Freud - Complete Works (365 page)

Analysis Of A Phobia In A Five-Year-Old Boy

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   But I must now enquire what harm
was done to Hans by dragging to light in him complexes such as are
not only repressed by children but dreaded by their parents. Did
the little boy proceed to take some serious action as regards what
he wanted from his mother? or did his evil intentions against his
father give place to evil deeds? Such misgivings will no doubt have
occurred to many doctors, who misunderstand the nature of
psycho-analysis and think that wicked instincts are strengthened by
being made conscious. Wise men like these are being no more than
consistent when they implore us for heaven’s sake not to
meddle with the evil things that lurk behind a neurosis. In so
doing they forget, it is true, that they are physicians, and their
words bear a fatal resemblance to Dogberry’s, when he advised
the Watch to avoid all contact with any thieves they might happen
to meet: ‘for such kind of men, the less you meddle or make
with them, why, the more is for your honesty.’¹

   On the contrary, the only results
of the analysis were that Hans recovered, that he ceased to be
afraid of horses, and that he got on to rather familiar terms with
his father, as the latter reported with some amusement. But
whatever his father may have lost in the boy’s respect he won
back in his confidence: ‘I thought’, said Hans,
‘you knew everything, as you knew that about the
horse.’ For analysis does not undo the
effects
of
repression. The instincts which were formerly suppressed remain
suppressed; but the same effect is produced in a different way.
Analysis replaces the process of repression, which is an automatic
and excessive one, by a temperate and purposeful control on the
part of the highest agencies of the mind. In a word,
analysis
replaces repression by condemnation
. This seems to bring us the
long-looked-for evidence that consciousness has a biological
function, and that with its entrance upon the scene an important
advantage is secured.²

  
¹
At this point I cannot keep back an
astonished question. Where do my opponents obtain their knowledge,
which they produce with so much confidence, on the question whether
the repressed sexual instincts play a part, and if so what part, in
the aetiology of the neuroses, if they shut their patients’
mouths as soon as they begin to talk about their complexes or their
derivatives? For the only alternative source of knowledge remaining
open to them are my own writings and those of my
adherents.

  
²
[
Footnote added
1923:] I am here
using the word ‘consciousness’ in a sense which I later
avoided, namely, to describe our normal processes of thought -
such, that is, as are capable of consciousness. We know that
thought processes of this kind may also take place
preconsciously
; and it is wiser to regard their actual
‘consciousness’ from a purely phenomenological
standpoint. By this I do not, of course, mean to contradict the
expectation that consciousness in this more limited sense of the
word must also fulfil some biological function.

Analysis Of A Phobia In A Five-Year-Old Boy

2122

   If matters had lain entirely in
my hands, I should have ventured to give the child the one
remaining piece of enlightenment which his parents withheld from
him. I should have confirmed his instinctive premonitions, by
telling him of the existence of the vagina and of copulation; thus
I should have still further diminished his unsolved residue, and
put an end to his stream of questions. I am convinced that this new
piece of enlightenment would have made him lose neither his love
for his mother nor his own childish nature, and that he would have
understood that his preoccupation with these important, these
momentous things must rest for the present - until his wish to be
big had been fulfilled. But the educational experiment was not
carried so far.

   That no sharp line can be drawn
between ‘neurotic’ and ‘normal’ people -
whether children or adults - that our conception of
‘disease’ is a purely practical one and a question of
summation, that predisposition and the eventualities of life must
combine before the threshold of this summation is overstepped, and
that consequently a number of individuals are constantly passing
from the class of healthy people into that of neurotic patients,
while a far smaller number also make the journey in the opposite
direction, - all of these are things which have been said so often
and have met with so much agreement that I am certainly not alone
in maintaining their truth. It is, to say the least of it,
extremely probable that a child’s upbringing can exercise a
powerful influence for good or for evil upon the predisposition
which we have just mentioned as one of the factors in the
occurrence of ‘disease’; but what that upbringing is to
aim at and at what point it is to be brought to bear seem at
present to be very doubtful questions. Hitherto education has only
set itself the task of controlling, or, it would often be more
proper to say, of suppressing, the instincts. The results have been
by no means gratifying, and where the process has succeeded it has
only been to the advantage of a small number of favoured
individuals who have not been required to suppress their instincts.
Nor has any one enquired by what means and at what cost the
suppression of the inconvenient instincts has been achieved.
Supposing now that we substitute another task for this one, and aim
instead at making the individual capable of becoming a civilized
and useful member of society with the least possible sacrifice of
his own activity; in that case the information gained by
psycho-analysis, upon the origin of pathogenic complexes and upon
the nucleus of every nervous affection, can claim with justice that
it deserves to be regarded by educators as an invaluable guide in
their conduct towards children. What practical conclusions may
follow from this, and how far experience may justify the
application of those conclusions within our present social system,
are matters which I leave to the examination and decision of
others.

