Dr. Pearson was a resident in psychiatry when she treated Mrs. X, a fifty-year-old married mother of two teenage children, for one year in an inpatient setting. This was Mrs. X's first hospitalization and came after ten years of psychotherapy with Dr. Z. Mrs. X, although externally accomplished, experienced an overwhelming sense of emptiness, had chaotic interpersonal relationships, and engaged in secret, self-mutilating behavior. She first came to Dr. Z after ending a dependent relationship with a nun, which caused longstanding difficulties to flare up. She became very dependent on Dr. Z over the course of ten years treatment. She hid the depths of her involvement for six years, which Dr. Z overlooked because of Dr. Z's own needs. When Dr. Z tried to work on the problem, Mrs. X became anxious and fragmented. She revealed other secrets, including an image of herself as split between a helpless undernourished infant who was slowly dying (the "real self") and an outwardly capable, dependable, but punitive gorilla (the "false self"). The gorilla self included behaviors such as abuse of alcohol and medications, self-mutilation with cigarettes and sharp objects, and ingestion of insecticides.
Dr. Pearson documents this same "split" in the patient's early life: an externally successful, wealthy family and the dependable structure of Catholic schools covering a chaotic family life and an alcoholic, impulse-ridden, sexually provocative father. Mrs. X found refuge in the church, in her intellect, in her identity as a teacher, and
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in an older husband she described as "reliable, predictable, strong, and very blocked emotionally. Perfect for me."
She was admitted after consultation and medication had failed to resolve the impasse with Dr. Z. Dr. Pearson describes in detail the one-year course of treatment in the hospital, coordinated to encompass all aspects of the patient's life: the transference relationship, the continuing relationship with Dr. Z, and the problems caused by it. She describes the family therapy and how this was integrated with the individual therapy, psychopharmacology, and art therapy. Work was also done with the nursing staff to contain Mrs. X's tendency to split.