The Failure of Manic Defense in the Face of the Pandemic: A Case Vignette

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As have many during the Covid-19 pandemic, I found myself reaching for edification and solace in Camus’ The Plague (1948). And among the many resonant and quotable passages, one remained in mind as it so aptly captured my feelings and thoughts about the patient I will shortly describe. Camus wrote ‘Thus, too, they came to know the incorrigible sorrow of all prisoners and exiles, which is to live in company with a memory that serves no purpose (p.73)’. ‘A memory that serves no purpose’, yet one which is presumably unforgettable – these words highlight a foundational psychoanalytic theorem that un-mourned memories inscribe themselves into our psyches and shape our destinies in disguised manners. There are, of course, multiple forms of concealment; mostly we have grouped them as either melancholic or manic. In the melancholic, external loss of the object is averted by internal incorporations into a narcissistically deficient self; whereas in the manic the aggrandizement of the self demands constant vigilance against dependencies of all sorts. In the case vignette that follows the manic is attacked by the pandemic.

Hana, born in 1934 in a small town in Czechoslovakia on the outskirts of Prague, survived the first years of Nazi occupation in hiding with her brother and parents. In 1944 her father and brother were arrested, sent to the concentration camp Theresienstatdt, and from there to their deaths in Auschwitz.  Hana and her mother settled in Prague after WWII and then managed to migrate to the West during the ‘Czech Coup’ of 1948 when Communist led forces overthrew the democratic coalition.  She arrived in the United States at age 14, and after a distinguished career and three childless marriages, she retired at age 75 as an extremely wealthy and isolated woman. 

Hana entered treatment two years ago at age 84, troubled by increasing bouts of depression that had been managed over the years solely with various anti-depressants. After some initial hesitations in reflecting about her early childhood experiences, Hana became more intrigued about the impact of her history of fleeing danger, and as she called it ‘hiding’ and ‘disappearing’. Gradually, we began to draw parallels between the actual threats to liberty and life posed by Nazi and Soviet control over her homeland and her experiences of persecutory anxieties within relationships with her three ex-spouses and numerous former colleagues.  

Then, the COVID-19 pandemic struck. What was in the realm of the ‘real’ migrated from its material domain and infiltrated the ‘imaginary’ accompanied by terror-filled nightmares and daily pre-occupation with safe-guarding her home. Anxieties drifted into fear, and fear into a dread that impelled her toward immediate action. As had been her experience, all that seemed so solid could vanish in an instant and security could only be found by hiding, by escape. Life seemed to hang in the balance as Hana engaged in frantic attempts to secure her finances through transfers of equity investments into gold and cash. One afternoon, after she managed to fill a suitcase with $100 bills and to bring her gun and ammunition down from the attic, she called me in desperation – ‘where should I go?’ she asked me repeatedly and in barely contained panic. 

Our work over the previous month had been limited to phone and video-interactions and soon followed a recurrent trajectory – one that moved from the immediate fears of infection, to concerns of financial ruin, and then to a fantasy of homelessness and abandonment. In the weeks following her attempt to flee this pattern began to shift as her concern with my well-being began to emerge. At first, her fears revolved around my tiring of her obsessions of escape and ending the treatment; then she began to fear that I would die. To both of our surprise, these concerns abruptly ended one day while Hana was talking about how people were dying without being able to say good-bye to their relatives. Suddenly she burst into tears and after some time of sobbing began to talk with a deep-throated sadness about the deaths of her father and brother.

This long averted mourning has occupied most of our recent sessions – mourning for her childhood, for her parents and sibling, for the spouses who found her ‘inaccessible’ and who she found ‘controlling’, for unborn children, and for a life shaped by the ever-present yet disavowed belief in inevitable destruction and escape. 

In this mourning process, we have also begun to appreciate how her fierce determination to be self-reliant, and to not have anyone become reliant on her, has served as a double-edged sword – protecting her from loss and dissolution, while simultaneously foreclosing the possibilities of a more secure attachment. We are now immersed in the very poignant process of grieving the losses of a lifetime and of recognizing the tragedy of how her attempts to find security via hiding provided an illusory escape from the unmetabolized traumas of the abrupt disappearance of her father and brother. 

Perhaps the pandemic crystallized the fearful atmosphere that accompanied all of her waking hours as a young girl in hiding during the Holocaust.  The subsequent failure of her attempt to solve the current persecutory anxiety by manic action also made available the possibility of mourning. The traumas reverberate now, yet their avoidance is diminished and in the midst of wrenching pain there is also a nascent sense of freedom to choose how to respond. 

As Camus (1948) and Freud (1915) have suggested, the acknowledgement of the presence of death can be a beginning, and not the end, of morality. Choice reaches the highest ground when the outcome is inescapable – and we face the question of how to live in the face of death.

Bibliography
Camus, A. (1948). The Plague. New York: Vintage, 1991.
Freud, S. (1915). On Transience. S.E. 14. London: Hogarth Press.