Analysis Of A Phobia In A Five-Year-Old Boy

2123

   I cannot take leave of our small
patient’s phobia without giving expression to a notion which
has made its analysis, leading as it did to a recovery, seem of
especial value to me. Strictly speaking, I learnt nothing new from
this analysis, nothing that I had not already been able to discover
(though often less distinctly and more indirectly) from other
patients analysed at a more advanced age. But the neuroses of these
other patients could in every instance be traced back to the same
infantile complexes that were revealed behind Hans’s phobia.
I am therefore tempted to claim for this neurosis of childhood the
significance of being a type and a model, and to suppose that the
multiplicity of the phenomena of repression exhibited by neuroses
and the abundance of their pathogenic material do not prevent their
being derived from a very limited number of processes concerned
with identical ideational complexes.

Analysis Of A Phobia In A Five-Year-Old Boy

2124

POSTSCRIPT (1922)

A few months ago - in the spring of 1922 - a
young man introduced himself to me and informed me that he was the
‘little Hans’ whose infantile neurosis had been the
subject of the paper which I published in 1909. I was very glad to
see him again, for about two years after the end of his analysis I
had lost sight of him and had heard nothing of him for more than
ten years. The publication of this first analysis of a child had
caused a great stir and even greater indignation, and a most evil
future had been foretold for the poor little boy, because he had
been ‘robbed of his innocence’ at such a tender age and
had been made the victim of a psycho-analysis.

   But none of these apprehensions
had come true. Little Hans was now a strapping youth of nineteen.
He declared that he was perfectly well, and suffered from no
troubles or inhibitions. Not only had he come through his puberty
without any damage, but his emotional life had successfully
undergone one of the severest of ordeals. His parents had been
divorced and each of them had married again. In consequence of this
he lived by himself; but he was on good terms with both of his
parents, and only regretted that as a result of the breaking-up of
the family he had been separated from the younger sister he was so
fond of.

   One piece of information given me
by little Hans struck me as particularly remarkable; nor do I
venture to give any explanation of it. When he read his case
history, he told me, the whole of it came to him as something
unknown; he did not recognize himself; he could remember nothing;
and it was only when he came upon the journey to Gmunden that there
dawned on him a kind of glimmering recollection that it might have
been he himself that it happened to. So the analysis had not
preserved the events from amnesia, but had been overtaken by
amnesia itself. Any one who is familiar with psycho-analysis may
occasionally experience something similar in sleep. He will be
woken up by a dream, and will decide to analyse it then and there;
he will then go to sleep again feeling quite satisfied with the
result of his efforts; and next morning dream and analysis will
alike be forgotten.

2125

NOTES UPON A CASE OF OBSESSIONAL NEUROSIS

(1909)

2126

Intentionally left blank

2127

NOTES UPON A CASE OF OBSESSIONAL NEUROSIS

The matter contained in the following pages
will be of two kinds. In the first place I shall give some
fragmentary extracts from the history of a case of obsessional
neurosis. This case judged by its length, the injuriousness of its
effects, and the patient’s own view of it, deserves to be
classed as a moderately severe one; the treatment, which lasted for
about a year, led to the complete restoration of the
patient’s personality, and to the removal of his inhibitions.
In the second place, starting out from this case, and also taking
other cases into account which I have previously analysed, I shall
make some disconnected statements of an aphoristic character upon
the genesis and finer psychological mechanism of obsessional
processes, and I shall thus hope to develop my first observations
on the subject, published in 1896.¹

