Id of the garden: A case study
Amy C. Blume-Marcovici
This is a room you would expect to find at a psychiatric hospital. The lights are dim but sharp, the color of a worn-out highlighter. There are no windows. The floor is checkered linoleum: black and white, as if that is the way the world works. And for many of the people here, it is a black and white world, in and out of psychiatric hospitals like this. They operate inside a sort of Kleinian masterpiece: constantly vacillating between hope and despair, love and hate, libido and aggression with nothing in between but silence. At times, the silence here is frightening.
Today, however, it is not silent. As an intake coordinator, I have done four admissions already, and it's only noon. I've gotten my interviews down to thirty minutes, moving from a mini-mental status to trauma history with the grace of a fighter pilot.
I'm hungry. It's lunchtime. When I was young, we were not allowed to eat between meals. Kitchen's closed, my mom would say. And that was that. I can picture her face: soft and ironic as she speaks. I suddenly want to feel the sound of those words, and so I whisper them:
"Kitchen's closed."
"What?" my new intake asks and I snap back to the present. "Can't eat" she moans, rolling onto her side. The mattress sags. "I can't, can't." Her bare feet rest on cold metal that is the end of the bed frame. Her thin ankles, swollen with liver spots, are shackled. I flip through her paperwork. She's been in the mental health system since she was 22. Now she's 60. Psychosis NOS. She mumbles something inaudible and I glance up. It's my turn:
"What?"
She looks at me but doesn't answer my question. Suddenly she bursts into a boisterous laugh, lips curled back to reveal a cave of mushy, red decay. Her round face turns so purple I wonder if I should get the nurse, but she stops laughing as quickly as she began. She turns onto her back and stares at the ceiling, quiet and pensive. I wonder what she sees there, in the stain and flake of the plaster. I could ask her: Tell me what it looks like to you. What might this ceiling be? I imagine her answer: a morbid, an ALOG, animal content.
The security guard waiting outside peaks in. I'd forgotten he was there. The Guard. He is a tall man, even in the humbling blue uniform, with sunken eyes. He looks like he could say something wise and funny and sad all at once. Instead he is quiet. "Everything alright?" he asks with his forehead. I smile and nod. A young woman in a room with a cackling patient. He lifts his eyebrows and retreats to the hallway.
"Let's continue," I say. My intake doesn't answer. "Can you tell me where you are?" …Silence… "Do you know why you're here?" …Nothing… I think of Nancy McWilliams' suggestion that psychotically-organized clients require more supportive therapeutic techniques and alter the pitch of my voice to make it gentler, earnest. "Do you know what sort of place this is?" I coo. Still, I get no response.
I breathe in deeply, rustling the paperwork I will soon need her to sign. This could take a long time and my stomach growls. Impatiens are high maintenance, my mother used to say when I got antsy. Flower puns were her favorite. I muse at the way the pun has hybrid itself here: inpatients are high maintenance. Thyme takes time, another she would dole out to her irritated children. I sigh and relax into my chair. "Do you know what day it is?"
Suddenly my intake looks at me. "Day?" She asks as though she has just been woken, eyes caked with fatigue. Her voice cracks as she whispers, "May I tell you my dream?" I am struck by the directness of her question. Saved by a dream! An image of Melanie Klein as a young woman comes to mind: she is lying in a hospital bed in Vienna. The room, despite decades passed, is precisely like this. She is depressed: unresponsive for days until she unexpectedly comes upon Freud's Interpretation of Dreams. I imagine her sitting upright in her bed, arching her arms toward the sky. A miracle case thrust back into a life that would be real and coherent and meaningful. The woman who would bring psychoanalytic theory to psychosis, to clients like my intake. A woman saved by a dream.
"I'd be honored," I answer my intake. I am aware that her dream will desecrate my 30-minute average but dreams are a rare find in this place. I can hear my mother's voice: A dream shared is a secret bared. Sometimes my sister and I told each other dreams over bowls of Lucky Charms at breakfast. Mom would listen, strong hands folded beneath her narrow chin, forehead wrinkled in earnest. It is only now that I realize my mother, a mother and a gardener by trade and choice, would have loved psychoanalysis: her belief that dreams expressed something essential about the dreamer – something bold and raw; her perpetual use of metaphor as a means of hinting at a grander truth, as if to reveal the tip of a Freudian iceberg; her love of digging up the roots of plants to show her children the worms and the scent and the dark, active world that lay beneath. The id of a garden. I almost laugh as I picture her in a large armchair, my skinny, long-haired mother smoking a pipe and nodding as a client free-associates on the couch. My mother, the psychoanalyst!
I suddenly wonder why I am thinking so much of my mother today. I can hear her now: Sometimes we don't know why we do things, but that we did them deserves attention. That line, stern and crisp, was a harbinger of punishment for a deed gone wrong. What, today, have I done wrong? I look at the woman before me. My intake. I try to imagine her as a mother for just a moment, her emaciated arms wrapped around a baby. I almost practice whispering – mom – but she cuts me off. The tone of her voice has shifted: low pitch, staccato.
