Yet is there good reason for my telling you what follows? After a great deal of deliberation, I have decided that there probably is. I know that these are not the pages of a professional journal, where there would be every justification for the publication of case histories. I know, too, that some will be reading this in the wrong spirit – in a prurient way perhaps – but others (I hope most) will be reading this because they have a real interest in human nature. It would be professional arrogance of the worst sort if psychiatrists were to decline to speak about the more curious interstices of the human mind. The workings of the human psyche are not our exclusive preserve: Freud’s essays, and the other classics of our craft, should be read by all. They are wonderful, liberating documents – profound literature, in fact. And if they are suffused with sexual matters, that is simply because human life itself is suffused with sex. There is nothing abnormal in wishing to understand how this affects the way in which we live.
Of course there is a great deal that is surprising in this part of people’s lives. Nobody leads the narrow sex life which restrictive notions of normality impose on us; the human mind is too imaginative for that. Even the most unimaginative – the dullest – have their fantasies (dull fantasies perhaps), although very few confess them. And there is nothing inherently wrong in fantasy – as long as it remains fantasy and does not intrude upon reality. For most people the dividing line is quite clear; for others the distinction between the world of the imagination and real life becomes blurred, and it is at that point that behaviour becomes bizarre or inappropriate. Such cases are really very difficult to deal with, as the hold which a fantasy exerts may be very strong. I have had patients in therapy for years, struggling to obliterate some deep-rooted, troublesome fantasy, but failing, again and again.
In my calling I am exposed to everything, and nothing shocks me any more. Nihil humanum mihi alienum est or, to use the demotic, I am surprised by nothing. I don’t say this to intimidate, or to suggest professional superiority; but it is nonetheless true. I have heard things which you simply would not credit.
But that is all by way of introduction. My real purpose is to talk about dating, which is an extraordinarily important and almost universal aspect of human life. Consider the word itself. For some it is an Americanism which is best avoided unless you happen to be an American. I am not. I am an Australian, but still I disagree. What are the alternatives? Seeing somebody? Going out together? These all sound rather coy to the modern ear. Dating is better.
Dating is patently a courtship ritual, and yet we very rarely see it as that. We acknowledge that courtship rituals are performed in other cultures; we identify them in other ages, in other species; but dating we take for granted, failing to realise just how significant it is. Dating is extraordinarily important: terrible things can happen on dates – traumatic things – which can trouble people to the very depths of their psyches. It is this insight which prompted me to record particular cases which I have encountered where something happens on a date to reveal some personal pathology, or where the date itself has a pathological effect. I discovered to my surprise that the pathology is extensive – one only has to be on the alert to spot it and expose it, layer after painful layer. Dating is the cause, and symptom, of great distress.
A major difficulty with our theoretical understanding of dating is that we simply do not appreciate the purpose of the entire encounter. If we see it for what it really is – a courtship ritual – then we can identify the deep structures of the ritual, and that enables us to detect what is really going on. So dating is really all about sex. In the conventional context, this means that the man invites the woman to go through a social encounter, the ultimate purpose of which is sexual engagement. It is most important, though, that this engagement does not occur too early. Attitudes, of course, have changed over the years, and the old question: “How far should one go on the first date?” strikes the modern generation as being charmingly old-fashioned. Yet the timing of an involvement is still important, and it can be very disturbing for both parties if things go too far, too quickly, as happened in the following case.
G consulted me after he had suffered a non-accidental injury in the course of a date. He was slapped by the woman, who dislocated and fractured his jaw. G required substantial treatment from a dental surgeon, which was particularly unfortunate, as in due course he revealed a morbid dread of dentists. This led him to assault the dentist, who fortunately was very understanding and agreed to let the matter rest, provided that G agreed to seek psychiatric help.
I suspected that the apparent dental phobia was displacement, and that the fear of dentists really masked a further, more difficult problem which had revealed itself in the dating behaviour. In other words, I wondered: why had the woman slapped him so hard? Here, I felt, we would find the key to the problem.
At first, G seemed reluctant to talk about the original episode, and kept coming back to the issue of his fear of dental pain.
G: But can’t you see? That’s what’s really worrying me. I don’t see that it matters how I broke my jaw. It’s what happened afterwards. I’m frightened of dentists.
Self: Of the dentist or the needle? Or of the drill, and the pain it brings?
G: I just don’t like dentists.
Self: I don’t think that is really what’s worrying you. Let’s return to the date. What happened?
G: What about the date? I took her out. Then she slapped me. Hard. My jaw was dislocated and two teeth became loose. Then all these dentists got involved.
Self: I suggest that we don’t talk about dentists. I’d like to go through the events of that evening, one by one. You went to collect her from her flat. Start from there.
G: All right. If you insist. I went to collect her from her flat. She lived on the fourth floor. I rang the bell and she answered the door. I’m just about ready, she said. Come in.
So I went in. Her flat was very attractive, very feminine. It made me feel excited just to be standing there, while she went through to her room to collect her coat. Then she came out and we left, by the front door.
Self: And you were still excited?
