Case Study No. 5 – The Case of Mr.

Mr. E is a 29-year-old unemployed accountant who has become increasingly incapacitated by panic
attacks, agoraphobia, and somatic preoccupations to the point that he can no longer tolerate being alone
and cannot go out without a companion. The patient has had similar symptoms on and off for many years,
but his symptoms worsened 3 months ago when his girlfriend suddenly left him because of his “passivity.”
He fears that he is losing his mind and experiencing a schizophrenic deterioration. The patient is now
spending most of his time at his parents’ home, where he behaves and is treated like an invalid.

The patient is the only child of parents who were already in their late 30s and expected to be childless
when he was conceived. As an infant, Mr. E had considerable separation anxiety and could not be left with
babysitters. He developed into a shy boy who was subject to many minor illnesses and was much more
comfortable with adults than in the rough-and-tumble of peer relationships. Mr. E developed mild school
refusal in the first and fourth grades and was never willing to try summer camp. He attended college and
business schools locally so that he could continue to live at home; he then went into the family business.
He was interested in dating but was usually too shy to initiate his own relationships with women and
depended on his mother to serve as matchmaker.

Mr. E’s symptoms have waxed and waned throughout his 20s. On occasion he has tried to establish his
separateness in various ways: taking trips overseas, dating a girl of his own choosing, and even quitting
his father’s firm and finding a job on his own. Each effort has ended in failure and humiliation because Mr.
E becomes anxious, ruminates that he is doing the wrong thing, and finally gives up and returns to the
“family routine.”

The patient feels especially bound to his physically ailing mother, worries that she will die soon, and is
troubled by the thought that she gets lonely without him, just as he feels lonely without her. Mr. E’s
mother is equally bound to him. She cannot tolerate his “suffering” and is willing to sacrifice her
relationship with her husband and her social life to be with him. When apart, Mr. E and his mother call
each other several times a day. At the same time, Mr. E is angry at both parents and blames them for his
difficulties, for not loving him enough and also for loving him too much, for not taking care of him, and for
making him dependent. He is particularly contemptuous of his father, who also has some mild phobias.

Mr. E feels defective and inferior. He expects to be criticized by others and is sensitive to rejection. He is
also highly critical of others and feels constantly let down. He has had close friends in the past but is now
too embarrassed to call them.

Mr. E has been in psychotherapy on several occasions, each of which lasted for about a year. Typically, he
becomes increasingly demanding and then becomes disappointed and disillusioned with his therapist and
decides that things are going nowhere. He has a strong tendency toward addiction to minor tranquilizers
and shows a little ability to use them within the recommended dosage. He has used neuroleptics with
poor results, and antidepressants in low dosages have not been helpful. He is bright and perceptive about
his motivations and behavior but seems unable to change them.