Caso clinico, Alessandro Luigi Cappelli

In his analytic transference Alessandro attributes characteristic of both his parents to me, but it is clear that I predominantly play the maternal role. And under this trusting friendly and affectionate relationship of collaboration, I am undervalued and unconsciously brutally attacked like his mother, in who he has put the values of dedication, faithfulness, submission, caution, parsimony, modesty, reasonableness and umility.
In the last session A. defines me as a «maternal father » in the attempt to integrate the two figures.
Even with his partner he manifests a strong ambivalence : the patient appreciates love, dedication, faithfulness, the tenderness that the young girl demonstrates towards him, but is afraid of close contact with these aspects. His sexual rapport is notably inhibited, when the fears are predominant of emotional involvement and of contamination with the female world of feelings, determining in these cases a complete colapse of libido.
These « weak » components hinder the male component and the narcissitic and megalomaniac ambitions induced by the father of A. and at the same time undervalued and derided by him.
The patient was contemporarelly strongly stimulated and strongly umiliated by his father.
Alessandro feels an implacable father’s figure inside that tells him something like this :
« You who are not worth anything and you are a ridiculous person compared to me, have to achieve extraordinary tasks, superhuman so as to try to redeem yourself and make me happy, only like this you can avoid refusal, abandonement, but you always fail, I can see, even if you do everything to try to show yourself capable and hide your disasterous inadequaces ! ».
This internal persecution produces shame, guilt, anxiety, distress, acute desperation, that are strongly fort with manical defenses.
A consequence of this pression is the occurrence of acute crisis of envy, when the patient imagines that someone is further ahead of him in his carrier, is richer, has achieved an important marriage or is serene and satisfied in his family or his work or is a priest in a state of holiness, or a powerful deacon.
The dispersion leading his activism has produced, in effect, a notable deceleration of A.’s carrier, not with standing the fact that he has qualities of ingenuity and culture and these one are generally recognized in him.
In these crisis of envy it is often evident that contradictory ideals are present and impossible therefore to pursue.
The acute depressive sufference tied to the sensation of being an unworthy individual brings an immediate turnabout of humour with sensation of incredible strength, of greatness, of invincibility, of omnipotence. The patient suddenly feels the impulse to act at 360° : compulsive search of pornographic sites and masturbation, uncontrollable greed, compulsive sexual approaches, elaborations of enterprises and magnificent work projects, frenetic study in a thousand directions, physical activity, social relationships etc.. These multidirectional drives are accompanied by headache, tachycardia, insomnia and recently worrying ipertensives crisises. (Lets not forget that both his parents suffered and/or died due to hearth problems at a relatively young age).
Recently rather, the patient has acquired the knowledge to have unconsciously attempted suicide, by means of his compulsive eating of things that children like, snacks, cheese, peanuts, chips, hamburger, sauces, Coca-Cola ect.
At the moment A. can with notable effort, keep a correct alimentary behaviour, and controlled, that has allowed him to loose around 30 kg from the beginning of the treatment.

Session on Monday
He comes a little earlier and wearing a dark suit, differently than usual, and closed shoes, thus he looks quite elegant, despite his massive figure. He lies down and begins to speak to avalanche. He tells me he is satisfied about his weight decrease and about he decided to accompany his weight loss allowing to himelf a classic suit jacket and trousers instead of the outerwear sneakers, large shirts and sandals « for fat men », that he usually was wearing. He doesn’t want to wait anymore the ideal weight to feeling himself more orderly. He tells me about his hypertensive crisis, when his minimum pressure is much more than a hundred, that arrived in sequence one after the other by last summer and he claims he can look after his health through the controls and diet and using diuretics. Maybe he shall hospitalize to monitor his physical condition. Then he reveals he is thinking he can arrive to pursuit three degrees, with a few supplementary exams to stabilize his formative debits. His guerl says to hime : « Why, who are you doing this ? you are already qualified and you work a lot ! ». He remembers a dietist obese, he met her in the past, who was conseling other people but she was clearly unable to counsel herself. And then he narrates a dream, that made him feel himself very confused.
Dream – the patient is speaking in prima persona :
« I was in my grand-mother’s house, where I lived in my childhood, and that I considered my actual house. I was wearing jacket and tie, but inelegant. I had to deal a course. There were a lot of people, comings and goings. I struggled to harangue the crowd. People were interested, but I find that terribly tyiring. I saw a guerl who was exhalted for my words, but I said to myself : « Who am I doing ?! ». A real mess was created and I thought in the dream I should narrate it to the professor, because I felt overwhelmed and I couldn’t find a secluded place to have a rest. When alarm sounded to go out to the analysis, I wanted to start to sleep ».

Associations :
« Lies. What a sucks ! An exaggerated brothel!… The grand-mother‘s house. When she died I also took her furniture, and also those of my parents, so now I have a large amount of things to be placed and I would put them in order in a measured way and simply, according to modest uses of my parents, that I have trasgressed because of my desire to have more. I am afraid I could have only theforgiveness, but does not erase my mistakes (the patient refers to the process).
I do an intervention underlying the private suffering and the effort that A. is making with his getting aware how he managed his life and how it is difficult re-organize the figures of his inner world, that before he used to control with his exhalted humour, his activism ans his use of lies. His confusion seems to me a result from the comparaison of this enormous amount of aspects that fill his mind and that are waiting for a different order, on a human scale, that can be coherent with simple life style of his parents, but honest, and for he is looking for my collaboration also in his dreaming.
At this point a painting of Francesco Clemente comes into my mind and I remember it illustrating a soccer pitch, in which the ball is a human head, that is kicked enough to break through the network and I describe this to A. I also say to him that his head is kicked every time tyrannical demands and conflicting struggle for the primacy.
The patient agrees and goes on saying that his inner pressure and may be that one of his blody arises from all things that he felt, done, studied, and that now ocupies his head. « Lets think that, only about my books, I have thirteen thousand of them that are not cataloged ! ». He proceeds by saying that he has brought in his work a great amount of different approaches, that did not expand deeply. « I got to have four offices ! I had to mantain a delirious project, I had drunk a potion ! Now I have no powers and feel better, but I am also troubled for this revival in which I clearly see what I made when I was raving. I see as a divine grace I have met you, but at the same time I feel a strong opposition to the analysis ».
He smiled shyly and goes on with a bit of embarrassment : « With you, here, I am ashamed, I am afraid you don’t esteem me, that you don’t like me anymore because of what I done wrong ».
I pointed out that he now is afraid I can umilate him, as it used to happen to him when he was a child and a boy, with the demanding judgment and contemptuous as that one of his father, although he feels me careful and comprehensive as his mother was.
Alessandro agrees and remembers as he sought to do difficult things, as his father wanted, but he failed : in fact he couldn’t continue his scientific studies.
However now he asserts he feels consoled in his relationship with me and with his analysis and to experience often a state of serenity that he never had felt before : he feels a feeling of compassion for himself and the relief that arises from a larger freedom from his obligation to make his father satisfied.

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