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Tsolas, V. (2009). The Extermination of Extimacy: An Internal View of a City Hospital Community. Psychoanal. Rev., 96(6):1055-1078.

(2009). Psychoanalytic Review, 96(6):1055-1078

The Extermination of Extimacy: An Internal View of a City Hospital Community

Vaia Tsolas, Ph.D.

Marie, a 37-year-old deaf patient with seizure disorder, was hospitalized for somatic delusions: “I suffer from seizures. My seizures come from the yellow spots on my tonsils. I do not want to take my medication because medication covers the spots and if the spots get covered then they will stay undiagnosed; I will never find out the cause of my seizures.”

After assessing Marie's presenting symptom, the inpatient team that I was part of focused the initial treatment plan on Marie's safety, which was translated as complying with anti-epileptic medication, the medication that was Marie's worst and most intimate enemy. By identifying themselves with this intimate enemy, the team became Marie's direct prey. She screamed with the loudest unintelligible sounds, which resonated in their ears as a temper tantrum of a three year old who seeks to be disciplined. The sign interpreter spoke Marie's voice, “Why someone cannot take care of me? See my spots? But instead, everyone says, here, here is your pill. Shut up!” The more Marie shouted, the more the staff politely kept her at a distance. Both sides of this struggle, without knowing, became the other's most intimate stranger, the stranger who strikes from outside to intrude and horrify.

“You are racists,” Marie screamed one day, attempting to reinvigorate the struggle, “you don't understand deaf culture”; “The problem is not that I don't understand your deafness, it is that I know the cause of your suffering and you don't,” the psychiatrist replied. “How can you say that? You don't even want to see my spots?” Marie challenged.

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