The Psychoanalytic Study of Society, V. 10

Werner Muensterberger, L. Bryce Boyer, Werner Muensterberger, L. Bryce Boyer, Simon A. Grolnick

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781317736936
• Edition: 1
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

First published in 1983. Volume 10 of the Psychoanalytic Study of Society papers. with essays on anthropology, religion, history, literature, and music.

PART I

ANTHROPOLOGY

1

A Case of “Brain-Fag” Syndrome: Psychotherapy of the Patient Adou A. in the Village of Yosso, Ivory Coast Republic

PAUL PARIN

Translated by Patricia Klamerth

During the course of our ethnopsychoanalytical field research among the Anyi of the Ivory Coast Republic, a young man named Adou A. made an appointment to talk with me. My interviews with him, begun in the interests of our study, developed into effective, psychoanalytically oriented psychotherapy. The case report has been published in German (Parin, Morgenthaler, Parin-Matthey, 1971), but was not included in the American edition of our book (id., 1980).

The disturbances from which Adou A. suffered are typical of many students of high-school and college age in West Africa and frequently compel their victims to give up their studies entirely. The course of psychotherapy sheds light on the genesis and the internal dynamics of the disturbances involved against the background of the culture-specific psychical development of a young man living in an Anyi coffee-growing village located in the rain forest belt of the eastern Ivory Coast. Insofar as possible, the method and the technique of resistance analysis followed the pattern established in Freudian psychoanalysis. No remuneration was requested or offered. The interviews were conducted in French and took place in an open-air tent, furnished with a table, two chairs, and a cot, which I had set up in the shade of a tree on the outskirts of the village of Yosso (approximately 300 inhabitants).

PRELIMINARY INTERVIEW (1 FEBRUARY 1966)

In a courtyard in Yosso a young man in European dress advances to greet me. He is the grand-nephew of Madame Akouassi, whom I regularly supply with medicines, and whom he addresses as “maman” (mother). With great politeness he delivers his “first news,” explaining that he has come from Abidjan with the village chief of Yosso, Monsieur N., to work for him, and that he will be going out into the rain forest with the foreman, whose job it is to mark the trees to be felled for their precious wood.

He also tells me that he is sick. He has lost his memory and thus has had to abandon his studies. He informs me that two psychiatrists (Dr. Abeh in Bingerville and Dr. Duplessis in Abidjan) had examined him thoroughly because of his complaint—his head, his eyes, blood tests, and EEG—and had found nothing organically wrong. Nevertheless, he insists, there is something the matter with him. His mind no longer functions properly, and he is bothered by an itching under the skin (he shows me the inner side of his lower arm).

When I suggest that he come to my medical consultation hour, he replies that today he has to go out into the rain forest, but that he will come without fail tomorrow at nine o’clock.

(Much later, in one of our therapy interviews, Adou asks me what this treatment is called. At my reply, “psychoanalysis,” he recalls that one of the two psychiatrists had mentioned that he might be cured by this method, but that there was no one in the Ivory Coast Republic who was able to apply it. He adds: “It’s a good thing that I have finally found someone here in Yosso.”)

FIRST INTERVIEW (2 FEBRUARY 1966)

I arrive in the village at eight o’clock and, with the help of some children, unlace the tent. Then I go down to the road where I meet Adou.

Adou chats with me on our way to the tent, and as soon as he is seated opposite me, he continues the conversation. We are “two intellectuals in a Negro village”; on this basis he is able to identify with me. At the beginning of the hour we are disturbed several times by villagers who want me to treat them. I greet them briefly and ask Adou to interpret for me and explain to them that I will examine them later. Soon he begins to do this independently, calling out to them before they reach the tent and telling them to go back to the village and make appointments with my “assistant” (our interpreter, Frarnçois) to be examined.

Later on he often comes back to this identificatory response, remarking about how dreadful it is that the people here in the village have no medical care and how sorry he is for them. Things were better in the village in which he grew up; there, at least, they had a medical orderly, and the hospital in Abengourou was only twenty kilometers away. In Yosso, though, when a child gets sick, it simply dies. And this, he feels, is very wrong.

It becomes clear to me later that Adou himself feels like a child who has no one to take care of him and who might simply die. His self-pity is expressed in various forms, such as when he wonders just how I happened to come to Yosso, and pretends to himself that I am being paid by the government as a doctor to help the people here. Actually, the village means little to him; he is not one of its inhabitants. He is a stranger here. And despite the fact that he is in the process of consulting me, this means that I am only here for the villagers and have no intention of helping him.

Without any prompting on my part, Adou describes his illness. He has two groups of symptoms which are closely related, one group in his head, and the other in his body. When he speaks of the latter group, he usually points vaguely to the inner side of his arm or occasionally to his chest.

Adou feels a pain in his head, between his spine and the back of his head, and this pain is constant, except when he is asleep. This is the consequence, or perhaps an accompanying phenomenon, or perhaps the reason for his inability to remember anything. Prior to his illness he had only to listen attentively in class and he would remember what the teacher had said. He was good in examinations and was always able to repeat what he had learned, not always by heart, but at least the sense. He had only to read a thing through once to be able to remember it. But since his illness began, he has found it impossible to remember anything, no matter how hard he tries, even when he goes over the lesson several times. And it’s not only his lessons—he can’t remember “anything at all.” He forgets everything people tell him to do, everything he sees, reads, or hears. His head is very sick.

