The Bloody Amputation: a discussion of a first dream in an analysis
George E. Atwood, Ph.D.
In a seminar taught by a psychoanalyst early in my clinical training, it was said that every psychotherapist should pay special attention to the first dream the patient presents. This dream, our instructor explained, will symbolically forecast the content and course of the analysis as a whole. I was skeptical that this could be the case, but I have to say that his idea has been largely borne out in my clinical experience over the last half-century.
What was my own first dream, in my very first attempt at psychoanalytic therapy as a patient? And did it forecast central aspects of the psychotherapeutic experience that then unfolded?
Here is the dream, which occurred in the night following my first meeting with a woman whom I saw twice each week for the next four and one-half years. I was 28 years old at the time. It was a devastating nightmare, and I call it the bloody amputation. I dreamt I was traveling along a road in the direction of a whorehouse, planning to have a good sexual experience. I need to say I have not made a practice of visiting prostitutes; but in my dream, in its manifest content anyway, that is exactly what I was doing. The road led to a gate, which opened out into a property with a huge multi-story house: it seemed like it might be the famous House of the Rising Sun. A very attractive woman with blond hair came from the house and approached me. She knelt down before me, smiling, and opened her mouth. But then, instead of anything of a sexual nature happening, she took my right hand and gently drew it into her mouth and into her throat. Suddenly biting down with great force, she severed my hand from my wrist and I pulled back with blood spurting and gushing from the site of the amputation. The feeling was one of unbearable shock and horror.
I have thought about this dream for 43 years, discussing it with my analyst at the time, and later with students, colleagues, and friends. What follows is an account of the understanding that has emerged.
I began this first analysis with trepidation. Although I had completed a Ph.D. in clinical psychology and undergone extensive post-doctoral training, I had never sought counseling or therapy of any kind for myself. I was he to whom others turn for assistance, not he who reaches out for help. Nevertheless I applied my developing clinical knowledge to myself, and perceived with great clarity how my life had been affected by a number of early and recent traumatic losses. I was suffering at that time with feelings of sadness and depression that would not abate, and it had become apparent to me that the age of self-sufficiency needed to be brought to an end.
I arrived for my first appointment at my analyst’s home, where she had her office. She came out of the house and beckoned me to come in. She was blond and very attractive.
We sat down in the office, and after a moment, she said: “So tell me what brings you here?” I took a deep breath, and then proceeded with a carefully thought out summary of the case of George E. Atwood, the 4th. For perhaps 40 minutes I spoke, setting out a detailed history of traumatic losses and a series of formulations of all the ways I had tried to cope with them. Holding nothing back, I gave accounts of my experiences of the sudden illness and death of my mother when I was a boy, of the pain caused by the heartbreaking ending of a long romantic relationship, and of the shock and suffering brought on by the then-recent suicide of my best friend. It was all very coherent and highly organized; but it was a sad tale of loss after loss. At the end of the presentation, to which my analyst had listened attentively, she said just a few things. I remember her precise words.
“Thank you for telling this history, George. I would like you to come back. I think it would be good if you came twice each week, and I want you to use the couch. One more thing: next time you come, I suggest that you leave the psychologist outside the door.”
I do not remember having much of a reaction to her words in the moment, other than one of relief that she had apparently accepted me as a patient and thinking I was at the beginning of a long process. Later, at the end of the day, I fell asleep and had the terrible dream.
Have you ever thought about the resemblance between prostitutes and psychoanalysts? They are pretty much the same thing: you pay the money and receive the attention. But this prostitute – this analyst – injured me in the dream horrifically. Blond and attractive, smiling and friendly, she bit off my right hand with her teeth - and I might have bled to death right there.
I remember my first thoughts about this dream. They centered around the image of loss, loss of my hand, loss of my mother, loss of my beloved ones – perhaps, I imagined, my mind had delivered up a picture of a disaster as a kind of warning of what could happen if I let myself count on someone other than myself. My analyst herself did not offer an interpretation of the dream, waiting instead for my thoughts.
A key event in the deciphering of the dream occurred in a conversation with one of my students a number of years later, after the analysis had come to an end. The student asked the question: “Why do you think it was, George, that it was your hand? Why not your foot, or your eye, or an ear? Could it be that this pertains somehow to how you were hand-ling yourself and the events of your life?” It sprang to my mind in a flash that I had been handling my life crises through an extensive series of intellectualizations, through a creating of theories of my history with all its traumas. These theories were what I had presented to my analyst in my survey of my background and personal psychodynamics. A psychologist had been speaking, informing her of the organized understandings he had achieved in reviewing the various items of his traumatic history. This detachment, this flight from shattering loss and chaos to coherence, assisted in holding at bay the storms of otherwise unbearably painful emotions.
Leave the psychologist outside the door, she had said. After letting me tell my story, she introduced a cut between what was permitted to be inside the door and what was unwelcome there and to be kept on the outside. But the psychologist had been my whole way of coping with the events of my life, and now I was to dispense with him entirely? I appear to have received my analyst’s remarks, without realizing it, as a terrible injury, as the dream expresses, traumatically stripping me of the primary method I had used to survive. Complying with her injunction, I tried to rid myself of the psychologist in the ensuing period, and collapsed into the worst depression of my life. Flooded by pain, all good feelings about myself then vanished, and I entered the darkness.
