EssenceThroughout the case one could feel a constant tension between:
- obedience versus rebellion
- guilt versus freedom
- contamination versus control
- duty versus pleasure
- submission versus aggression
The patient felt trapped inside inherited family structures whilst desperately trying to maintain autonomy and dignity.
MindPresenting guilt, rebellion, control, contamination fears and the exhausting effort to maintain autonomy whilst remaining emotionally trapped inside her family system.
At one consultation she arrived particularly upset because her father was now very elderly and refusing food. Although she admitted she had never had a good relationship with him, she was overwhelmed by guilt.
“My brother makes me feel guilty if I don’t call.”
“Every summer I feel obliged to go back and care for them.”
“If I didn’t go, I’d be a bad daughter.”
She had left Italy aged 19 and came to the UK largely to escape her father.
“I couldn’t go out and be FREE.”
Her father was described as extremely controlling, old-fashioned and abusive. He would hit her if she came home late and constantly accused her of sexual impropriety despite the fact she described herself as sensible and not rebellious in a destructive sense.
“I was just having fun with my friends.”
“I was terrified he’d be at the door.”
“You couldn’t wear make-up.”
Yet she was also fiercely oppositional and combative.
“I ALWAYS challenged him.”
“I want to stand up for myself.”
“I don’t like to be told.”
“I don’t want to be CONTROLLED.”
One striking childhood memory emerged. At 14 years old she was wearing nail varnish. Her father, a butcher, criticised her appearance whilst carving meat at the table. She replied:
“It’s none of your business.”
This escalated into them literally chasing each other around the table, her father brandishing a knife.
“There was always shouting and fighting.”
This resulted in a fear of knives.
The mother appeared weak, submissive and emotionally unavailable.
“My mum waited on my father.”
“She was a doormat.”
“She didn’t protect me.”
“She cared more for my brothers.”
There was a strong cultural and Catholic atmosphere of guilt and repression. The patient attended a convent school run by nuns and described “Catholic guilt” around pleasure, anger and freedom.
She repeatedly returned to themes of equality and resistance to domination:
“He’d say, ‘Take my plate,’ and I’d say, ‘Take your own plate.’”
At work she functioned extremely well. She worked as an executive assistant in an intense start-up environment, organising travel, meetings and schedules with precision and stamina.
“I like organising things.”
“I have more patience with my boss than my parents.”
Yet underneath was exhaustion and sadness.“You feel under the ground.”
“Exhausted.”
“I cry easily.”
There was marked perfectionism, anxiety and fear of criticism.
“If someone criticises me it eats at me.”
“I give out confidence but I’m not.”
“I’m a perfectionist.”
A major layer of OCD contamination symptoms developed, especially after working for an Orthodox Jewish employer whom she described as “domineering like my father.” This period around 2010 seemed to coincide with the beginning of obsessive cleaning rituals.
“I have to wipe my desk.”
“If someone touches my stuff it’s a daily battle.”
“I wash my hands all the time.”
“Two showers a day.”
After the pandemic the symptoms became dramatically worse:
“It’s controlling me.”
“If I stop, will I get dirty?”
Everything she touched required washing. Even touching dogs, whom she loved, triggered compulsive hand washing. She still wore a mask on the Tube years later.
Cleaning occupied her weekends:
“Every weekend I have to clean deeply.”
There was an interesting contradiction between sociability and burden. She loved people, dinners, food, conversation and organising social gatherings:
“When I’m with people I feel very happy.”
Yet she also felt she spent her entire life organising others.
“At work I organise everybody.”
“I don’t want to organise my friends’ lives as well.”
There were fears about security and survival:- fear of losing job
- fear of losing flat
- fear of the future
At age 18 the father lost all his money through a bad investment, creating major instability.
Physically there was Hashimoto’s thyroiditis beginning during intense work stress in an investment bank in 2021. There were tendon tears and pulling pains in the right hip and legs, worse walking. Energy was paradoxical — exhausted yet hyperactive and restless.
Desire: meat and steak +++; salt; spicy food, chilli, cakes.
Food: milk caused diarrhoea.
There was also a history of:- recurrent cold sores on the nose
- aggravation after Covid and vaccinations
- fevers after Covid vaccination
Analysis