Patient H: An acute worry about urination
7th March 2024
I have resumed my explorations in the Melanie Klein archive this month after a short time away. My latest find comes from the B files, which contain Klein’s clinical notes on both adult and child patients. Here I'm sharing some excerpts from file B.69, which contains notes on a male patient, ‘H’, from 1940. The file is fairly large, running to some 67 pages, so I am picking out some particularly thought-provoking fragments here. If you want to read more of this material, you can do so at PP/KLE/B.69 on the Wellcome Library website.
The file opens with Klein describing patient H’s ‘acute worry about urination’, which is connected to fears he has about his penis. She writes,
‘…from an analysis many years ago, he knows much about castration fear, and has evidently stabilised himself in localising his fears in this way.’ [image 3/67]
Klein writes that H’s worry about his penis and about urination is connected to a fear of ‘internal trouble’ or disease, and of cancer specifically. She links these preoccupations to a concern that arose during H’s adolescence, related to his enthusiasm for collecting butterflies and insects: namely, a presentiment that the cabinets in which the creatures were displayed would become disarranged. Klein describes the rituals by which H tried to ensure the cabinets were not tampered with, and records that he could eventually no longer bear the strain of his anxieties and gave up collecting altogether.
She writes, ‘his fears about internal disaster…actually, the fears about the inside, the cabinets, and the penis, are alternating…,’ and also that his, ‘fear about the penis [is] obviously over-emphasised in order to keep away from these internal fears’. [image 4/67]
‘Abundant dream material’ follows from Klein’s connection of these things, and she records that,
‘the butterfly, a very much admired and loved object to begin with, in a dream changed into another insect with mutilated wings, much less good, and also much less attractive, and then into the insect which paralyses another insect.’ [image 4/67]
Klein’s notes show her interpreting H’s dream in light of his dread of homosexuality, which he feels ‘would be somehow disastrous for his penis’. H associates to catching a butterfly with a white net, and Klein says this highlights H’s longing for a good penis, and that the net represents, ‘the mouth by which he took in the penis of the father, a good object, [which] changes instantly into a more and more dangerous one as soon as it is inside.’ In association, H recalls,
‘…feelings of being insincere towards his mother, who seemed to think that he was a paragon of virtue, beyond temptation, as it were, and he knew, when she said something of the kind…that he was interested in other boys’ penises. This interest was quite conscious. He took it that it was mainly to compare them with his own, which, in childhood he had felt to be inferior and damaged. He feels also that in his frequent urination the penis has shrunk, and he must see it and make sure that it is still there. That is one of his conscious feelings about the obsession to urinate.’ [image 5/67]
Feelings of insincerity follow, Klein writes, from H’s sense that he has robbed his mother of father’s good penis, represented by the butterfly he tries to catch.
H’s father, Klein notes, is a frightening figure felt to be violent and dangerous. Whilst H recalls feeling little warmth for his mother, he does bring a memory of clinging to her bedsheets when he was terrified of going to kindergarten. Klein notes that,
‘…he was so terrified that his only help was to stand there with closed eyes, which seem[ed] to relieve some anxiety, as if he would see something awful if he opened his eyes…he feels the terror was that he left his mother behind in danger.’ [image 6/67]
H also remembers,
‘…that when his parents had not come up from the evening meal by eight o’clock – which had been a ritual – then he started to yell, so that it could be heard all over the house. If they came up by eight then it seemed to be all right. We understood that some awful danger was to happen to them at night time, and that this was shifted on to this definite hour at which he knew that the parents were at a meal with the people there as well.’ [image 6/67]
On 19th March 1940, H tells Klein that he feels peaceful. He is reluctant to admit any improvement, lest things go wrong again (Klein thinks that he is referring here to intercourse), but there are no symptoms to speak of, no indigestion or urination trouble. H then reports a dream, a fragment of which I will share here:
‘A man drove him in a very fine car to someplace which he thinks must have been a scientific meeting. (This man has been a very important person in his own line of work. In the past he looked up very much to him and would also have liked this man to take notice of him and be interested in him, but that was not the case. Now of course the situation is altered. This man has retired, and H feels that he can triumph over him because he may quite easily get ahead of this man’s former work.) In the dream it seemed quite a…[word missing] that this man drove him there, but then both the man and the car seem to have gone, and H was trying hard to find them. He had already taken notice of landmarks to remember the way back…as if he himself would have to find the way.’ [image 15–16/67]
Klein tells H that the man who drove him had clearly helped him, and meant something to him. He was important too, and has a very fine car. She notes H’s great wish to have a car of his own. The situation of being driven by an important man, Klein says, ‘points to the internalised father’, and she connects H’s admiration of this man’s work to his admiration of his own father, who built a harbour in a place where they spent summer holidays. She suggests,
‘…there may have been great admiration in [the] early days for the potent father, the father who owned mother, who made children, who had skill and power, etc. Great desire and longing to be on good terms with his father, to be taught by him, to be introduced into sexuality, to share with him mother. I suggest that the fine car stands for mother.’ [image 17/67]
Klein also writes that,
‘H was in the dream trying to undo the loss of the important and good father and the mother, wishing to have the two with him and united in a good way inside him. At the same time the wish to become independent of his internal figures, the landmarks he made because he was going to find the way himself…In this hour as well as in former ones, much work about the repression of his love and admiration for his father, actually there is only one friendly memory so far, when his father had him on his knee, and offered him a chestnut, which H very much liked, but could not accept it, and told his father he could not accept it because he had to find chestnuts for himself. He thinks his father was very angry.’ [image 18-19/67]
To learn more about Klein’s work with H, readers should go to PP/KLE/B.69, and start from image 19/67, where the notes reproduced here end. I will certainly be doing this, and in my next blog post may bring more about H, or perhaps another of the patients who appear in this fascinating file. I am struck that, in the brief excerpts I have shared, Klein is once more grappling with the way in which the patient’s conception of a parental couple powerfully influences both his sense of himself and his relations with others. She clearly feels it is part of her role to help H uncover the better memories of his parents, which she perceives in his material – though often deeply buried.