Freud - Complete Works (250 page)

  
¹
[
Footnote added
1923:] This is an
extreme view which I should no longer maintain to-day.

  
²
See my
Psychopathology of Everyday
Life
, 1901
b
.

Fragment Of An Analysis Of A Case Of Hysteria

1414

   On some other occasion I will
publish a collection of these symptomatic acts as they are to be
observed in the healthy and in neurotics. They are sometimes very
easy to interpret. Dora’s reticule, which came apart at the
top in the usual way, was nothing but a representation of the
genitals, and her playing with it, her opening it and putting her
finger in it, was an entirely unembarrassed yet unmistakable
pantomimic announcement of what she would like to do with them -
namely, to masturbate. A very entertaining episode of a similar
kind occurred to me a short time ago. In the middle of a session
the patient - a lady who was no longer young - brought out a small
ivory box, ostensibly in order to refresh herself with a sweet. She
made some efforts to open it, and then handed it to me so that I
might convince myself how hard it was to open. I expressed my
suspicion that the box must mean something special, for this was
the very first time I had seen it, although its owner had been
coming to me for more than a year. To this the lady eagerly
replied: ‘I always have this box about me; I take it with me
wherever I go.’ She did not calm down until I had pointed out
to her with a laugh how well her words were adapted to quite
another meaning. The box -
Dose
,
πύξις
-, like the reticule and the jewel-case, was once again only a
substitute for the shell of Venus, for the female genitals.

   There is a great deal of
symbolism of this kind in life, but as a rule we pass it by without
heeding it. When I set myself the task of bringing to light what
human beings keep hidden within them, not by the compelling power
of hypnosis, but by observing what they say and what they show, I
thought the task was a harder one than it really is. He that has
eyes to see and ears to hear may convince himself that no mortal
can keep a secret. If his lips are silent, he chatters with his
finger-tips; betrayal oozes out of him at every pore. And thus the
task of making conscious the most hidden recesses of the mind is
one which it is quite possible to accomplish.

   Dora’s symptomatic act with
the reticule did not immediately precede the dream. She started the
session which brought us the narrative of the dream with another
symptomatic act. As I came into the room in which she was waiting
she hurriedly concealed a letter which she was reading. I naturally
asked her whom the letter was from, and at first she refused to
tell me. Something then came out which was a matter of complete
indifference and had no relation to the treatment. It was a letter
from her grandmother, in which she begged Dora to write to her more
often. I believe that Dora only wanted to play
‘secrets’ with me, and to hint that she was on the
point of allowing her secret to be torn from her by the doctor. I
was then in a position to explain her antipathy to every new
doctor. She was afraid lest he might arrive at the foundation of
her illness, either by examining her and discovering her catarrh,
or by questioning her and eliciting the fact of her addiction to
bed-wetting - lest he might guess, in short, that she had
masturbated. And afterwards she would speak very contemptuously of
the doctor whose perspicacity she had evidently over-estimated
beforehand.

Fragment Of An Analysis Of A Case Of Hysteria

1415

   The reproaches against her father
for having made her ill, together with the self-reproach underlying
them, the leucorrhoea, the playing with the reticule, the
bed-wetting after her sixth year, the secret which she would not
allow the doctors to tear from her - the circumstantial evidence of
her having masturbated in childhood seems to me complete and
without a flaw. In the present case I had begun to suspect the
masturbation when she had told me of her cousin’s gastric
pains, and had then identified herself with her by complaining for
days together of similar painful sensations. It is well known that
gastric pains occur especially often in those who masturbate.
According to a personal communication made to me by Wilhelm Fliess,
it is precisely gastralgias of this character which can be
interrupted by an application of cocaine to the ‘gastric
spot’ discovered by him in the nose, and which can be cured
by the cauterization of the same spot. In confirmation of my
suspicion Dora gave me two facts from her conscious knowledge: she
herself had frequently suffered from gastric pains, and she had
good reasons for believing that her cousin was a masturbator. It is
a very common thing for patients to recognize in other people a
connection which, on account of their emotional resistances, they
cannot perceive in themselves. And, indeed, Dora no longer denied
my supposition, although she still remembered nothing. Even the
date which she assigned to the bed-wetting, when she said that it
lasted ‘till a short time before the appearance of the
nervous asthma’, appears to me to be of clinical
significance. Hysterical symptoms hardly ever appear so long as
children are masturbating, but only afterwards, when a period of
abstinence has set in;¹ they form a substitute for
masturbatory satisfaction, the desire for which continues to
persist in the unconscious until another and more normal kind of
satisfaction appears - where that is still attainable. For upon
whether it is still attainable or not depends the possibility of a
hysteria being cured by marriage and normal sexual intercourse. But
if the satisfaction afforded in marriage is again removed - as
it may be owing to
coitus interruptus
, psychological
estrangement, or other causes - then the libido flows back again
into its old channel and manifests itself once more in hysterical
symptoms.

  
¹
This is also true in principle of adults;
but in their case a
relative
abstinence, a diminution in the
amount of masturbation, is a sufficient cause, so that, if the
libido is very strong, hysteria and masturbation may be
simultaneously present.

