Case Study: Suzanne

Suzanne came to therapy complaining of exhaustion and depression. She was raising two children, holding down a part-time job, and supporting her unemployed husband. While she said that she understood her husband's difficulty in finding work - "Middle aged, middle managers are not very employable" - she resented the fact that he didn't seem to be looking very hard and she would come home from a long day to find that he hadn't done much around the house. Suzanne would come home from work, cook, feed the kids, clean the house, get up early, and take the kids to school. Her weekends consisted of catching up on all of the tasks she lacked the time to complete during the week. She knew she was tired, and she understood why. However, she had become concerned about her depression and recent suicidal thoughts. "My life is good," Suzanne told me. "I have children, a husband, a good job, my health, so why do my thoughts drift to killing myself? It must be some chemical imbalance.” 

During our first few sessions I noticed that Suzanne would always ask me questions about how I was feeling. She seemed very sensitive to my facial expressions, movements, and gestures. A couple of times she asked me if I was eating right and getting enough rest. She then began bringing me coffee and a muffin to our meetings because she thought I wasn't eating enough. One day when I had to change the time of an appointment, she responded very quickly by saying that we could skip the session if I was too busy or tired to see her that week. It became clear that despite the fact that she paid me to take care of her, she, in fact, had made it her job to be my caretaker. She had added me to her list of responsibilities.

Suzanne grew up the only girl in a large traditional family. Her family never addressed her needs and feelings. They evaluated her each day based on her ability to help her mother attend to the needs of the men and boys they served. Suzanne’s cultural and religious beliefs also reinforced this kind of family structure. As she grew older, her primitive and reflexive imitative, resonance, and mirror systems had been reinforced and fine-tuned to the point where she prided herself on being able to "read the minds" of others. At times, she suspected she might be clairvoyant because she could predict the needs of others moments before they would ask her for something, “just like that guy Radar on M.A.S.H." Unfortunately, she never learned to know herself, to be aware of her own feelings, or to articulate her needs.

In Suzanne's mind, to be needed was to be loved, to be loved was to be connected, and to be connected was to survive. She came to realize that she was attracted by and attractive to dependent men who fit her need for caretaking, and that she had shaped her children to be dependent so that she would always feel needed, and hence, loved. Suzanne's experience suggests that while resonance systems are automatic, having a sense of self and being conscious of your own needs and emotions requires a mirroring relationship, one that respects you and helps you to come to know yourself. Because of her family and culture, Suzanne's brain was shaped to serve as an adjunct to others. 

Through the course of therapy, Suzanne learned about the source of her depression. She discovered many things she needed: a vacation, more help from her husband, an easier schedule, and some time each week to relax, have her hair done, or spend time with friends. Her intrusive suicidal thoughts came to be understood as her desire to kill the part of her self that lived completely for other people. Many psychotherapy clients experience a common condition of having an inadequate boundary between the self and others in tandem with an inability to be aware of their own feelings and needs. The awareness, exploration, and conscious articulation of the self in narratives are core components of most forms of psychotherapy. 

This is an excerpt from Dr. Cozolino’s book The Neuroscience of Human Relationships.