Presenting Symptoms

When an individual comes in for the first appointment, he or she usually has some specific difficulty for which they are seeking help such as a morbid fear of Toyotas. Their reason for consulting me is called the presenting symptom; however this is often not the real problem. Sometimes the problem is unconscious in origin, but sometimes it is not repressed and thus easier to uncover, that is, if I'm paying close attention and asking the right questions.

The couple I mentioned previously in "The Sadomasochism Tango" came in again this week. All in all they are doing quite well. In passing the wife mentioned that she'd had a doctor's appointment this week. It seems that many years ago she was diagnosed breast cancer. There was recurrence a year later and then several more lumps which turned out to be cysts. During this time she was in treatment for her cancer, the two of them hardly mentioned their fears for the future. Each bottled up their emotions and suffered in silence. As they talked I'm mentally calculating that the husband's drinking became problematic about the time of the cancer siege. This week's appointment was to see her family doctor to check out a new lump. She is scheduled to see the surgeon next week, but her doctor is 90% sure it's another cyst. Suddenly everything made sense to me. I asked when she first noticed the new lump. She told me the date. It was the next day she called to make an appointment with me asking for help with her husband's drinking. His drinking appears to be his coping mechanism to handle his fears about his wife. And it also serves to effectively divert his wife's anxiety on to him. The "problem" is no longer her cancer, but his boozing. Aren't people complex?

Another man came in recently after having a truly horrible fight with his wife. He's wondering if their marriage can be saved. He's so miserable that he's not sure it's worth trying any longer. He mentions casually that he thought the last time he and his wife had a fight like this was a year ago, just about this time of year. We did a little checking and found out that they'd had a baby die..wanna guess when?....in late October. Training analyst says it takes on the average eight years before a couple can talk about the death of a child. It has been four years for them. The rage they feel, they direct at one another and for the guilt they each feel, they seek punishment. The fight had to do with unresolved grief no matter what else they might have thought it was about.