Freud - Complete Works (251 page)

Fragment Of An Analysis Of A Case Of Hysteria

1418

   A consideration of the
significance of the leucorrhoea to which Dora admitted promises to
give us a still better understanding of her symptoms. She had
learnt to call her affection a ‘catarrh’ at the time
when her mother had had to visit Franzensbad on account of a
similar complaint; and the word ‘catarrh’ acted once
again as a ‘switch-word’ and enabled the whole set of
thoughts upon her father’s responsibility for her illness to
manifest themselves in the symptom of the cough. The cough, which
no doubt originated in the first instance from a slight actual
catarrh, was, moreover, an imitation of her father (whose lungs
were affected), and could serve as an expression of her sympathy
and concern for him. But besides this, it proclaimed aloud, as it
were, something of which she may then have been still unconscious:
‘I am my father’s daughter. I have a catarrh, just as
he has. He has made me ill, just as he has made Mother ill. It is
from him that I have got my evil passions, which are punished by
illness.’¹

  
¹
This word played the same part with the
fourteen-year old girl whose case history I have compressed into a
few lines on
p. 1365 
n
.
I
had established the child in a pension with an intelligent lady,
who took charge of her for me. The lady reported that the little
girl could not bear her to be in the room while she was going to
bed, and that when she was in bed she had a marked cough, of which
there was no trace in the daytime. When the girl was questioned
about these symptoms, the only thing that occurred to her was that
her grandmother coughed in the same way, and that she was said to
have a catarrh. It was clear from this that the child herself had a
catarrh, and that she did not want to be observed while she
performed her evening ablutions. This catarrh which, thanks to its
name, had been
displaced from the lower to the upper part of her
body
, exhibited a quite unusual degree of intensity.

Fragment Of An Analysis Of A Case Of Hysteria

1419

   Let us next attempt to put
together the various determinants that we have found for
Dora’s attacks of coughing and hoarseness. In the lowest
stratum we must assume the presence of real and organically
determined irritation of the throat - which acted like the grain of
sand around which an oyster forms its pearl. This irritation was
susceptible to fixation, because it concerned a part of the body
which in Dora had to a high degree retained its significance as an
erotogenic zone. And the irritation was consequently well fitted to
give expression to excited states of the libido. It was brought to
fixation by what was probably its first psychical coating - her
sympathetic imitation of her father - and by her subsequent
self-reproaches on account of her ‘catarrh’. The same
group of symptoms, moreover, showed itself capable of representing
her relations with Herr K.; it could express her regret at his
absence and her wish to make him a better wife. After a part of her
libido had once more turned towards her father, the symptom
obtained what was perhaps its last meaning; it came to represent
sexual intercourse with her father by means of Dora’s
identifying herself with Frau K. I can guarantee that this series
is by no means complete. Unfortunately, an incomplete analysis
cannot enable us to follow the chronological sequence of the
changes in a symptom’s meaning, or to display clearly the
succession and coexistence of its various meanings. It may
legitimately be expected of a complete analysis that it should
fulfil these demands.

   I must now proceed to touch upon
some further relations existing between Dora’s genital
catarrh and her hysterical symptoms. At a time when any
psychological elucidation of hysteria was still very remote, I used
to hear experienced fellow-doctors who were my seniors maintain
that in the case of hysterical patients suffering from leucorrhoea
any increase in the catarrh was regularly followed by an
intensification of the hysterical troubles, and especially of loss
of appetite and vomiting. No one was very clear about the nature of
the connection but I fancy the general inclination was towards the
opinion held by gynaecologists. According to their hypothesis, as
is well known, disorders of the genitals exercise upon the nervous
functions a direct and far-reaching influence in the nature of an
organic disturbance - though a therapeutic test of this theory is
apt to leave one in the lurch. In the light of our present
knowledge we cannot exclude the possibility of the existence of a
direct organic influence of this sort; but it is at all events
easier to indicate its psychical coating. The pride taken by women
in the appearance of their genitals is quite a special feature of
their vanity; and disorders of the genitals which they think
calculated to inspire feelings of repugnance or even disgust have
an incredible power of humiliating them, of lowering their
self-esteem, and of making them irritable, sensitive, and
distrustful. An abnormal secretion of the mucous membrane of the
vagina is looked upon as a source of disgust.

Fragment Of An Analysis Of A Case Of Hysteria

1420

   It will be remembered that Dora
had a lively feeling of disgust after being kissed by Herr K., and
that we saw grounds for completing her story of the scene of the
kiss by supposing that, while she was being embraced, she noticed
the pressure of the man’s erect member against her body. We
now learn further that the same governess whom Dora cast off on
account of her faithlessness had, from her own experience of life,
propounded to Dora the view that all men were frivolous and
untrustworthy. To Dora that must mean that all men were like her
father. But she thought her father suffered from venereal disease -
for had he not handed it on to her and her mother? She might
therefore have imagined to herself that all men suffered from
venereal disease, and naturally her conception of venereal disease
was modelled on her one experience of it - a personal one at that.
To suffer from venereal disease, therefore, meant for her to be
afflicted with a disgusting discharge. So may we not have here a
further motive for the disgust she felt at the moment of the
embrace? Thus the disgust which was transferred on to the contact
of the man would be a feeling which had been projected according to
the primitive mechanism I have already mentioned (
p. 1373
), and would be related
ultimately to her own leucorrhoea.

   I suspect that we are here
concerned with unconscious processes of thought which are twined
around a pre-existing structure of organic connections, much as
festoons of flowers are twined around a wire; so that on another
occasion one might find other lines of thought inserted between the
same points of departure and termination. Yet a knowledge of the
thought connections which have been effective in the individual
case is of a value which cannot be exaggerated for clearing up the
symptoms. It is only because the analysis was prematurely broken
off that we have been obliged in Dora’s case to resort to
framing conjectures and filling in deficiencies. Whatever I have
brought forward for filling up the gaps is based upon other cases
which have been more thoroughly analysed.

