A physician needs to gaze at corpses and he can’t stop the impulse to do so.
Dennis, a staff physician at a hospital, began having urges to gaze at corpses. He said that it felt like he really wanted “to look at dead bodies.” When he ended his duties for the day, he would visit the pathology department lab of the hospital. There he would look at the dead bodies in their various stages of dissection.
At first, Dennis said it was just an idea. Then he said that his urge to go look at the bodies was like “a visit.” Finally, however, he admitted that to do what he was doing “was really strange.”
He was right. The problem was a recurring or persistent idea in his mind—an obsession—followed by an action (his behavior), which was compulsive; that is, he would think about looking at the dead bodies and then actually go and gaze at them.
“I felt like I was possessed—kind of like the possession you might need an exorcism for,” is how he put it. He also said that whenever he visited the bodies, the tension he felt would vanish. He explained, “I liked the environment of the lab—it gave me a good feeling.” In contrast, he believed that not visiting the lab when he had the urge to do so would increase his tension, and then he would feel agitated and deprived.
His wife became concerned when she noticed that he was becoming emotionally detached. She told Dennis he was gazing into space a lot and that he wasn’t talking to her very much. When she asked him what he was thinking, he would deny that anything was wrong. When she persisted, he confessed that he did know what he was thinking about: it was about looking at dead bodies in the hospital lab.
He told her that he was keeping it from her because the whole thing was very strange, even to him. His wife then thought it was a sign that he was overworked at the hospital. “No,” he said. Then he countered with a different story. What he told her was that he had discovered that his chief of service at the hospital had selected him to be on staff only because another doctor refused the position. He said he then realized that the insignificant assignments he was getting were based upon his chief’s poor opinion of him. He said he realized “that (a) he didn’t like me or didn’t respect me and (b) he was discriminating against me by giving me these unimportant assignments.”
Thus, the upshot was that rather than feeling overworked, Dennis felt underworked and, more important, undervalued.
Based on our symptom code of one (the wish), two (the anger), and three (the who), we would guess that Dennis:
1. had his wish blocked;
2. got angry about it; and,
3. didn’t realize he was angry at someone in particular—a who.
Of course, knowing who the who was, was particularly important here. Although Dennis’s wife, as his closest person, would have been a chief suspect, he knew that he was not angry at her. Who he was really angry with, but couldn’t face—or be fully conscious of—was his departmental chief. As it turned out, this chief was the best suspect.
The more Dennis described his feelings about the chief, the more certain it became that this chief was really the anger culprit—the who. In describing his reactions to the chief, the physician said he felt awkward in his chief’s presence; he felt shy, withdrawn, and unnatural. He felt the chief didn’t respect him, trust him, or even like him.
An interesting little passing comment made by this physician related to his sense of tranquility when describing the calm he felt when he was in the lab gazing at these corpses. And here’s the twist. He followed this comment by saying that the feeling he got in the lab reminded him of some of the things he liked to do, such as having dinner with his wife in a nicely lit restaurant, especially one that had pleasant ambience. He loved the romance of it and described what he felt to be one of the “little things” in life that he realized wasn’t so little. That is, he felt strongly that the romance with life included many little things, little pleasures. And dinner with his wife in a warmly, tranquil restaurant—especially with soft jazz playing—qualified as an example of this sort of romantic aspect of life. When asked whether this example, in fact, actually qualified as this kind of romantic experience, he answered:
“Yes, definitely, big-time. I like that kind of environment in a nice restaurant. It gives me a good feeling. When I’m like that, I feel everything’s good with the world. My wife is beautiful and I love her, and I know she loves me. The music is playing, we’re drinking wine, and we never run out of things to say to one another. I love to hear her talk, and she says that she finds what I say endlessly interesting. Imagine that,” he ended, “she says that what I say is endlessly interesting. She used that word. I can’t get over it.”
Of course, I instantly recognized that this was the exact phrase Dennis used to describe the good feeling he got in the lab. Apparently, when he was in the lab, everything was good with the world, and so he felt fine, good, accepted, loving, endlessly interesting, and even romantic. Imagine that! When gazing at dead bodies in various states if dissection, this man felt romantic! That’s what it boiled down to.
And that’s also the irony of it all. Here was a man who enjoyed feeling he had it all; he was conscientious, did all his work, married the woman he fell in love with, and had a sense that when you are responsible in life, everything will work out. And this bit of his philosophy was really the wellspring of his romantic sense of life. Do it right and everything will be fine. But then, there he was in a position at the hospital where no matter how responsible he was, or wanted to be, he was still seen by his chief of service as someone who perhaps could not be trusted with important assignments. And he felt that given who he believed he was, this didn’t jibe with how he was being treated. It just wasn’t the natural order of things.
Dennis described his symptom in detail. It would begin when he felt isolated, or after he was feeling shy, or withdrawn, or underutilized at the hospital. It would first start with an increase in tension. In other words, he knew something was wrong when he would begin feeling uncomfortable or tense. Only then would the idea of viewing corpses enter his mind. He kind of knew, he said, “that if I could just see even one corpse, my discomfort would definitely disappear. I just knew it.”
Then, when he could not immediately follow through on this urge, the urge itself would climb and he would also feel a strong compulsive impulse to go and do it; that is, he could barely wait for the day to be over so that he could scoot over to the lab and do his gazing. So, in fact, at the end of his shift, and with great anticipation, he would actually rush over to the lab and as soon as he saw the dead bodies, he would begin to relax, and his tension would decline. He would feel better.
And this is when he would spend undue amounts of time at the lab talking with lab personnel about autopsies, techniques, and reasons for the death of each of the persons whose bodies were being worked on. Then, instead of getting home at a decent hour, he would be perennially late. It was why his wife originally thought that he was being overworked. And when she originally mentioned it to him, he knew, of course, that the opposite was true. But he couldn’t tell her the real reason for always arriving home late.
It was bizarre and Dennis knew it. And he also knew that the feeling of calm he got was exactly opposite of the feeling he would experience working in the department where his chief was the absolute law. There he felt tense and awful.
Each element of the symptom code could now be applied to Dennis’s symptom:
One: The wish that was thwarted or blocked was his desire to be valued as a physician. This was a direct wish but it fueled another direct wish that was—surprise, surprise—for the death of his chief. He felt he could only be valued if his chief was no longer the chief. Thus, this latter wish produced a symptom that reduced his tension. This was so because he wished that one of those dead bodies was his chief’s!
Two: The sense that he had that he was considered second-rate and therefore not very valued made him very angry.
Three: The who toward whom he was angry and about whom the anger was suppressed (or repressed), so that even he didn’t know it was there, was this departmental chief.
Clearly, Dennis was so angry at his chief that he was wishing for his chief’s death. And the main point is that his urge to continue to view corpses was a repeated attempt to see his chief as one of the corpses (or as all of them). And he would always feel better gazing at these dead bodies because, in a symbolic way, each time he looked at one, it represented seeing the dead body of the chief.
Point Four—the to do, was to have Dennis not shy away from his chief. Rather, the to do here was to be able to talk to the chief. Fortunately, this did occur, and again, fortunately, the chief responded favorably and a new and helpful attitude was forged between them.
The one, two, three of symptom cure required knowing:
1. What the wish was;
2. That the phyisican was angry; and,
3. That he was angry at his chief—the who.
The important point here is that this physician was able to step out in front of the line and verbalize his discomforts. His symptom then quickly disappeared into thin air. Going to work each day began to give him a good feeling—so his work gradually became one of those examples of the romance of life—and, finally, his urge to gaze at dead bodies was, itself, then dead.