The second group of symptoms, the physical ones, are either the cause of his forgetfulness, or are the result of it, or are connected with it. He can feel something moving around in his body, worms underneath his skin; they leave him no peace, he is already weak and has lost weight, as anyone can see. People can tell from his face, especially from his eyes, that he is sick. (Adou is powerfully built and is obviously well-nourished. His eyes and face are perfectly normal; his expression is somewhat depressive.)

Adou describes his ailment as suddenly appearing “two years ago” when he was attending school in Bassam, and as a result of it was forced to repeat the same class twice without passing. Since that time the ailment has continued unabated, with no sign of remission, let alone improvement. Later on we shall have to reassess and correct all this information.

Adou describes his symptoms in somewhat the same fashion that gravely depressed European patients usually speak of their ailments, though it must be admitted that his mood is far less depressive. Sometimes he seems fearful, like a typical hypochondriac, sometimes resigned and hopeless; sometimes he bemoans his fate and blames others for it; and sometimes—when he speaks of the worms in his body—one has the impression that he is the victim of physical hallucinations. All in all, his laments are more resigned, more stereotyped, more matter-offact, and less demonstrative than those of hysterical European patients.

So far, Adou has been speaking spontaneously, interrupted only by occasional questions from me. Now he begins to repeat himself, telling me again about the two psychiatrists who had examined him and giving me to understand that they had deliberately withheld the proper medicine. Once again he intimates that there is no one who is willing to help him.

When I make no reply to this, he repeats the account of his illness, especially his inability to remember things. At this point I venture my first interpretation, explaining to him that he has experienced some very bad things and that this is why his head refuses to remember anything. At first he accepts my interpretation; he laughs, but then comes right back to the stereotype account of his symptoms.

I interrupt him after a moment and explain to him the basic rules of psychoanalysis, emphasizing that he must talk with me for one hour every day and tell me whatever comes to his mind.¹ I point out that this is the only proper treatment for his illness. He would lie on the cot, completely relaxed, I would sit behind him, and he would tell me his thoughts, just as they came to him. Again, to begin with he is delighted and agrees. But then an objection occurs to him, and he informs me that he will be in Yosso only until Friday. I reply that we can’t possibly get very far by Friday, that treatment of this kind requires much longer. Hereupon he says that he could come back to the village after his trip and continue the treatment. He adds: “It would be better, though, if you would give me some medicine. That would be quicker and simpler.” My response to his request for medicine is to assure him that I will tell no one anything about what we discuss together and that this discretion is necessary so that he can tell me everything. I promise him that I will always interrupt our conversation if we should be disturbed by visitors.

This confirmation of my willingness to concern myself with him and to keep his secret has an immediate and extraordinary effect. It appears—not only at this moment, but also during the later course of treatment—that Adou is capable of accepting friendly interest in exchange for the “object withheld,” but that his feeling that he is somehow being taken advantage of is not so easy to dispel.

Adou starts to relate the story of his life, beginning with the period of poverty and loneliness in Bassam and going on to his childhood, then the later years, with their setbacks and disappointments. The episodes he narrates are not chronologically ordered, but related in keeping with the contrast between the time before his illness—when everything was good—and the period after his illness began—when everything became bad. This turn for the worse is now attributed to the evil machinations of his teachers or of Monsieur N., who favor others over him or withdraw their patronage for selfish reasons and discriminate against him, and now to his poor physical condition. It is significant that Adou’s complaints of pains in his head and of his weakened body with its peculiar internal upheavals appear consistently when he is forced to recall sad, lonely periods of his life. His accounts of occasions on which he played a more energetic role, presumably during periods when he did not feel so alone, generally end in a repetition of his suspicions of evil-intentioned persons, suspicions that I would immediately regard as paranoid distortions of memory if they occurred in a European.

The most important events in Adou’s life are outlined chronologically below. He contradicted himself several times in his account of his most recent years. His conscious belief that his sickness began while he was attending school in Bassam and that it resulted in the unfortunate dependence on his uncle, Monsieur N., which began immediately thereafter, could not be substantiated. The onset of this illness is the only significant episode in his life which—later on during the course of treatment—I shall have to place at a different point of time. Though all his other memories were subsequently embroidered in great detail, it was possible to confirm them during treatment.

Adou has no idea how old he is—and in this he resembles most Anyi who were born in a village. He gives his age as 19 or 20. The reconstruction of his life story makes it seem more likely that he was about 23 at the time he came to me for treatment.

He was born and raised in a village located some twenty kilometers from Abengourou along the road leading to Agnibilekrou. He is his mother’s only child. He reports that from early childhood he was always alone; not only did he have no brothers and sisters, but he was also without playmates. His parents are planters. He makes no mention of whether his mother or father ever had other marriage partners, either before or after his birth. He describes them as simple people who were never very successful in life because neither had important relations of any kind who might have helped them along. They worked their plantations separately, but together they managed to save enough money to be able to send their son (then about 9 or 10 years of age) to a foster father in Agnibilekrou so that he could attend school there. Adou proved to be such an apt pupil that he was able to pass the examination admitting him to a secondary school (“collège”). He tells me nothing about this foster father, but does mention that he had no friends or playmates during that period and was often alone.

After passing his examinations, he enrolled in the secondary school in Bassam. There he did not live with a foster family, but rented a room of his own, bought food at the market, and cooked for himself. His father had given him 2000 or 3000 francs^*. When his money ran out, he wrote to his father. He often had to go hungry because it took such a long time for his parents to send him money. During the school vacations he was unable to return home (as he had been able to do when he was still in Agnibilekrou).

Apparently he was unable to make any friends in Bassam. He was different from the othe...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Part I: Anthropology
• Part II: Religion
• Part III: History
• Part IV: Literature
• Part V: Music
• Author Index
• Subject Index