Early in my training I was a great admirer of Sigmund Freud. He was all over my books and magazines, peering out from black and white photographs and renderings. I was impressed with his glaring eyes and his spade-like beard. His waist-coat fit comfortably over a slight paunch, with a small Havana perched between his fingers.
I longed to understand what he was really getting at and
secretly hoped for enlightenment in his ways. His recorded voice seemed to
arise from a deep and measured place of wisdom and competence. He eluded me,
but I did manage to grab onto the mysterious notion of uncovering unconscious
I had a new patient arrive in my fourth year of practice, whom we’ll call Mary. She had long, curly brown hair, with several bald spots, and
wore a modest dress shaded in greys and whites. She was accompanied by her
father whose concern was written in his lowered eyebrows and stooped posture.
Her mother did not come, despite several invitations.
Mary was only sixteen but stared right through me in a way that
suggested a long and troubled life. I kept reminding myself that she was blind.
Little information accompanied Mary. She was referred by her busy and blunt
internist. The note, congruent with her appearance, said, “Psychogenic blindness and hair-pulling.”
During her father’s description of her
sudden loss of sight, Mary sat rigidly, hands folded tightly in her lap, eyes
fixed straight ahead. It was an unnerving presentation in one so young. By this
time Mary had been through a number of medical workups, all with no physical
findings to explain her blindness. I thought perhaps she was bored and
disinterested in yet another one.
Mary’s face remained stiff throughout the initial
interviews. Nothing penetrated the stillness. The blankness, shrugs, and
monotone, communicated an air of indifference. She made no edges visible and
was impossible to read.
The first small crack in the facade came when I commented on her missing
chunks of hair and asked her to tell me about that.
“It’s just a bad habit,” she blurted in a tone of
warning. I wondered if someone had said this to her, maybe admonishing her in
I heeded this caution, but planned to return
to it later.
“How are you feeling just before you pull your hair?”
A slight wrinkling of her nose with a crease between her brows suggested
confusion. “What do you mean?” she said.
“How do you feel in your guts?” I said while rubbing my
belly. I caught myself; she couldn’t see me.
Mary had no idea how she felt. Anxiety resided in her body without her
knowledge. She sat tightly with shoulders hunched and back straight. I asked
her how she was feeling in her body right now.
“Fine,” she said.
I moved on but over the next few weeks had her do a series of muscle
relaxation exercises that helped her to drop her shoulders, soften her jaw, and
deepen her breathing. She began to become conscious of the difference between
relaxation and tension. She liked fishing at the family cottage, so we talked
about “catching the tension and throwing it back into the
water”. An almost mischievous smile passed quickly over her face when we talked
At my suggestion she began to track how she was feeling just before and
after she pulled on her hair. “It helps me relax,” she
said with a shrug and a shy smile. Another little crack in the wall. Without
using the word addiction, I asked what might help break this “bad habit.”
She scrunched her face, raised her eyes to mine, and shifted in her
seat. With a sigh she said, “Catch it and throw it back
in.” It became sort of a game where she practiced the magic of asking her
muscles to relax. And they did. She pulled her hair less often.
We began to talk about her childhood. There were long pauses as she
seemed to stare at the floor. I wondered what she was seeing in her mind’s eye. She remembered very little. Her voice was mild and childlike,
disconnected from the adolescent sitting so still in front of me. It was as if
she only had a dim notion of those years, like she knew but didn’t know what
went on back then. I asked her to draw some things from her childhood, if she
could. Art was her favourite subject in school.
She hesitated, pencil poised over the page, grimacing as if in pain. “No…” she said. “I don’t want to make it real.”
went cold when she said those words. There was such a feeling of sadness and
despair in them, especially for this very self-contained, non-expressive
youngster. She knew but didn’t know or didn’t want to know. I was troubled by
this sudden change in her, but I had to respect her wishes and let it go. I
began to feel like I knew, but didn’t know something, like there were depths
here that we both needed to explore.
But we never got the chance. Her father withdrew her from treatment
shortly after, citing lack of progress with the blindness and a need for yet
another opinion. I remember thinking that she left just as we had started
therapy. Sometimes this happens. It’s intriguing to
ponder why a parent might scuttle in and pull their child out just as you start
to get close. Sigmund has been silent on the matter. I’m still waiting.
Alan MacLeod is a writer and retired psychologist living
in Bruce County, Ontario. He's grateful for the Bruce County writing buddies
and the inspiration of mighty Lake Huron. Thanks especially to those excellent
writers in Brian Henry's Tuesday morning intensive.
See Brian Henry’s schedule here, including online and in-person writing workshops, weekly writing classes, and weekend retreats in Algonquin Park, Alliston, Bolton, Barrie, Brampton, Burlington, Caledon, Collingwood, Georgetown, Georgina, Guelph, Hamilton, Jackson’s Point, Kingston, Kitchener-Waterloo, London, Midland, Mississauga, Oakville, Ottawa, Peterborough, St. Catharines, Southampton, Sudbury, Toronto, Windsor, Woodstock, Halton, Muskoka, Peel, Simcoe, York Region, the GTA, Ontario and beyond.