Tales from the Couch

Seeing the patient from psychiatry’s perspective

The Bedbug Dilemma

When things are not what they seem

A few years ago, a bedbug epidemic took place in New York City. The media hyped the problem and many people were fearful of staying in hotels, going to the movies or being in situations where the creatures could be hiding in mattresses or upholstered furniture.

Jeanette B., an attorney and recent mother, visited me because of phobic anxiety. After returning to work following a 6-month maternity leave, she and some other co-workers were bitten by bedbugs. The office was thoroughly fumigated and determined to be bedbug-free.

Despite assurances to the contrary, Jeanette went to work, convinced bedbugs lurked somewhere in the office, and was terrified of bringing them home, where her infant would be bitten.

She repeatedly examined her baby girl, and discovered a reddish “mark” on her arm. She rushed the infant to the pediatrician who assured her the lesion was an inconsequential rash seen commonly among babies. 

This didn’t quell Jeanette’s anxiety which heightened each day she went to the office. Even more distressing was her escalating level of anxiety about her baby’s well-being. Upon returning home each evening, she was reluctant to touch the child, fearing she might transfer a bedbug onto her baby’s bedding.

Find a Therapist

Search for a mental health professional near you.

Jeanette developed a full-blown phobia (a form of entomophobia—fear of insects), although her specific phobic fear was of bedbugs and the possibility she might transfer them to her daughter. 

Jeanette’s phobia worsened. She would no longer touch her child. Jeanette and her husband were forced to hire a live-in caretaker. While on some level Jeanette realized her fear was irrational, it persisted; and became a formidable barrier to her interaction with the child. Her husband knew something deeper was going on, and convinced Jeanette to come for a consultation.

Most mental health professionals know certain phobias have symbolic or lifestyle significance. We also learn (from our teachers and experience) that “spontaneous denials” can be important. When someone says, “It’s not that I want to be mean, but…” and then makes a nasty comment, the unsolicited denial often presages an unkind remark. Notably, one of Jeanette’s first utterances in consultation was, “It’s not that I don’t love my child or want to avoid her, but I just can’t go near her…”

To me, this “spontaneous denial” was a key to the significance of Jeanette’s bedbug phobia. 

During the next five sessions, we explored her feelings about having had a baby, and the possible ramifications it could have on her career. She was then able to acknowledge she’d been ambivalent about having a child, and realized the phobia was in the service of her uncertainties about motherhood. 

Over the next few months, Jeanette’s unrealistic—even irrational—fear of harming her baby subsided and she was able to resume touching her daughter. There was still work to do concerning her feelings about motherhood, but the phobia that masked her ambivalence was out in the open, and Jeanette was dealing with the real dilemma in her life.

 

Mark Rubinstein

Author of Mad Dog House, Love Gone Mad and The Foot Soldier

Mark Rubinstein, M.D., is a former professor of psychiatry at Cornell. His most recent book is the novel Mad Dog House.

more...

Subscribe to Tales from the Couch

Current Issue

Love & Lust

Who says marriage is where desire goes to die?