G: Very. But I don’t think it showed. Anyway, we went to my car, where I opened the door for her and then went round to get into the driver’s seat. I was thinking at the time: What a wonderful woman. This one really is nice – much better than the last, who only went out with me once. Then I sat down in my seat and a few moments later, quite without warning, she slapped me and got out of the car. I drove straight to hospital. They looked at me, and took an X-ray of my jaw. They were very concerned about what had happened. Then the dentists came.
Self: But why should she slap you? Did you touch her in too familiar a way? Did you make an advance?
G: No, I did not! I never touched her at all. I just experienced a rather emotional moment. It was a physiological matter. That’s all. I couldn’t help it. Sitting there in the car, in such close proximity to her. It was all too much for me. This is not the first time it has happened. In fact, it happens on every date.
At the beginning of an encounter with a patient I usually find that I have a fairly shrewd idea of the general nature of the problem, but I had frankly not expected that this was one of those extremely rare cases of excessively premature ejaculation. Now that this was established, I was able to treat G with some success, using precisely those techniques which are appropriate when a man is embarrassed by ejaculatio praecox. The details of the treatment are irrelevant here, but it involved the conjuring up of mental imagery associated with non-sexual matters. I told him to think of something else when he next went on a date, and to keep that non-sexual image in his mind throughout the evening. This can’t have been easy for him, but it was probably better than telling him to count. In any event, it worked reasonably satisfactorily – after one or two initial let-downs – and G, I believe, is now happily married. Married people don’t need to go out on dates, and so his problem may be regarded as quite satisfactorily
solved.
G’s case is valuable in that it not only illustrates the fact that timing is still important, but also because it portrays a patient who told the truth in a quite disarming fashion. He did not intend to mask his real problem by talking about dentists: dentists were, in a way, the real problem – at least in so far as he saw it. When I pressed him on this, there was no attempt to conceal the cause of his social disgrace – on the contrary, he revealed it quite openly. It can be very difficult if a patient does not do this, and even more difficult if the patient is an out-and-out liar, as happened in the next case, that of Ms Ms.
It is very bad practice to allow oneself to dislike a patient, particularly to dislike her on first sight. This, I must confess, was how I felt about Ms Ms the moment she entered my consulting rooms. There was no question of my revealing it, of course, and so she would have had no idea how very distasteful I found her. I pondered my feelings for a moment while I read the referral letter written by her own doctor. Don’t trust this patient, he had written. Just don’t trust her.
We talked about her family for a while. I was prepared to take everything she said with a grain of salt, but most of it was, at that point, quite uncontroversial.
Ms Ms: I still see my mother and father regularly. They’re retired now, and so they can come over for the weekend. They stay near me for a few days and we go on picnics – go out to dinner – that sort of thing. I don’t really like going for picnics with my parents.
Self: Really?
Ms Ms: Yes.
Self: But even if you don’t like the picnics, you don’t really feel anxious about them. It’s just when you go out with a man? Is that it?
Ms Ms: Yes. I get terribly anxious.
Self: Why do you think that is? Have you had something unpleasant happen to you on a date? (I wondered, at this point, whether she had been out with G, but that would have been too much of a coincidence.)
Ms Ms: Yes. Precisely. It happened about two years ago. I was just twenty two then and I had not been out with men a lot. Anyway, I met this older man – or I put him into that category then. In fact, he was only about thirty, low thirties I think. I met him through a friend, and I thought that he was rather charming. It was at a tennis party, and I noticed that he was wearing long white trousers and a white sweater. It was quite warm at the time, and this struck me as a little bit odd, but perhaps he just felt the cold more than others. He was called M.
Self: Just M. Nothing else?
Ms Ms: Yes, I thought that a bit strange, too. I always think of M as a character in the James Bond books. But that’s what he was called. Anyway, I didn’t think much about him afterwards. In fact I didn’t think about him at all until a week or so later, when he telephoned me.
M: It’s M. You remember me? We met at Roger’s tennis party?
Ms Ms: Oh yes, of course. How are you?
M: Fine, just fine. I wondered whether we could meet up some time. How about dinner?
We agreed to meet for dinner the following Friday. He said that he knew the chef at an Italian place and that it was probably the best restaurant in town. I said that I always ate ethnic and that I would expect him at eight.
We drove there in his car. I noticed that the car was rather unusual. It had a lever coming out of the instrument panel, and this ended with a curious handle. I couldn’t help thinking about James Bond now, and I wondered whether this controlled an ejection seat and whether I should be ejected prematurely.
M didn’t touch the handle on the way to the restaurant, and I did not like to ask him about it. He parked the car and we went in to the restaurant. As we did so, I noticed something about M which I hadn’t noticed before. He walked in a remarkably stiff way – almost as if he was feeling the results of excessively strenuous exercise. In fact, he moved rather like a tin soldier.
The proprietor greeted M as an old friend, and was very polite to me. He kissed my hand, in an old-fashioned way, and made some compliment in Italian. Then he led us to the table and we sat down. Again, M’s movements were rather stiff.
The dinner, as M had predicted, was wonderful. Then afterwards, over a glass of Sambuco and tiny almond cakes, M told me more about his life.
