Helping a Boy with Chronic Medical Problems Get on Friendly Terms with His Body and Puberty

By Todd, Victoria | The Psychoanalytical Study of the Child, January 1, 2012 | Go to article overview

Helping a Boy with Chronic Medical Problems Get on Friendly Terms with His Body and Puberty


Todd, Victoria, The Psychoanalytical Study of the Child


"My mom wants me to shave off my facial hair, but I like it. I think it makes me look mature, " said sixteen-year-old Alex as he proudly stroked the crop of hairs sprouting from his chin. I was speechless. Why ? Because for years I had heard about all the medical things that were wrong with Alex's body. Then, when puberty arrived, his distress about his changing body was intense. So how did psychoanalysis help him get on friendly terms with body changes, even enjoying signs of growing up? We shall see.

I WILL BEGIN THIS CLINICAL PAPER WITH A BRIEF EXPLANATION OF Alex's medical condition; I will review the relevant background information and an account of the first year of his analysis. Lastly, I will focus on our subsequent work and his struggles to engage in pubertal development.

Alex B suffers from a rare, inherited enzyme deficiency. The purpose of the enzyme, which is deficient in these patients, is to break down fats in the body. Without it, lipid accumulation causes vastly enlarged livers and spleens, anemia, low platelet counts, and bone pain and deterioration. If untreated, it can also lead to neurological damage. The disease course is quite variable, ranging from an absence of outward symptoms to severe disability and death. A simple blood test is done to identify carriers of the gene and to accurately diagnose those who have it. Fortunately, effective treatments are available, with a synthetic version of the missing enzyme administered via a port (per Alex's medical specialist).

INITIAL REFERRAL

Alex was eleven and a half years old when he was referred to me by the Mobile Crisis Unit following an extended out-of-control outburst, during which he expressed a desire to kill himself. The mother also reported that he constantly fought with her and his younger brother, sneaked "junk food" in defiance of the mother's health consciousness, and had difficulty learning in school.

FAMILY HISTORY

Following the initial referral, I met with Ms. ? to obtain the family history and gain a better understanding of her son's emotional upset and his complicated medical problems. A pale woman of diminutive stature, she appeared to carry the weight of the world on her shoulders. As she spoke, Ms. ? had difficulty providing an organized account of Alex's childhood. On one occasion, she became tearful and said, "It was so hard. We were all completely overwhelmed."

In regard to her own personal history, Ms. ? was two years old when her mother left for Florida, where she married for the third time and started another family. The younger of two children, Ms. ? was raised by a single father - a construction worker who frequently traveled on his job. The paternal grandparents helped the father raise his two children, favoring her older brother.

Ms. ? did "okay" in school, excelling in music. Following high school, she attended college for two years and then became pregnant with her first son, Alex. Ms. ? had met Mr. G, Alex's father, through mutual friends. Mr. G, who was biracial, was a hard worker who appeared pleasant and caring; soon the couple was living together. But when Ms. ? learned that she was pregnant with Alex, Mr. G "didn't want anything to do with the baby." In fact, he left the country, moving to London, where he took up with a former girlfriend.

Alex's pregnancy and delivery were uncomplicated. Initially he was an easy baby to tend. But by ten weeks of age he had developed eczema that covered his face. This was followed by abdominal pain, which gradually worsened. Having difficulty tolerating his constant crying, Ms. ? was relieved when Mr. G returned from the United Kingdom when Alex was four months old.

When Alex was eighteen months old, his brother, Dylan, was born. According to the mother, Alex did not show any signs of regression following Dylan's birth. In fact, he was very kind to his baby brother. As Dylan grew, he also began experiencing health problems. He was severely asthmatic, and the doctors suspected he had vocal-cord dysfunction. …

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