"What you must know is that I grew up in Oklahoma. The farm was. Oh yes," Staccato beat. She puts her hand up to her hollow eyes, as if trying to get a look at something spectacular. But she fails. "Sometimes in the dream I am inside me. Sometimes I'm not. Do you get that?" She doesn't look at me but I nod, one swift movement. "When I'm inside me, I'm a child again. When I'm not, I'm grown up and I watch myself with my little girl." Beat. She smiles at the ceiling. A sad smile. Perhaps human content this time, likely fictional. "In the dream, my daughter is an infant. She's grown now. All grown up. Yes. How old are you?" I don't answer – an attempt at neutrality – and she doesn't ask again. There is a pause and the silence leaves me guilty. I rustle paperwork and she goes on.
"The dream is in a house –always in this house. It is – yes – on our land – on the farm – but it is not our house. Not. Our. House!" She cringes here, shaking her head. Two beats go by. "Yes. I'm in the house. Inside myself. I'm a child again and I look out the window. I see meadows and the gold sky. Oh, so nice! Grandfather is plowing and all the sun is on him. I could look at this – yes!
"Then, outside of me, I have my daughter in my arms. I am watching myself. I'm rocking her to sleep in the small kitchen in that house. But it's not ours! There is something cooking on the stove. Bubbling. It's milk. Burning milk. Yes." Beat. "Then I'm back in myself. I'm a child again but my child is alive. We are both children! Do you get that? We're both children and she's crying and I cannot reach her. She's inside that little kitchen but I'm outside now and I'm too small to open the door. All I want is to get through that door! To get into that room. I cry, too. Our cries are the same. They are exactly the same." She pauses. A complete shift in her face and she smiles. "Sometimes I like knowing that we sound the same, my daughter and I. Get that?"
I think about it for a moment. Does her daughter speak like this, now? A staccato hum? Do I speak as my mom did? Would our cries be in sync? Silent moments pass. The Guard looks in, assessing our condition. He seems to understand that we are okay and he puts his hand up, gesturing to us across a black and white divide, letting us know he is near. A superego in waiting. My intake's face recoils. She turns on her side, away from me. Mattress sag and she continues.
"The kitchen door is so tall. It's covered in wallpaper. Blue and gold paper just like the one my mother put in her bedroom when I was little. I remember. The gold was so bright. So smooth against the fuzzy blue. I was not allowed to touch it. Forbidden." Staccato beat. "This is the paper covering the door to the little kitchen. I will have to ruin it to get inside. Destroy the paper to get my daughter! She is crying so loud now she is starting to melt. All I want is to get to her but I can hardly bear to rip the paper. I'm so scared. I'm scared to touch it!" Beat. "And then the crying stops. Just – yes – suddenly. Instead there is this awful noise. This terrible, terrible drilling. I don't know what it is. I am inside my little body and I am a small child, yet I know that my mind is not little anymore. I should know what is making that noise! I try to get to the window to look out but the window is crashing in on me. The house is caving in! Oh! It is my grandfather – yes – and he's plowing right into the house. He's plowing through the brick walkway and up the front step. He's plowing right through the floorboards. The blades are moving so quick and throwing dirt into my eyes. I can smell the dirt and it is rotten. Dirt is in my mouth and I cannot breathe!
"Then I realize he is plowing right to the kitchen. He is going to rip the wallpaper! He is going to tear it down! He is going to plow right through my baby!" Her voice has gotten loud and her eyes are shut tight. She turns onto her back again, lying like a corpse. The purple has left her face entirely and she is pale. She looks so small. "But then – the most awful part – awful! Awful part. I am outside myself and I realize." Beat. "I realize that it's me. I'm riding the tractor. I'm plowing through the door. I am going to kill the child I love." She moans, once, loudly. One sorrowful staccato. Then, her eyes open. She blinks and her face smoothes. She smiles red decay at the ceiling. INCOM: of this I feel sadly certain.
I feel the pen in my hand. I turn it over and over. I look down at my paperwork – nearly blank. Diagnosis? It daunts. Family history? It chides. I think: on the outside it's empty, but on the inside there's not room for another word. In her own way, through fantasy – through a dream – she completed my assessment. A dream shared…and yet impossible to translate. I close my eyes.
Diagnosis: Schizoid personality, I want to write. I think of long moments of silence and my intake staring at the ceiling like a tiny, frightened child. Diagnosis confirmed by use of primary process defense: withdrawal into fantasy. It dawns on me that my intake is stuck, both in her dream and in her reality, in infancy. I think of Klein's theory that early infancy is characterized by a paranoid-schizoid state and realize that my intake is stuck in that chasm, small and unarmed. Notable split between aspects of self: an inside-me and an outside-me, I imagine myself sketching in the air across the blank page.