Self: I find that rather strange. People usually don’t do that. They give a few facts, make a few brush strokes of the picture, but it’s odd for somebody to tell another about his life.
Ms Ms: Well, he did. Why would I make it up? I’ve already told you that there was something unusual about him. M wasn’t an ordinary sort of person. He simply wasn’t.
Self: I’m sorry. I shouldn’t have interrupted. Please continue.
Ms Ms: Well, he told me about his boyhood and how his father had been a well-known racing driver. He raced vintage racing cars – those funny old ones with bull noses – and he was very successful. He was a wonderful father for a boy to have, and M was proud of him.
M was sent off to boarding school, because his father believed in that sort of thing. M was unhappy there at first, as he was tormented by the other boys, who laughed at his name. Boys are like that, aren’t they? Cruel – just like men. Then, one weekend, M’s father drove up to the school in one of his vintage Bugattis and all the boys were terribly impressed. Now that they realised who M was, and what sort of father he had, they stopped teasing him. In fact, M was even cultivated by some of the older boys, who enquired whether they could come and stay with him during the school holidays. They wanted to drive a Bugatti, which is the sort of thing that most boys want to do. Men, too.
When M left school he went to university, but was asked to leave at the end of his first year. It was not that he could not have passed the exams, he told me, it’s just that he had developed a passion for racing and he spent all his time on an old Bugatti his father had given him on leaving school. He wanted to get it into good enough order to race it, and that took over six months.
Then his first race came. He began to tell me about it, about how excited he was at the prospect, but then quite suddenly he stopped, and I saw that he was overcome by emotion. I knew that something awful had happened, and so I wanted to reassure him that he could tell me about it. I wanted to comfort him, as I have always found vulnerability in a man brings out my maternal instincts.
The table was very small, and I could easily reach out to M, which I did. I reached out and laid my hand on his leg, just above the knee. I meant to pat him, but I froze. My hand was laid upon metal. I felt overcome with embarrassment, and quickly transferred my hand to the other leg. That was metal too!
I suppose I should have stopped there, but it seemed to me that to stop at that stage would have been tactless. So I reached out for his forearm and touched it lightly. But even that light touch was enough to feel the pulleys of an artificial arm.
Now M looked up at me. “Yes,” he said. “There was a terrible accident on that very first race. My two legs, my arms – both artificial. That’s why I’m wearing white gloves.”
I looked at his hands. It was extraordinary, but I simply hadn’t noticed. M had a very strong face, you see, and my eyes had been held there.
Then M continued: “Not only that. Other bits of me are artificial too.”
That was more than I could bear. Flustered, I changed the subject.
“Let’s not talk about it any more,” I said. “Let’s talk about …”
“You,” said M quickly. “Has anything ever happened to you?”
It was at this point that I made my diagnosis. I felt excited about it, as it was the first case of its sort in my own experience. Confabulism: Ms Ms was making everything up. M would not exist, or if he did exist, she would have totally distorted her encounter with him. There would be no car with a special lever – no Bugattis – and certainly no artificial limbs.
My intellectual excitement was mixed, though, with anger. The confabulist, who simply cannot resist making up stories, wastes an enormous amount of other people’s time. I found that I resented being used by Ms Ms in this way, in much the
same way as must those doctors feel who are tricked into providing elaborate operations for Munchausen’s patients. How dare she sit there and spin me this story of this imaginary date!
Self: Let me stop you there, Ms Ms. This is all made up, isn’t it? You’re lying to me.
Ms Ms: Oh. Oh, so you can tell? Yes, I do tend to exaggerate a bit, I suppose. Some of what I say is true though …
The interesting thing about confabulism, of course, is what the patient’s fables tell you about them. There was a reason why Ms Ms went to such trouble to construct the story of M. M, of course, could have been her father, and for some reason she wished to castrate him. As Freud has shown, that is quite a normal thing for a boy to want to do – indeed every boy wishes to castrate his father; it’s perfectly normal – but why should a woman wish to do it? The clue, I think, lay in the name that Ms Ms had invented for herself. She wished to underline her status as a woman who didn’t need men, and to do so had called herself Ms, and then doubled it. Not only that, but her desire to castrate went very much further than normal. It was a profoundly abnormal castration urge: she wanted to cut everything off – hands, arms and legs. What is more, she even shortened his name. This is what made her case so extreme.
But why did she want to emphasise her feelings of antipathy for men? The reason was self-evident: she had been badly treated by a man, and was playing out the hostility that she felt for all males as a result of this bad treatment. I was sure that if I delved more deeply into Ms Ms’s background, I should find some boy or man who had spurned her, or let her down. It was probably not her father. I suspected that she liked her father because she had told me (untruthfully) that she did not enjoy going on picnics with him. It was some other male then. So I said to her:
“There was a boy in your life, some time ago. You loved him. You loved him a great deal. But he didn’t love you. He let you think that he loved you, but he didn’t. You wanted him forever, because that’s what women want – they want men forever – but this boy was only playing with you and he let you down. He went off with another girl. You didn’t hate her; you hated him. You hate all men now. That’s true, isn’t it? Well, isn’t it?”