Psychosomatic Medicine 19:275-286 (1957)
© 1957 American Psychosomatic Society

Psychoanalytical Observations in Two Cases of Thrombophlebitis Migrans

¹ New York State Psychiatric Institute, New York, N. Y.

Two cases of thrombophlebitis migrans are presented in which psychoanalytical pschotherapy played a significant role in promoting recovery.

Both patients were men in their thirties, who had made unsuitable marriages and were struggling to regain their freedom and selfrespect.

Despite the fact that there were manifest differences in the racial, social, and religious background of the patients, certain features in their personality and in the nature of the conflicts which they were unable to settle seemed to the authors to have more than a chance significance.

This report makes no claim to offer a new explanation for the etiology of thrombophlebitis migrans but attempts to stress the importance of unresolved emotional stresses in triggering or complicating the attacks. It also seeks to provoke interest in the careful search for evidences of unresolved emotional conflicts in patients who are afflicted for the first time with this painful, recurrent, and potentially fatal illness.

The particular points of similarity in the history and personality structure of these two patients and in their manner of response to stress are the following:

Both patients had strongly affectionate and dependent ties to their parents.

Both had fathers who were widely respected, soft-hearted, friendly, warm people, who took no part in family discipline, and mothers who were strongly supportive, held definite opinions and loyalties, and set the moral tone for the family.

Both patients were strongly tied to their mothers by bonds of affection, respect, and sibling rivalry; both were also increasingly resistent to their mothers' domination, but unable to escape from it except by acting out their defiance in marrying wives whom their mothers considered unsuitable, only to transfer their dependency patterns to their wives.

While the wives were very different in character, each showed in the last analysis a readiness to use whatever means came to hand for the purpose of maintaining power over their husbands for the purpose of exacting tribute or submission.

Both men characterologically resembled their fathers and established a somewhat unstable psychic equilibrium during their developmental years by following the lines which their mothers laid down for them. Repression of all hostile and rebellious thoughts and feelings was the price paid for the continuing love, support, and approval of their parents, and especially their mothers.

Sexual matters were never discussed in either family and sex was looked on as carrying a heavy taboo. A few early adventures in sex play were soon abandoned, and masturbation was either nonexistent or attended with severe guilt feelings. With full sexual maturity this high degree of repression gave way before the force of the libido, the compromise being the selection of an object which was unacceptable to the mother, and, at a deeper level, to the patient himself.

Thus came a period of entrapment within a self-erected prison. They were soon beset with mounting feelings of antagonism toward their wives, complicated by fear of vituperation or even of abandonment, which were at the same time looked on as a fate which they doubtless deserved. There followed a steadily mounting tide of anxiety, which, at moments of crisis, when the outcome was uncertain, led to sudden and explosive discharge over the autonomic nervous system, with disturbances in the humoral regulatory system; the consequent changes in vascular tone and blood composition leading to the thrombotic end result.

In both cases a gradual re-establishment of equilibrium in the functioning of the peripheral vascular system coincided with the period during which intensive psychotherapy, based on the psychoanalytical approach, was introduced into the therapeutic program. Liberation of the ego from the domination of a compulsive and threatening conscience made possible important changes in the life situation, so that a new adaptive equilibrium was possible of establishment.

From the psychodynamic standpoint the most striking feature in both cases was the long-continued and desperate battle between highly charged libidinal and murderous impulses, imprisoned by repression, and a rigidly feminized superego from whose tyranny the masculine ego strove vainly to extricate itself until the assistance of psychoanalytical insights was made available.

While there was some evidence of a familial tendency to vascular dysfunction in both cases it was more clearly demonstrable in the second case. However, additional stress existed in the second case which was absent in the first, the stress arising from lack of social and economic advantages. At one point in the development of the second patient his parents were so poor that they partly starved themselves in order to give their two boys enough to eat.

It is just such discrepancies in the total life pictures of patients with similar psychosomatic disorders which make it next to impossible to evaluate the relative significance of heredity and of the complicated mixtures of emotional response and of defense patterns which result from the experience of the individual.

These cases are now presented, partly from the standpoint of their clinical interest, and partly in support of the thesis that further advances in the understanding and therapy of peripheral vascular disorders will require a pooling of the insights and techniques of the geneticist, the biochemist, the hematologist, the neurophysiologist, and the social worker, with those of the psychologist and the clinician. Last, but by no means least, in all cases--as was exemplified in the history of case No. I--the surprises which Dame Fortune holds up her sleeve may turn the tide at any moment, to the point where the issue of invalidism or health, or even of death or survival, may be definitively settled.