. He is shimmering between close and distant.
Injections of that sort ought not to be made so thoughtlessly
He understands the paradox of taking care of himself with cocaine a way that is revealing his self-attacking mechanisms. On another level the injection could be an interpersonal injection that is necessary to be done thought anxiety provoking if not regulated in proper dose of proximity.
And probably the syringe had not been clean
Here there is indication of phantasies of being contaminated by close relationships (indication that his mother was scary for him).
by Stavros Charalambides