Copyrighted Material. For use only by UPENN. Reproduction prohibited. Usage subject to PEP terms & conditions (see terms.pep-web.org). Inc. J. Psycho-Anal. (1979) 60,3 THE TWO ANALYSES OF MR Z HEINZ KOHUT, CHICAGO INTRODUCTION in the writing of The Analysis ofthe Self (l97 l). Although hardly more than a dozen years old, The second installment, then, coincided with the the psychoanalytic psychology of the self has time when I was beginning to test a new frame now reached a point in its development when, of references-a new viewpoint, which, to state for the benefit both of those who understand it it briefly, allowed me to perceive meanings, or thoroughly, and are used to applying the new the significance of meanings, I had formerly not concepts in their clinical work and in their consciously perceived. This case thus allows me research, and for the benefit of those who are to demonstrate that the change in my theoretical seriously trying to learn more about this new outlook that had taken place during this time step and want to form a judicious judgement influenced decisively the focus of my perception about it, we need to summarize our theoretical of Mr Z's psychopathology and enabled me, to conclusions and to demonstrate their usefulness the great benefit of the patient, to give him in our clinical work. The first-a summary of access to certain sectors of his personality that the present state of our theoretical insights- had not been reached in the first part of his was attempted in the summarizing statement treatment. which appeared recently in this Journal (Kohut & Wolf, 1978), the second-the demonstration CLINICAL DATA of the clinical usefulness of the new viewpoint- was undertaken with the publication of The When Mr Z consulted me for analysis he was Psychology of the Self, A Casebook (Goldberg, a graduate student in his mid-twenties. He was a 1978). The present case report belongs, of handsome, well-built, muscular man. His pale course, in the second realm: it aims at showing and sensitive face, the face of a dreamer and the relevance of the new psychoanalytic insights thinker, stood in noticeable contrast to his in the clinical field. athletic appearance. He was soft-spoken, his Two considerations determined my choice of speech often halting. this particular case within the context outlined The patient lived with his widowed mother in above: First, the structure of Mr Z's personality very comfortable financial circumstances be- illustrates with great clarity the explanatory cause the father, who had died about four years power of the psychology of the self. Second, this earlier, had not only been a highly successful purpose is also served, and perhaps even more business executive but had himself inherited a unambiguously, by the fact that Mr Z's analysis considerable fortune. Mr Z was an only child. took place in two installments, each conducted The disturbances for which he sought relief five times a week and lasting about four years, seemed at first quite vague. He complained of a which were separated by an interval of about number of mild somatic symptoms-extra- fiveand a half years. During the first installment systoles, sweaty palms, feelings of fullness in the I was viewinganalytic material entirely from the stomach, and periods of either constipation or point of view of classical analysis. But the diarrhoea. And he also mentioned that he felt second installment started when I was writing socially isolated because he was unable to form 'Forms and Transformations of Narcissism' any relationships with girls. Although his (1966) and ended when I was deeply immersed academic work, as measured by his grades and Copyrighted Material. For use only by UPENN. Reproduction prohibited. Usage subject to PEP terms & conditions (see terms.pep-web.org). 4 HEINZ KOHUT the reaction of his teachers, was good, he that is driven on by the coachman's whip to give expressed the opinion that he was functioning its last ounce of strength, or similar to Roman below his capacities. He tried to relieve his galley slaves whipped on by their overseer loneliness by reading and by going to movies, during a sea battle. the theatre, and concerts-either alone, or with The genetic data obtained during the first an unmarried friend with whom he had been phase of the analysis can be divided into two close since high school and who also seemed to groups: material from Mr Z's childhood; and have had some trouble in his relations with material from his preadolescence and early women. Not infrequently, the two friends were adolescence. accompanied by the patient's mother, a woman There was every indication, both from with a variety of artistic interests (she painted external evidence and from the over-all flavour and she wrote poetry). It was my impression of Mr Z's personality, that the unremembered that however pathological and unsatisfactory earliest part of his life, perhaps the first year or this mode of life might have been for an year and a half, had been a happy one. However intelligent and handsome young man in his mid- severely distorted the personality of his mother twenties, the balance he had achieved in his basically might have been, as will be discussed relationship to mother and friend had spared later on, she was quite young when the patient him the full impact of a confrontation with his was born, and the intense relationship with her inhibitions, and I wondered what specific event male baby might, as long as he was still small might have prompted him to seek therapy at this and the interweaving of her with him still phase- time. As I found out later, there was indeed an appropriate, have brought out her healthiest event that had upset the balance which the attitudes. At any rate, to all appearances, he was defensively established threesome had provided: the apple of her eye, and the father, too, seems a few months before the patient consulted me, to have been pleased with him-at least as far as his friend had become attached to a much older could be judged from entries in a baby book and woman. He not only excluded the patient from snapshots and home movies that had been taken the relationship to this woman-Mr Z never met by the young couple. Whether his picture was her nor did he even know her name-he also taken as he was held by his mother or, became much less interested in seeing Mr Z. He occasionally, by the father, his facial expression no longer participated in the social and cultural and general demeanour seemed that of a happy, activities that had included Mr Z's mother, healthy baby. And, to anticipate, although in although he did retain some contact with both the second analysis we came to see the of them by telephone. significance of many of the data from childhood The revelation of the details of Mr Z's in a quite different light, our impression problems proceeded at first very slowly and concerning the earliest part of his life remained against resistance motivated by shame-it was unchanged: there was a core of vitality, playful particularly difficult for the patient to reveal not vigour, and enterprisingness in Mr Z's person- only that he masturbated frequently, but that ality that had survived from earliest times, the masturbatory fantasies were masochistic. In despite the distortions it underwent later. his fantasies-he had never tried to enact When the patient was about three and a half them-he performed menial tasks submissively years old certain events of far-reaching signifi- in the service of a domineering woman. He cance took place. Mr Z's father became seriously always reached sexual climax after spinning out ill and was hospitalized for several months. The a story of being forced into performing the father's illness by itself would undoubtedly have sexual act by a woman whom he imagined as been upsetting. What was of even greater being strong, demanding, and insatiable. At the importance, however, was that during the moment of ejaculation he typically experienced hospitalization the father fell in love with a the feeling ofdesperately straining to perform in nurse who took care of him, and after his accordance with the woman's commands, recovery he decided not to return home but to similar, as he explained, to a horse that is made live with the nurse. During the time of this to pull a load that is too heavy for its powers and relationship, which lasted about a year and a Copyrighted Material. For use only by UPENN. Reproduction prohibited. Usage subject to PEP terms & conditions (see terms.pep-web.org). THE TWO ANALYSES OF MR Z 5 half, the father seems only rarely to have visited calm manner. He said that the change had taken his family. Still, there was no divorce and, place not primarily because of a change in him when the patient was 5-years-old, the father, but because of something I had done. I had, he according to his mother's accounts, broke off said, introduced one of my interpretations with the nurse and returned home. Although the concerning his insatiable narcissistic demands family was thus externally re-established, there with the phrase' Of course, it hurts when one is can be no doubt that the parents' marriage was not given what one assumes to be one's due '. I an unhappy one thereafter. (A modicum of did not understand the significance of my affection seems to have become rekindled remark at that time-at least not consciously- between the parents during the last year of the and continued to believe that the patient was father's life when, during his final illness, Mr Z's now giving up his narcissistic demands and that mother took care of him.) his rages and depressions had diminished The theme that was most conspicuous during because of the cumulative effect of the working- the first year of the analysis was that of a through processes concerning his narcissism.