One could argue that the dream of the bloody amputation did indeed forecast the content of the analysis that was to come: the gushing blood metaphorically symbolized the depression, until that time more or less held at bay, now bursting forth with a terrible intensity. Sometimes I wonder though whether the flood of dark feeling was a reaction to the analysis itself, which had from the outset attacked my means of emotional survival as I passed through the many traumas of my youth and young adulthood. Leave the psychologist outside the door, she had said. I trusted her and did as she instructed. But in doing so I lost the one who had held my world together, the bright gentleman who hand-led things for me. What would have been my course in the therapy if my analyst had responded differently to my ultra-organized presentation? What if she had said: “George, your account makes a lot of sense. I want you to know I understand how important this thinking has been to you – it has helped you to find order in the chaos as the most important people in your life have fallen away. I have a prediction: you and I are going to get along very well. You can use the couch in our meetings if you like.” If she had given this response, I am quite certain there would have been no dream of the bloody amputation. Maybe there would instead have been a dream of enjoyable fun and games in the House of the Rising Sun. And maybe the depression into which I descended would not have been quite so bad. Do you think I should try to get my money back?
The first dream a person has in an analysis is very likely to show the themes that will emerge and dominate the course of the psychotherapy – how could it be otherwise? Dreams express the subjective life of the dreamer, and the issues to be dealt with in anyone’s analysis are exceedingly likely to be salient at its outset. But this dream will draw its imagery from an intersubjective tapestry that is coming into being, one that includes the participating presence of the analyst. In parallel, the whole pattern shown by the analysis unfolding over time will arise out of a dialogue between the subjective universes of patient and analyst, at every step codetermined by the contributing influences of both. My instructor in the early psychoanalytic seminar was right in his emphasis on the importance of first dreams. But he was a Cartesian thinker, one who did not perceive clearly the embeddedness of all clinical phenomena in intersubjective contexts.
Occasionally I find myself asking about what it was that motivated my analyst to utter her fateful words: Leave the psychologist outside the door. What was it that drove her to bite off my hand? Her words seem kind of aggressive to me, looking back now, like a forceful putting of me in my proper place. When those teeth came down, they did so with a ferocious power: CHOMP! Perhaps she found my elegant summary of my history and dynamics overwhelming, or even a bit intimidating. Such a reaction would be understandable. But it seems that she did hurt me very badly, and I find it sad that my first analysis began on such a disastrous note. And it is also sad that neither she nor I comprehended what had happened. Oh well, I was able to figure things out eventually, and my depression finally lifted.
What was my own first dream, in my very first attempt at psychoanalytic therapy as a patient? And did it forecast central aspects of the psychotherapeutic experience that then unfolded?
Here is the dream, which occurred in the night following my first meeting with a woman whom I saw twice each week for the next four and one-half years. I was 28 years old at the time. It was a devastating nightmare, and I call it the bloody amputation. I dreamt I was traveling along a road in the direction of a whorehouse, planning to have a good sexual experience. I need to say I have not made a practice of visiting prostitutes; but in my dream, in its manifest content anyway, that is exactly what I was doing. The road led to a gate, which opened out into a property with a huge multi-story house: it seemed like it might be the famous House of the Rising Sun. A very attractive woman with blond hair came from the house and approached me. She knelt down before me, smiling, and opened her mouth. But then, instead of anything of a sexual nature happening, she took my right hand and gently drew it into her mouth and into her throat. Suddenly biting down with great force, she severed my hand from my wrist and I pulled back with blood spurting and gushing from the site of the amputation. The feeling was one of unbearable shock and horror.
I have thought about this dream for 43 years, discussing it with my analyst at the time, and later with students, colleagues, and friends. What follows is an account of the understanding that has emerged.
I began this first analysis with trepidation. Although I had completed a Ph.D. in clinical psychology and undergone extensive post-doctoral training, I had never sought counseling or therapy of any kind for myself. I was he to whom others turn for assistance, not he who reaches out for help. Nevertheless I applied my developing clinical knowledge to myself, and perceived with great clarity how my life had been affected by a number of early and recent traumatic losses. I was suffering at that time with feelings of sadness and depression that would not abate, and it had become apparent to me that the age of self-sufficiency needed to be brought to an end.
I arrived for my first appointment at my analyst’s home, where she had her office. She came out of the house and beckoned me to come in. She was blond and very attractive.
We sat down in the office, and after a moment, she said: “So tell me what brings you here?” I took a deep breath, and then proceeded with a carefully thought out summary of the case of George E. Atwood, the 4th. For perhaps 40 minutes I spoke, setting out a detailed history of traumatic losses and a series of formulations of all the ways I had tried to cope with them. Holding nothing back, I gave accounts of my experiences of the sudden illness and death of my mother when I was a boy, of the pain caused by the heartbreaking ending of a long romantic relationship, and of the shock and suffering brought on by the then-recent suicide of my best friend. It was all very coherent and highly organized; but it was a sad tale of loss after loss. At the end of the presentation, to which my analyst had listened attentively, she said just a few things. I remember her precise words.
