Telephone Associated Pathology: Clinical Case Studies and Discussion

Abstract

The advancement of modern technology shapes a nd deve lops new expressio ns of psychopathology and accompanying treatments. This is most apparent with the telephone, an instrument ofcontact and communicati on fo r th e pat ie n t , and assessment and intervention for the therapist. T he telephone both const rains and creates unique constellations of patient sym pto matology . T his paper will examine one suc h te lephone symptom complex-the habitual over use of the telephone by non-bipolar patients. T he frequent monopolization of th e phone seen in some b ipolar patients will not be considered, th ough the e lements of in t rusion a nd aggression d iscussed in this paper are probably shared by manic patients . A review of the psychiatric literature reveal s a sur pr ising pau cit y of wr iting about the psychodynamic significance of patient 's use of th e telephone , even in the area of sexual paraphilias and sexually obscene phone ca lls. Freud describes th e telephone as a representation of the body, and as a metaphor for psych oa na lysis (1,2). Stekel (3) discusses the telephone as a se xua l sym bol, a nd Har r is (4) relates phobic anxiety of the telephone to castration anxiety. Fliess (5) is th e first to write of telephoning as a sym bo l for masturbation , an idea elaborated by Shengold in his paper The Symbol of Telephoning (6). Alman si, Soca rides, and others have written of the use of the telephone in sexua l paraph ilias (7 ,8) . The bulk of writing in the mental health literature, however, focu ses o n th e use of th e te lephone in counseling services and suicide hotlines. With th e ever increasing utilization of the te lephone by patient and therapist alike , thi s limited analysis of the meaning and uses of the telephone in the psychi atric literatu re is a n intriguing deficiency in the understanding of patient behavior. Throughout two yea rs of residency training in clinical psychiatry in inpatient and outpatient sett ings, I have treated two patients whose sole presenti ng complaint was the overuse or abuse of the telephone. These patients would make upwards of fifty ca lls a day to their parents, spouse, or th erapist. This beha vio r was independent of manic or psychotic symptoms, and without over t sexual deviancy or perversion . Such an affinity for the telephone is not un common among psych iatric patients, as many psychiatrists a nd their sec reta r ia l staff can attest. Some possible meanings and the various expressions of this behavio r will be examined in these two case stud ies. Mrs. Z is a thirty-three year old, married, Jewish mother of two children who presented to the ew York Hospital-Westch ester Division Outpatient