Fragment Of An Analysis Of A Case Of Hysteria

1416

   I should like to be able to add
some definite information as to when and under what particular
influence Dora gave up masturbating; but owing to the
incompleteness of the analysis I have only fragmentary material to
present. We have heard that the bed-wetting lasted until shortly
before she first fell ill with dyspnoea. Now the only light she was
able to throw upon this first attack was that at the time of its
occurrence her father was away from home for the first time since
his health had improved. In this small recollection there must be a
trace of an allusion to the aetiology of the dyspnoea. Dora’s
symptomatic acts and certain other signs gave me good reasons for
supposing that the child, whose bedroom had been next door to her
parents’, had overheard her father in his wife’s room
at night and had heard him (for he was always short of breath)
breathing hard while they had intercourse. Children, in such
circumstances, divine something sexual in the uncanny sounds that
reach their ears. Indeed, the movements expressive of sexual
excitement lie within them ready to hand, as innate pieces of
mechanism. I maintained years ago that the dyspnoea and
palpitations that occur in hysteria and anxiety neurosis are only
detached fragments of the act of copulation; and in many cases, as
in Dora’s, I have been able to trace back the symptom of
dyspnoea or nervous asthma to the same exciting cause - to the
patient’s having overheard sexual intercourse taking place
between adults. The sympathetic excitement which may be supposed to
have occurred in Dora on such an occasion may very easily have made
the child’s sexuality veer round and have replaced her
inclination to masturbation by an inclination to anxiety. A little
while later, when her father was away and the child, devotedly in
love with him, was wishing him back, she must have reproduced in
the form of an attack of asthma the impression she had received.
She had preserved in her memory the event which had occasioned the
first onset of the symptom, and we can conjecture from it the
nature of the train of thought, charged with anxiety, which had
accompanied the attack. The first attack had come on after she had
over-exerted herself on an expedition in the mountains, so that she
had probably been really a little out of breath. To this was added
the thought that her father was forbidden to climb mountains and
was not allowed to over-exert himself, because he suffered from
shortness of breath; then came the recollection of how much he had
exerted himself with her mother that night, and the question
whether it might not have done him harm; next came concern whether
she
might not have over-exerted herself in masturbating - an
act which, like the other, led to a sexual orgasm accompanied by
slight dyspnoea - and finally came a return of the dyspnoea in an
intensified form as a symptom. Part of this material I was able to
obtain directly from the analysis, but the rest required
supplementing. But the way in which the occurrence of masturbation
in Dora’s case was verified has already shown us that
material belonging to a single subject can only be collected piece
by piece at various times and in different connections.¹

  
¹
The proof of infantile masturbation in
other cases is established in a precisely similar way. The evidence
for it is mostly of a similar nature: indications of the presence
of leucorrhoea, bed-wetting, hand-ceremonials (obsessional
washing), and such things. It is always possible to discover with
certainty from the nature of the symptoms of the case whether the
habit was discovered by the person in charge of the child or not,
or whether this sexual activity was brought to an end by long
efforts on the child’s part to break itself of the habit, or
by a sudden change. In Dora’s case the masturbation had
remained undiscovered, and had come to an end at a single blow (cf.
her secret, her fear of doctors, and the replacement by dyspnoea).
The patients, it is true, invariably dispute the conclusiveness of
circumstantial evidence such as this, and they do so even when they
have retained a conscious recollection of the catarrh or of their
mother’s warning (e.g. ‘That makes people stupid;
it’s dangerous’). But some time later the memory, which
has been so long repressed, of this piece of infantile sexual life
emerges with certainty, and it does so in every instance. I am
reminded of the case of a patient of mine suffering from
obsessions, which were direct derivatives of infantile
masturbation. Her peculiarities, such as self-prohibitions and
self-punishments, the feeling that if she had done this she must
not do that, the idea that she must not be interrupted, the
introduction of pauses between one procedure (with her hands) and
the next, her hand-washing, etc, - all of these turned out to be
unaltered fragments of her nurse’s efforts to break her of
the habit. The only thing which had remained permanently in her
memory were the words of warning: ‘Ugh! That’s
dangerous!’ Compare also in this connection my
Three
Essays on the Theory of Sexuality
, 1905
d
.

Fragment Of An Analysis Of A Case Of Hysteria

1417

   There now arise a whole series of
questions of the greatest importance concerning the aetiology of
hysteria: is Dora’s case to be regarded as aetiologically
typical?  does it represent the only type of causation? and so
on. Nevertheless, I am sure that I am taking the right course in
postponing my answer to such questions until a considerable number
of other cases have been similarly analysed and published.
Moreover, I should have to begin by criticizing the way in which
the questions are framed. Instead of answering ‘Yes’ or
‘No’ to the question whether the aetiology of this case
is to be looked for in masturbation during childhood, I should
first have to discuss the concept of aetiology as applied to the
psychoneuroses. It would then become evident that the standpoint
from which I should be able to answer the question would be very
widely removed from the standpoint from which it was put. Let it
suffice if we can reach the conviction that in this case the
occurrence of masturbation in childhood is established, and that
its occurrence cannot be an accidental element nor an immaterial
one in the conformation of the clinical picture.¹

  
¹
Dora’s brother must have been
concerned in some way with her having acquired the habit of
masturbation; for in this connection she told me, with all the
emphasis which betrays the presence of a ‘screen
memory’, that her brother used regularly to pass on all his
infectious illnesses to her, and that while he used to have them
lightly she used, on the contrary, to have them severely. In the
dream her brother as well as she was saved from
‘destruction’; he, too, had been subject to
bed-wetting, but had got over the habit before his sister. Her
declaration that she had been able to keep abreast with her brother
up to the time of her first illness, but that after that she had
fallen behind him in her studies, was in a certain sense also a
‘screen memory’. It was as though she had been a boy up
till that moment, and had then become girlish for the first time.
She had in truth been a wild creature; but after the
‘asthma’ she became quiet and well-behaved. That
illness formed the boundary between two phases of her sexual life,
of which the first was masculine in character, and the second
feminine.