“Thank you for telling this history, George. I would like you to come back. I think it would be good if you came twice each week, and I want you to use the couch. One more thing: next time you come, I suggest that you leave the psychologist outside the door.”
I do not remember having much of a reaction to her words in the moment, other than one of relief that she had apparently accepted me as a patient and thinking I was at the beginning of a long process. Later, at the end of the day, I fell asleep and had the terrible dream.
Have you ever thought about the resemblance between prostitutes and psychoanalysts? They are pretty much the same thing: you pay the money and receive the attention. But this prostitute – this analyst – injured me in the dream horrifically. Blond and attractive, smiling and friendly, she bit off my right hand with her teeth - and I might have bled to death right there.
I remember my first thoughts about this dream. They centered around the image of loss, loss of my hand, loss of my mother, loss of my beloved ones – perhaps, I imagined, my mind had delivered up a picture of a disaster as a kind of warning of what could happen if I let myself count on someone other than myself. My analyst herself did not offer an interpretation of the dream, waiting instead for my thoughts.
A key event in the deciphering of the dream occurred in a conversation with one of my students a number of years later, after the analysis had come to an end. The student asked the question: “Why do you think it was, George, that it was your hand? Why not your foot, or your eye, or an ear? Could it be that this pertains somehow to how you were hand-ling yourself and the events of your life?” It sprang to my mind in a flash that I had been handling my life crises through an extensive series of intellectualizations, through a creating of theories of my history with all its traumas. These theories were what I had presented to my analyst in my survey of my background and personal psychodynamics. A psychologist had been speaking, informing her of the organized understandings he had achieved in reviewing the various items of his traumatic history. This detachment, this flight from shattering loss and chaos to coherence, assisted in holding at bay the storms of otherwise unbearably painful emotions.
Leave the psychologist outside the door, she had said. After letting me tell my story, she introduced a cut between what was permitted to be inside the door and what was unwelcome there and to be kept on the outside. But the psychologist had been my whole way of coping with the events of my life, and now I was to dispense with him entirely? I appear to have received my analyst’s remarks, without realizing it, as a terrible injury, as the dream expresses, traumatically stripping me of the primary method I had used to survive. Complying with her injunction, I tried to rid myself of the psychologist in the ensuing period, and collapsed into the worst depression of my life. Flooded by pain, all good feelings about myself then vanished, and I entered the darkness.
One could argue that the dream of the bloody amputation did indeed forecast the content of the analysis that was to come: the gushing blood metaphorically symbolized the depression, until that time more or less held at bay, now bursting forth with a terrible intensity. Sometimes I wonder though whether the flood of dark feeling was a reaction to the analysis itself, which had from the outset attacked my means of emotional survival as I passed through the many traumas of my youth and young adulthood. Leave the psychologist outside the door, she had said. I trusted her and did as she instructed. But in doing so I lost the one who had held my world together, the bright gentleman who hand-led things for me. What would have been my course in the therapy if my analyst had responded differently to my ultra-organized presentation? What if she had said: “George, your account makes a lot of sense. I want you to know I understand how important this thinking has been to you – it has helped you to find order in the chaos as the most important people in your life have fallen away. I have a prediction: you and I are going to get along very well. You can use the couch in our meetings if you like.” If she had given this response, I am quite certain there would have been no dream of the bloody amputation. Maybe there would instead have been a dream of enjoyable fun and games in the House of the Rising Sun. And maybe the depression into which I descended would not have been quite so bad. Do you think I should try to get my money back?
The first dream a person has in an analysis is very likely to show the themes that will emerge and dominate the course of the psychotherapy – how could it be otherwise? Dreams express the subjective life of the dreamer, and the issues to be dealt with in anyone’s analysis are exceedingly likely to be salient at its outset. But this dream will draw its imagery from an intersubjective tapestry that is coming into being, one that includes the participating presence of the analyst. In parallel, the whole pattern shown by the analysis unfolding over time will arise out of a dialogue between the subjective universes of patient and analyst, at every step codetermined by the contributing influences of both. My instructor in the early psychoanalytic seminar was right in his emphasis on the importance of first dreams. But he was a Cartesian thinker, one who did not perceive clearly the embeddedness of all clinical phenomena in intersubjective contexts.
Occasionally I find myself asking about what it was that motivated my analyst to utter her fateful words: Leave the psychologist outside the door. What was it that drove her to bite off my hand? Her words seem kind of aggressive to me, looking back now, like a forceful putting of me in my proper place. When those teeth came down, they did so with a ferocious power: CHOMP! Perhaps she found my elegant summary of my history and dynamics overwhelming, or even a bit intimidating. Such a reaction would be understandable. But it seems that she did hurt me very badly, and I find it sad that my first analysis began on such a disastrous note. And it is also sad that neither she nor I comprehended what had happened. Oh well, I was able to figure things out eventually, and my depression finally lifted.