[Music therapy used on a patient in the terminal stage of cancer who narrated a tale based on her fantasy].
Music therapy was used on a patient in the terminal stage of cancer who described a fantastic tale built around her imagined pregnancy. We believe that psychiatric intervention was successful through the introduction of music therapy as part of her palliative treatment. Particularly notable in this case was that the patient dealt with the development of ascites by telling a fantastic tale related to a pregnancy--i.e., becoming pregnant with the therapist's child. Her tale started by statements such as "I am pregnant and suffering from morning sickness" and "I am in the third month of pregnancy with the child of my therapist." This progressed in parallel with the actual changes in her physiological symptoms. Among the attending physician, the patient, and her family, this imaginary tale was an important means of communication. The theme of pregnancy, love, and family developed from an unconscious dynamic process between the physician and patient, which could be interpreted as a family-related story originating in the mind of a terminally ill patient. Through this family romance with a major theme of pregnancy, the patient was able to sense her physical crises. This process may be thought of as a product of the so-called "mythgenerating capacity" under limited conditions, which was proposed by Ellenberger. Being aware of this situation, the attending physician and others in charge of her care did not insist on negating her story: instead they accepted her fantasy, and through it they succeeded in establishing psychiatric communications. The process may be considered a form of the narrative approach that is currently attracting attention. In this example, the "process of mourning" and "stages of accepting death" in the terminal state found an outlet in the creation of a fantasy. We believe that this case illustrates the important role of communication between the physician and a patient through the acceptance by the former of a fantastic tale given by the latter; and of a psychotherapeutic intervention, i.e., a sincere interaction between them through music therapy.
Yamashita
Akihiro
A
Department of Psychiatry, Jichi Medical School.
Kato
Satoshi
S
D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D005201:Fantasy; D005260:Female; D006801:Humans; D009147:Music Therapy; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000628:therapy; D010817:Physician-Patient Relations; D011247:Pregnancy