Family history: A grandfather, a mother, a daughter. I think of Harry Guntrip's work on object relations. He wrote of the schizoid person's ambivalence toward attachment: her longing for closeness conflicted by a deep fear of obliteration by those who get close. For Guntrip, the schizoid is preoccupied with questions of her own boundaries. Does she exist? Will she be overtaken? My intake's Grandfather comes to mind: a man with all of the sun in the world, and yet able to turn my intake into a monster on a tractor, to take her over completely. A powerful man, safe at a distance – through a window – and yet deadly up close. Mother: a woman with boundaries as fragile and forbidden as wallpaper. Daughter: a child so loved that the boundaries between mother and daughter have become permeable and distorted, merging two humans into one sad and lonely cry. I imagine my pen moving across the page: Disorganized attachment, indicative of Ainsworth's confused and disoriented type.
Homicidal ideation: I think of a mother who loves her child and, yet, believes she may murder her. While not actively homicidal, patient is preoccupied with sources danger and, through introjection, afraid of her own aggressive tendencies.
Mood: Annihilation anxiety. Terror. The patient is paranoid about her own death. Terrified of melting, of being obliterated.
Thought Process: Internal preoccupation. Splitting defense in which patient vacillates between a world that is all-good (the outside-me world in the field beyond the window) and a world that is all-bad (the inside-me world in a suffocating house).
Appetite: I realize my own hunger has dissipated. I am on a roll and I smile at the thought of the psychiatrist reading my imaginary notes. Preoccupation with oral-level issues, I write, thinking of Fairbairn's "love made hungry" which characterized his schizoid position. In their inability to get what they need from their love object (mother, daughter), the schizoid person becomes increasingly hungry for love, increasingly needy. In turn, the strength of their hunger brings the growling fear that love itself will devour and obliterate that which is loved. And thus, a daughter is churned by a tractor. Noted also by continuous mention of a "kitchen".
Sleep: Characterized by nightmares. A time when the id brings forth a world of terror and fears of being taken over, engulfed by an evil house.
Appearance: Thin…I think, looking at the gaunt woman before me. McWilliams theorized that schizoid people tend to be physically thin in order to ward off fears of their own hunger, their own propensity toward engulfment, absorption. Thin by fear, I airbrush. Thin by defense.
Speech: Whispers and staccato beats. Splitting even in her speech. Paucity.
Substance Abuse: Burning milk.
Past trauma: A plow through floorboard. Ripping wallpaper. A murderous tractor.
I sigh. Would this do?
I want to say something. I want to thank her. I want to tell her a dream of my own – a dream I'd had about my mother soon after she died. In the dream, I was looking for my mom, digging frantically through the earth. My hands were raw, fingernails chipping. I could hear the sound of them breaking – snap, snap, snap – as I dug. But I needed to find her. I knew she had to be somewhere in this earth – somewhere in the depths of it. The soul has the deepest roots, she would have said. Mustn't she be somewhere? But then I woke and in my hands were nothing but sheets, sweaty and crinkled. In my heart, I was paralyzed with the dread: she's gone.
I thought about us: my intake deep in the trenches of annihilation fears, terrified of being wiped out, smothered by dirt, plowed over by a man with the power of the sun. Paranoid anxiety. And me, clenched by fears of utter abandonment; depressive anxiety surfacing with the force of a death-plow. Is this some sort of projective identification? An intense countertransference? Am I feeling her daughter's anxiety, what Heinrick Racker would have called complementary countertransference? Is her daughter rooting in the dirt, searching for her mother, my intake? Is she crying when her hands come to surface, bloody and failed?
Or am I feeling what my intake feels, Racker's concordant countertransference: this strange sense of being constantly lost in my own fantasy. Am I, like her, lost in primitive withdrawal? And if so, what am I defending against?
I hear The Guard come into the doorway. In his presence, I realize that I have a job to do and it must be done. Stuttering over my words, my voice meek, I ask my question again: "Do you know what day it is?" I expect nothing as I watch my intake scrutinize the plaster.
But I am surprised.
"Day?" she starts. "Yes. Today. Today is Mother's Day."
I drop my pen. On the upper right corner of my paperwork, in my own handwriting: Sunday, May 10, 2009. In haste, I had scribbled the date of my first Mother's Day without a mom a hundred times today. Yet I had no idea.
I feel tears in my eyes and I start to turn away, so my intake cannot see. But for some reason I change my mind. I let the tears come, facing her.
My intake looks at me. Then, a red smile.
"You're melting," she whispers and takes my hand.
References
Ainsworth, M.D., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological
study of the strange situation. New Jersey: Lawrence Erlbaum Associates, Inc.
Fairbairn, W.R.D. (1954). An object-relations theory of the personality. New York: Basic
Books.
Guntrip, H. (1969). Schizoid phenomena, object relations and the self. New York:
International Universities Press.
Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psycho-
Analysis, 27, 99-110.
McWilliams, N. (1994). Psychoanalytic diagnosis: Understanding personality structure
in the clinical process. New York: The Guilford Press.
Mitchell, S.A. & Black, M.J. (1995). Freud and beyond: A history of modern
psychoanalytic thought. New York: Basic Books.
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