Perspectives in Biology and Medicine

NEW HORIZONS IN PSYCHOANALYSIS: TREATMENT OF NECROSISTIC PERSONALITY DISORDERS DON R. SWANSON* Whether the insights of psychoanalysis can be used to cast light on historically important activities of people long dead is a matter of spirited dispute among scholars [1, 2]. The disputants seem to be singularly uninterested, however, in whether such insights might benefit the patients themselves. Insensitivity of this kind is only part of a larger pattern of discrimination against the dead. Grave inequities are revealed by a few lethal statistics. Of the 60 billion people on earth, over 90 percent are dead. Yet nearly everyone in treatment for a mental or emotional disorder is alive. So great a disparity invites suspicion that the dead do not have equal opportunity for help. Resources are not lacking; surely in a country where even the national product is gross, more can be done. Origins of Necroanalysis The foundation for a clinically based theory of necrosism has been in place for over a century. The origin of this work can be credited to the generally excellent care, attention, and treatment that dead patients receive in medical schools and teaching hospitals, even though elsewhere they are discarded and ignored. In the summer of 1883, at the General Hospital of Vienna, a brilliant young resident in psychiatry, Floyd Siegman , first began to wonder why face-to-face therapy consistently failed with these patients. The immediate problem seemed to center on their inability to remain upright for the required 50-minute session. Floyd could not escape the compelling idea that the dead have an affinity for the horizontal. He observed, too, that they are prone to remain silent for long periods of time. These two principles—silence and horizon- *Professor, Graduate Library School, University of Chicago.© 1986 by The University of Chicago. AU rights reserved. 003 1 -5982/86/2904-050 1$0 1 .00 Perspectives in Biology and Medicine, 29, 4 ¦ Summer 1986 \ 493 talness—were destined to become headstones for a revolutionary approach to psychotherapy, an approach that offers new hope for the dead. Dr. Einar Kleine Schwanstücker, a noted Viennese necroanalyst, recently unearthed heretofore unknown correspondence between Floyd and his friend Felice [3, pp 137-153], letters that encapsulate the body of this new theory and provide dramatic evidence from two case histories , outlined herewith, that death can be understood and successfully treated as a necrosistic personality disorder. Case 1 : Leda Leda, an attractive woman, 26, single, and the youngest in a large family, sought help a few years after her death. She complained that death held no meaning, that she lacked spirit, felt stiff, and often thought she might be better off alive. Unable to accept the loss of her living companions, Leda frequently attempted tojoin them. Her friends, unreceptive to these overtures, fled in panic whenever she materialized in their presence. Leda was mortified. She took to lying around Central Park at night and had a series of brief encounters with occasional necrophilic passers-by. These adventures brought little genuine satisfaction. Men thought she was cold. When finally someone took her home, Leda was hopeful that a more enduring relationship might develop, but the authorities soon discovered the liaison and intervened. This event precipitated Leda's initial visit to a necroanalyst, Dr. Einar Grosser Schwanst ücker. The analyst correctly perceived Leda's pathology in terms of a failure to mourn her self. Loss of the self, as object, brings about an introjection ofthe object, as self. Working-through ofhostility toward the introjected self-object is prerequisite to mourning. The eventual decathexis and extrojection of the self-object and the object-self are appropriate therapeutic aims and lead finally to mature acceptance of death. After 2 years of analytic work, the patient learned to extroject introjects by turning her insights out. The analysis then progressed rapidly. By the time of termination, Leda was virtually free of her crippling zest for life and made no further attempts to commit animation. She abandoned her haunts in Central Park and moved to Chicago. The opportunity for employment by the city, and being encouraged to vote, helped her for the first time since she died to feel valued. A few months later Leda...