A simple example 2

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Patient T, aged 55, requests help because she wants to ‘live life more fully’.  In her 30’s she developed leukoplakia, a precancerous condition of the mouth.  By the time she came to me she had had 7 surgical interventions, including removal of cancer of the mouth, and plastic reconstructions of the tongue and the floor of the mouth–the last requiring 18 months rehabilitation as she learned to speak again.

Early in the interview she proffered the interesting comment that “if only I could get rid of it I would be able to live more fully from day to day”.  Though she was obviously (!) referring to the leukoplakia and cancerous tendency I suspected the it was not the cancer which had been removed 2 years before, with no evidence of recurrence.  I noted the words but made no comment.

e1A review of her life-story was illuminating.  Apparently, after she was born, she and her mother were collected by father from the hospital.  He dropped them off at home and went off to see his mistress.  When T.  was 7 years old her father suicided, though she was not aware of the nature of his death.

At age 12 she was crying in her bedroom.  Mother found her, asked what was wrong, and T. replied she was crying about “Daddy”.  Mother, who was now alcoholic, responded: “It’s your fault your father is dead–you would never sit on his knee.”

The background to this cruel comment is not entirely clear.  T. did remember that as a child she often felt much more identified with her absent father than with her mother.

At age 16 she learned from relatives that her father had suicided.  At 19 she entered a marriage that, over 6 years, repeated in some ways the traumas of childhood.  At age 33 she developed the leukoplakia of the mouth.  It turns out that this was the age that her father suicided.  Her father was an oral surgeon.  I pointed this out to T. who had herself wondered, over the years, whether this was significant, though it had never been discussed with doctors.

Returning in my mind to the it referred to above, I asked her what, apart from this cancerous tendency, she would most like to get rid of in her life.  She seemed to understand what I was asking, but struggled initially, becoming very tearful, unable to find the right word.  Eventually she said she most wanted to get rid of the shame.  To me it seemed likely that the shame and the precancerous leukoplakia were intimately connected.

e2Lots of questions ran through my mind.  If this woman’s story had been known, and taken seriously, when she was 33, and if the shame had been resolved, would she have run the same clinical course?  Would this cancerous tendency remit if she did some appropriate therapy?  In fact she did do some brief psychotherapy, lasting only nine sessions.  A year later she reported no further problems and her surgeon expressed some  astonishment with the good state of her mouth.

Perhaps more compelling is that the turning point in the psychotherapy occurred when she actually started to remember sitting on her father’s knee.  She reported a persistent “joy” starting immediately after the session in which that memory surfaced.  The joy persisted, and seems to have expressed itself in a variety of interpersonal and social freedoms.  She also reports now that for the first time in her life she finds herself considering living into her eighties.

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