Susan, a fifty-four year old lawyer who had been working with child protection cases found that she could not longer function. She was having terrifying nightmares. So many of the cases she was encountering reminded her of her own terrible experience as a child. She had deliberately selected this area of work because she hoped to rescue children from child abuse and neglect like she had not been rescued herself. She could well remember so many times lying in bed with a bruised body or bruised emotions wondering why her teacher didn’t notice or the neighbours across the street intervene when she was beaten by her mother. She had gone back to law school in her early 40’s after divorcing from a terrible marriage. She had raised her 3 children and when they were sufficiently mature she would now fulfill her life’s vocation. She worked well and was highly regarded, but soon found herself dragging her feet going to work. She was very sensitive to the issues that were brought before her and not infrequently had difficulties controlling her anger.
When interviewed, she was moderately depressed and markedly anxious. She was unquestionably not responding the anti-depressants provided by her family doctor. However, when she was taking Selective Seretonin Reuptake Inhibitor type of antidepressants, she recognized she did not dream and she was grateful. However, it didn’t take much help on my part for her to recognize that when she did not dream she became more anxious. When she stopped taking the medications there was a flood of nightmares and so she desperately wanted to get back on the antidepressants, not so much because they diminished her depression, but because they stopped her nightmares. During her childhood she had inadvertently heard her mother discussing an abortion which would have been her older brother or sister. She had all the cardinal features of Post Abortion Survivor Syndrome (PASS). Through most of her life she could clearly remember having a sense of impending doom, feeling that she did not deserve to be alive, feeling guilty about existing and not trusting her parents. She said quite clearly that these symptoms had suddenly subsided approximately 8 years ago. I looked over my notes and say that 8 years ago she had almost successfully committed suicide.
This case illustrates 2 important hypothesis that are being further clarified, 1) People who have unresolved conflicts arising from trauma in their childhood tend to help recreate these tragedies in their adult life. Most frequently the re-experiencing of them many times does not provide insight into the original conflict. The repeated exposure however, increases the intensity of that conflict until a person’s defenses are overwhelmed. 2) The feeling one does not deserve to be alive because a sibling was aborted seems to subside or disappear at that point when the individual has a close brush with death, particularly an attempted suicide. This occurs when the person suddenly realizes that they are glad to be alive and that family or friends would have suffered a great deal had they killed themselves. This seems to be one of the most particular ways they are convinced they should be alive.