Catathymia with a Predominant Obsession
An obsession is “an idea, emotion, or impulse that repetitively and insistently forces itself into consciousness even though it is unwelcome” (Hinsie and Campbell, 1970, p. 518). Although obsessive features often accompany depressive states, some depressed individuals also have a distinct and pronounced obsession beyond that associated with the affective disorder. Frequently, obsessions appear as ideas “which are strongly charged with emotions” (p. 518), and sometimes there is a strong urge to act, such as in “impulsive obsessions which are repetitively intrusive ideas that lead to action” (p. 519).
The case of Ricardo Lopez (Schlesinger, 2006) is illustrative. Lopez was a young man who became obsessed with a rock star and attempted to kill the celebrity by sending her an acid bomb. He then committed suicide, videotaping his death. Prior to the suicide, he wrote a detailed 807 page diary of his thoughts with respect to his fantasy relationship with the celebrity and his plan and motive for killing her. The 21-year-old offender became obsessed about 2 years before the attempted homicide and suicide. His idolization of the celebrity turned to anger when she left her long-term boyfriend and quickly developed a relationship with another man and moved in with him. Lopez was depressed, withdrawn, fairly intelligent, and quite insightful with respect to many of his own psychodynamics. He felt extremely inadequate, based on having gynecomastia (enlargement of breasts in men), and on his belief that a woman would never want to be with him, as he considered himself “a freak.” He initially saw the celebrity as “so angelic, elegant, and sweet,” a view that was shattered when he learned of her new boyfriend, whom he considered to be “unacceptable.” The incubation phase of the catathymic process lasted about 3 months. Because he did not actually kill her, the emotional (catathymic) tension was not fully released and he shot himself in the head.
Cases of filicide (the murder of one’s child) frequently involve obsessional states. In many instances, the homicide is essentially a catathymic murder. Neonaticides (the killing of newborns), as well as early filicides (the killing of young children) and late filicide (the killing of older children or adult children), are committed in states of depression, dissociation, or sometimes psychosis, or as a result of fear or panic (Sadoff, 1995). Many such homicides occur during postpartum depression (Gold, 2001; Haapasalo and Petaejae,
1999) in which an obsessional altruistic idea becomes fixed. Here, the parent kills in order to relieve the child from suffering or to spare the child from some ominous fate (Bourget and Labelle, 1992).
In a study of 120 women admitted to their forensic hospital, McDermaid and Winkler (1955) found that 12 were charged with some form of infanticide. Three of these cases were triggered by social pressure; three cases involved a clear-cut psychosis, but six women were considered to be suffering from a condition the authors termed “child-centered obsessional depression.” Symptoms included long-standing tension, depression, and obsessional preoccupation with the child’s health; the obsessions were “produced in a ruminating manner” (p. 36). In essence, the parent became preoccupied with the child’s appearance, health, safety, or future. The murder was followed by suicide or a suicide attempt, as is found in many catathymic acts of violence. In such cases, the parent-child relationship becomes so intense that the parent overidentifies with the child. “It is the combination of the catathymic thinking, the obsessional fears, and the depression with suicidal tendencies which was considered as causative in the formation of short-circuit reactions leading to infanticide” (p. 38). The mother is usually the offender, but in a minority of cases, the father develops an obsessive rumination that leads to a fixed idea to kill the child and results in a catathymic homicide.
The following case of a father who shot his son after a prolonged period of preoccupation with the boy’s allegedly deformed mouth is illustrative.
Case 6.3: Filicide after Prolonged Obsession
Following oral surgery (to extract a superimposed tooth) on his 7-year-old son, a 54-year- old man (CC) developed an obsessive preoccupation with the child’s “mutilated” mouth. He believed that the youngster would “suffer” when he grew up as a result of the perceived deformity. Initially, his obsessive preoccupation was of a recurrent nature and diminished after discussion with either his wife or the dentist.
The obsession continued for several years in a mild form, but after his wife died of breast cancer, CC’s symptoms grew in intensity. CC was exceptionally close to his son, particularly following his wife’s death. All his emotion and affection were concentrated on the child. He blamed himself for making the wrong decision in allowing the oral surgeon to extract his son’s tooth and believed that, through this decision, he had “mutilated” the child. He suddenly developed an idea which appeared ego-alien at the time—that it was necessary to kill his son in order to free him from future suffering. CC thought of discussing this idea with a clergyman, but he realized it sounded so absurd that he feared he would not be believed.
The idea subsided in intensity for several months but then increased again and grew stronger. CC became depressed and preoccupied with the bleak future his son would have, and he concluded again that the only solution was to kill the child to prevent his suffering.
The offender bought a rifle and hid it in his room. For the next several days, he waited for the “proper time” to commit the act. He finally shot his son while the child was asleep. Immediately afterward, he felt that he “did the right thing.” He did not believe his act was wrong or criminal. In fact, he felt no remorse and was interested only in the salvation of his son’s soul. The tortured feelings he experienced prior to committing the homicide dissipated after the shooting. However, several months after the murder, CC realized that he had made “a stupid mistake” and came to believe that he had “exaggerated” the idea that the mild deformity of his son’s mouth would somehow interfere with his life. CC was found legally insane and spent 2 years in a psychiatric hospital, followed by outpatient psychotherapy.
As a child, CC had been unpopular and teased in school. He described himself as rather rigid and orderly, always fearful of making mistakes or hurting another’s feelings. He worked as an accountant, a profession in which his personality traits were useful. CC’s intelligence fell within the superior range; projective testing reflected a rather bland, unoriginal, and practical approach to life with no signs of structural disorganization.
This case is typical of a child-centered obsessional depression, culminating in a catathymic homicide. The treating psychiatrist concluded—after 6 years of therapy—that the extremely close relationship with the son and the quasi-delusional preoccupation with the child’s mouth pointed to a deeper source of disturbance and conflict. Although unable to document or substantiate his conclusions in a direct way, the psychiatrist believed that incestuous homosexual conflicts were at the root of CC’s disturbance.