   A programme of this kind seems to
me to require some justification. For it might otherwise be thought
that I regard this method of making a communication as perfectly
correct and as one to be imitated; whereas in reality I am only
accommodating myself to obstacles, some external and others
inherent in the subject, and I should gladly have communicated more
if it had been right or possible for me to do so. I cannot give a
complete history of the treatment, because that would involve my
entering in detail into the circumstances of my patient’s
life. The importunate interest of a capital city, focused with
particular attention upon my medical activities, forbids my giving
a faithful picture of the case. On the other hand I have come more
and more to regard the distortions usually resorted to in such
circumstances as useless and objectionable. If the distortions are
slight, they fail in their object of protecting the patient from
indiscreet curiosity; while if they go beyond this they require too
great a sacrifice, for they destroy the intelligibility of the
material, which depends for its coherence precisely upon the small
details of real life. And from this latter circumstance follows the
paradoxical truth that it is far easier to divulge the
patient’s most intimate secrets than the most innocent and
trivial facts about him; for, whereas the former would not throw
any light on his identity, the latter, by which he is generally
recognized, would make it obvious to every one.

  
¹
‘Further Remarks on the
Neuro-Psychoses of Defence’, 1896
b
(Section II.
‘The Nature and Mechanism of Obsessional
Neurosis’).

Notes Upon A Case Of Obsessional Neurosis

2128

   Such is my excuse for having
curtailed so drastically the history of this case and its
treatment. And I can offer still more cogent reasons for having
confined myself to the statement only of some disconnected results
of the psycho-analytic investigation of obsessional neuroses. I
must confess that I have not yet succeeded in completely
penetrating the complicated texture of a
severe
case of
obsessional neurosis, and that, if I were to reproduce the
analysis, it would be impossible for me to make the structure, such
as by the help of analysis we know or suspect it to be, visible to
others through the mass of therapeutic work superimposed upon it.
What add so greatly to the difficulty of doing this are the
resistances of the patients and the forms in which they are
expressed. But even apart from this it must be admitted that an
obsessional neurosis is in itself not an easy thing to understand -
much less so than a case of hysteria. Actually, indeed, we should
have expected to find the contrary. The language of an obsessional
neurosis - the means by which it expresses its secret thoughts -
is, as it were, only a dialect of the language of hysteria; but it
is a dialect in which we ought to be able to find our way about
more easily, since it is more nearly related to the forms of
expression adopted by our conscious thought than is the language of
hysteria. Above all, it does not involve the leap from a mental
process to a somatic innervation - hysterical conversion - which
can never be fully comprehensible to us.

   Perhaps it is only because we are
less familiar with obsessional neuroses that we do not find these
expectations confirmed by the facts. Persons suffering from a
severe degree of obsessional neurosis present themselves far less
frequently for analytic treatment than hysterical patients. They
dissimulate their condition in daily life, too, as long as they
possibly can, and often call in a physician only when their
complaint has reached such an advanced stage as, had they been
suffering, for instance, from tuberculosis of the lungs, would have
led to their being refused admission to a sanatorium. I make this
comparison, moreover, because, as with the chronic infectious
disease which I have just mentioned, we can point to a number of
brilliant therapeutic successes in severe no less than in light
cases of obsessional neurosis, where these have been taken in hand
at an early stage.

   In these circumstances there is
no alternative but to report the facts in the imperfect and
incomplete fashion in which they are known and in which it is
legitimate to communicate them. The crumbs of knowledge offered in
these pages, though they have been laboriously enough collected,
may not in themselves prove very satisfying; but they may serve as
a starting-point for the work of other investigators, and common
endeavour may bring the success which is perhaps beyond the reach
of individual effort.

