Case examples of illusion/disillusion (JL)

During my residency training at the Sheppard and Enoch Pratt Hospital, I (JL) had three experiences that involved a patient’s unexpected disruption of an illusion.

Mr. M, a brilliant man in his thirties, had been appointed by President Truman to a high governmental position in health care. Mr. M was ill-prepared for the leadership responsibility, failed, and became psychoti-cally depressed with paranoia ideation. I was the resident in charge of his treatment and we got along well as he unfolded the narrative of his life experience. One day, several months into his hospitalization, we were waiting in the hospital grounds where two men were playing catch with a football. The football got loose and rolled over to where we were. I picked it up and threw it about 20 yards with a spiral - I had been a quarterback. When I looked at Mr. M, I saw he was startled, like he had seen a ghost. He became so agitated that I had an attendant take him back to his ward. Only after a struggle did it become clear what had happened. Mr. M had come to regard me as a twin: an above-average sweet Jewish boy and man. As scholars we were treated as nerds - or even sissies - by the athletes who could bully us whenever they liked. Suddenly, in his eyes I had become one of the bully athletes who had humiliated him. Mr. M’s illusion of me in the twinship transference that had sustained the treatment had been disrupted into a traumatic disillusion.

Bonny, a depressed teenager and the only child of a famous family, was hospitalized at Sheppard after a suicide attempt. When I went to see her, she informed me emphatically that her mother had gone to an analyst and it had destroyed her family. She would not talk with me, and that was that. I told her it was my responsibility to see her regularly. For a time, we would sit together in silence. Then I introduced checkers so there was some degree of conviviality between us. I discussed her with Lewis Hill, my brilliant mentor. Lewis said “have her brought to my house and I’ll see what I can do.” At Lewis’s house something totally unexpected happened. On seeing Butch, Lewis’s large boxer dog. Bonny was transformed out of her depression and apathy and into an animated, loving playmate with Butch. Bonny asked for, and was granted, visits to Lewis’s to play with Butch. One day, several weeks later. Bonny and I were sitting in our usual silence on top of a hill on the hospital grounds. As he frequently did, Butch ran out of the house and headed straight up the hill. Bonny prepared eagerly to receive him, but he came to me - our playful boxing relationship having begun a long time back. Bonny, hands out to receive Butch, looked like she had been hit by a brick. The good - the creative you love and trust - was drawn to the evil - the wrecker of families. An acute moment of disillusion.

I had an attendant take Bonny back to her room. An hour later, to my great surprise, I received a call saying Bonny wanted to see me. When I got to her room, she was sitting in an armchair with wide arms, crying freely for the first time. I sat on the arm of the chair and put my arm around her as she wept. The nurse entered saying she had to take Bonny to dinner. I told her no: she should get Bonny a tray and I would stay with her until she returned. When the nurse returned with the tray. Bonny spoke for the first time: “Now you go home. You should be with your family - your wife and your children.” Subsequently, our verbal sessions began.

Mr. E came to Sheppard for a second hospitalization with a schizophrenic episode marked by hearing voices and paranoid thinking. Entering his seclusion room, I quickly sensed his intense hatred and felt an element of physical threat. When I consulted Lewis Hill, who had known Mr. E on his prior hospitalization, Lewis assured me that Mr. E was treatable and agreed to my request to see him with me. I arranged for the two biggest attendants to accompany us. As the four of us entered, Mr. E cowered in the corner, looking a mixture of murderous and frightened. Lewis briefly attempted to reinstate their connection from Mr. E’s previous hospitalization. He then turned to the task at hand, saying “You hate him?” Mr. E nodded vigorously. “Is it because he’s a Jew?” Intense nod of confirmation. “And you believe the Jews killed Jesus Christ?” Another nod. And then Lewis’s challenge to the psychotic illusion: “Who do you think Christ learned all he knew from?” From Mr. E, a look of confusion. “He learned it from the Jews - and this Jew knows something you need to know. Let him teach you.” And with that we left the room, a puzzled-looking Mr. E moving out of the corner. About an hour later I had the door opened and spoke to a blank-faced Mr. E: “To get out, stop peeing in the room; call an attendant to take you to the bathroom. Do that and I'll be back tomorrow to tell you the next step.” Happily, this “disillusion” with a bigoted moralist illusion about a therapist’s religion evolved into a successful therapeutic relationship.

Mrs. T, my first analytic patient, entered treatment depressed. She wanted to have children but so far was unsuccessful. She found it very difficult to talk about or to access and reveal her feelings. She was easily frustrated, and on one occasion was silent for six consecutive sessions. She was a twin, the smaller and less developed at birth. The twin’s mother preferred the larger, more developed, easier to feed and handle sister. From the age of four onwards, Mrs. T was determined to win any competition between the sisters - in play and at school. Gradually, her analytic voice became stronger, and she went on to have two children. Her relationship with me became more trusting, with tiny indications of affection. On one occasion I tried to give verbal recognition to an association she had made that suggested mutual affirming between us. I likened the feeling to a rare, golden moment from her childhood when her mother had held her, not her sister, hugging her closely. I chose to repeat her phrasing of “close to her mother’s heart” in the language she had used. She erupted in fury, leaving both of us confused and shocked. She yelled “I know it. You are one of the German Jews who looked down on my family, making them feel they were nothing.” I later found out that my pronunciation of “heart” was not the Yiddish of her childhood and family but the German of my childhood and school course. It was a moment of disillusion for each of us. I was under the illusion that we had brought into awareness all of the sources of significant negative transferences and were proceeding to a successful ending. Mrs. T, I believe, had long sensed at some levels of awareness a cultural distinction between us, but was proceeding with the illusion that trust in me was earned and goodwill was predominant. So we were both shocked and disrupted: I, that I had triggered such a destructive outrage; and she, that I had revealed myself to be a disdainful bigot. Fortunately, the actual nonillusion strength of our relationship was strong enough that we could recognize and work analytically to resolve our disillusions.

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