Fragment Of An Analysis Of A Case Of Hysteria

1421

   The dream from the analysis of
which we have derived this information corresponded, as we have
seen, to an intention which Dora carried with her into her sleep.
It was therefore repeated each night until the intention had been
carried out; and it reappeared years later when an occasion arose
for forming an analogous intention. The intention might have been
consciously expressed in some such words as these: ‘I must
fly from this house, for I see that my virginity is threatened
here; I shall go away with my father, and I shall take precautions
not to be surprised while I am dressing in the morning.’
These thoughts were clearly expressed in the dream; they formed
part of a mental current which had achieved consciousness and a
dominating position in waking life. Behind them can be discerned
obscure traces of a train of thought which formed part of a
contrary current and had consequently been suppressed. This other
train of thought culminated in the temptation to yield to the man,
out of gratitude for the love and tenderness he had shown her
during the last few years, and it may perhaps have revived the
memory of the only kiss she had so far had from him. But according
to the theory which I developed in my
Interpretation of
Dreams
such elements as these are not enough for the formation
of a dream. On that theory a dream is not an intention represented
as having been carried out, but a wish represented as having been
fulfilled, and, moreover, in most cases a wish dating from
childhood. It is our business now to discover whether this
principle may not be contradicted by the present dream.

Fragment Of An Analysis Of A Case Of Hysteria

1422

   The dream does in fact contain
infantile material, though it is impossible at a first glance to
discover any connections between that material and Dora’s
intention of flying from Herr K.’s house and the temptation
of his presence. Why should a recollection have emerged of her
bed-wetting when she was a child and of the trouble her father used
to take to teach the child clean habits? We may answer this by
saying that it was only by the help of this train of thought that
it was possible to suppress the other thoughts which were so
intensely occupied with the temptation to yield or that it was
possible to secure the dominance of the intention which had been
formed of combating those other thoughts. The child decided to fly
with
her father; in reality she fled
to
her father
because she was afraid of the man who was pursuing her; she
summoned up an infantile affection for her father so that it might
protect her against her present affection for a stranger. Her
father was himself partly responsible for her present danger, for
he had handed her over to this strange man in the interests of his
own love-affair. And how much better it had been when that same
father of hers had loved no one more than her, and had exerted all
his strength to save her from the dangers that had then threatened
her! The infantile, and now unconscious, wish to put her father in
the strange man’s place had the potency necessary for the
formation of a dream. If there were a past situation similar to a
present one, and differing from it only in being concerned with one
instead of with the other of the two persons mentioned in the wish,
that situation would become the main one in the dream. But there
had
been such a situation. Her father had once stood beside
her bed, just as Herr K. had the day before, and had woken her up,
with a kiss perhaps, as Herr K. may have meant to do. Thus her
intention of flying from the house was not in itself capable of
producing a dream; but it became so by being associated with
another intention which was founded upon infantile wishes. The wish
to replace Herr K. by her father provided the necessary motive
power for the dream. Let me recall the interpretation I was led to
adopt of Dora’s reinforced train of thought about her
father’s relations with Frau K. My interpretation was that
she had at that point summoned up an infantile affection for her
father so as to be able to keep her repressed love for Herr K. in
its state of repression. This same sudden revulsion in the
patient’s mental life was reflected in the dream.

Fragment Of An Analysis Of A Case Of Hysteria

1423

   I have made one or two
observations in my
Interpretation of Dreams
on the relation
between the waking thoughts which are continued into sleep (the
‘day’s residues’) and the unconscious wish which
forms the dream. I will quote them here as they stand, for I have
nothing to add to them, and the analysis of this dream of
Dora’s proves afresh that the facts are as I have supposed:
‘I am ready to admit that there is a whole class of dreams
the
instigation
to which arises principally or even
exclusively from the residues of daytime life; and I think that
even my wish that I might at long last become a Professor
Extraordinarius¹ might have allowed me to sleep through the
night in peace if my worry over my friend’s health had not
still persisted from the previous day. But the worry alone could
not have made a dream. The
motive force
which the dream
required had to be provided by a wish; it was the business of the
worry to get hold of a wish to act as the motive force of the
dream.

   ‘The position may be
explained by an analogy. A daytime thought may very well play the
part of
entrepeneur
for a dream; but the
entrepeneur
,
who, as people say, has the idea and the initiative to carry it
out, can do nothing without capital; he needs a
capitalist
who can afford the outlay, and the capitalist who provides the
psychical outlay for the dream is invariably and indisputably,
whatever may be the thoughts of the previous day,
a wish from
the unconscious
.’

   Any one who has learnt to
appreciate the delicacy of the fabric of structures such as dreams
will not be surprised to find that Dora’s wish that her
father might take the place of the man who was her tempter called
up in her memory not merely a casual collection of material from
her childhood, but precisely such material as was most intimately
bound up with the suppression of her temptation. For if Dora felt
unable to yield to her love for the man, if in the end she
repressed that love instead of surrendering to it, there was no
factor upon which her decision depended more directly than upon her
premature sexual enjoyment and its consequence - her bed-wetting,
her catarrh, and her disgust. An early history of this kind can
afford a basis for two kinds of behaviour in response to the
demands of love in maturity - which of the two will depend upon the
summation of constitutional determinants in the subject. He will
either exhibit an abandonment to sexuality which is entirely
without resistances and borders upon perversity; or there will be a
reaction - he will repudiate sexuality, and will at the same time
fall ill of a neurosis. In the case of our present patient, her
constitution and the high level of her intellectual and moral
upbringing decided in favour of the latter course.