The Porcupine Dilemma: When Intimacy is Desperately Sought But Simultaneously Dangerous to a Fragile Self

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Length: 23 minutes

Nirit Gradwohl, PhD

This 52 year old has a longstanding history of mental illness that dates back to his adolescence, with multiple hospitalizations following episodes of bizarre and hostile behavior, increased agitation, and anxiety. His mother and sister report that his first hospitalization occurred at the age of 21, after a period of decompensation that began around age 19. During this time, they recall him having a “nervous breakdown,” quitting his job at his father’s store, and spending the majority of his days inside watching television. Reportedly, his behavior became increasingly bizarre as he began hearing voices of the devil commanding him to hurt his parents “because they were evil.” He responded to these commands, becoming aggressive and hostile toward his parents; this culminated in physical altercations with his father. The patient spent fifteen years at a psychiatric hospital and was ultimately released to a community residence. However, after severe decompensation, he was returned to the hospital where he has resided for the past eight years.

In her presentation, the presenter discusses a psychodynamic account of a year-long psychotherapy with this client.  Her work illustrates the complexity of engaging this patient in relational work, given his fragmented sense of self that results from severe early trauma.  Paradoxically, while many patients lose their words, this man floods the room with verbalizations and humor and suffocates the possibility of symbolization or interpersonal engagement.  He has built a protective fortress against intimacy and connection while simultaneously, and desperately, demanding both.

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