Notes Upon A Case Of Obsessional Neurosis

2129

I

EXTRACTS FROM THE CASE HISTORY

A youngish man of university education
introduced himself to me with the statement that he had suffered
from obsessions ever since his childhood, but with particular
intensity for the last four years. The chief features of his
disorder were
fears
that something might happen to two
people of whom he was very fond - his father and a lady whom he
admired. Besides this he was aware of
compulsive impulses
-
such as an impulse, for instance, to cut his throat with a razor;
and further he produced
prohibitions
, sometimes in
connection with quite unimportant things. He had wasted years, he
told me, in fighting against these ideas of his, and in this way
had lost much ground in the course of his life. He had tried
various treatments, but none had been of any use to him except a
course of hydrotherapy at a sanatorium near ---; and this, he
thought, had probably only been because he had made an acquaintance
there which had led to regular sexual intercourse. Here he had no
opportunities of the sort, and he seldom had intercourse and only
at irregular intervals. He felt disgust at prostitutes. Altogether,
he said, his sexual life had been stunted; masturbation had played
only a small part in it, in his sixteenth or seventeenth year. His
potency was normal; he had first had intercourse at the age of
twenty-six.

   He gave me the impression of
being a clear-headed and shrewd person. When I asked him what it
was that made him lay such stress upon telling me about his sexual
life, he replied that that was what he knew about my theories.
Actually, however, he had read none of my writings, except that a
short time before he had been turning over the pages of one of my
books¹ and had come across the explanation of some curious
verbal associations which had so much reminded him of some of his
own ‘efforts of thought’ in connection with his ideas
that he had decided to put himself in my hands.

  
¹
The Psychopathology of Everyday
Life
.

Notes Upon A Case Of Obsessional Neurosis

2130

(A)  THE BEGINNING OF THE
TREATMENT

   The next day I made him pledge
himself to submit to the one and only condition of the treatment -
namely, to say everything that came into his head, even if it was
unpleasant
to him, or seemed
unimportant
or
irrelevant
or
senseless
. I then gave him leave to
start his communications with any subject he pleased, and he began
thus:¹

   He had a friend, he told me, of
whom he had an extraordinarily high opinion. He used always to go
to him when he was tormented by some criminal impulse, and ask him
whether he despised him as a criminal. His friend used then to give
him moral support by assuring him that he was a man of
irreproachable conduct, and had probably been in the habit, from
his youth onwards, of taking a dark view of his own life. At an
earlier date, he went on, another person had exercised a similar
influence over him. This was a nineteen-year-old student (he
himself had been fourteen or fifteen at the time) who had taken a
liking to him, and had raised his self-esteem to an extraordinary
degree, so that he appeared to himself to be a genius. This student
had subsequently become his tutor, and had suddenly altered his
behaviour and begun treating him as though he were an idiot. At
length he had noticed that the student was interested in one of his
sisters, and had realized that he had only taken him up in order to
gain admission into the house. This had been the first great blow
of his life.

   He then proceeded without any
apparent transition:-

  
¹
What follows is based upon notes made on
the evening of the day of treatment, and adheres as closely as
possible to my recollection of the patient’s words. - I feel
obliged to offer a warning against the practice of noting down what
the patient says during the actual time of treatment. The
consequent withdrawal of the physician’s attention does the
patient more harm than can be made up for by any increase in
accuracy that may be achieved in the reproduction of his case
history.

Notes Upon A Case Of Obsessional Neurosis

2131

(B)  INFANTILE SEXUALITY

   ‘My sexual life began very
early. I can remember a scene during my fourth or fifth year. (From
my sixth year onwards I can remember everything.) This scene came
into my head quite distinctly, years later. We had a very pretty
young governess called Fräulein Peter.¹ One evening she
was lying on the sofa lightly dressed, and reading. I was lying
beside her, and begged her to let me creep under her skirt. She
told me I might, so long as I said nothing to any one about it. She
had very little on, and I fingered her genitals and the lower part
of her body, which struck me as very queer. After this I was left
with a burning and tormenting curiosity to see the female body. I
can still remember the intense excitement with which I waited at
the Baths (which I was still allowed to go to with the governess
and my sisters) for the governess to undress and get into the
water. I can remember more things from my sixth year onwards. At
that time we had another governess, who was also young and
good-looking. She had abscesses on her buttocks which she was in
the habit of pressing out at night. I used to wait eagerly for that
moment, to appease my curiosity. It was just the same at the Baths
- though Fräulein Lina was more reserved than her
predecessor.’ (In reply to a question which I threw in,
‘As a rule,’ the patient told me, ‘I did not
sleep in her room, but mostly with my parents.’) ‘I
remember a scene which must have taken place when I was seven years
old.² We were sitting together one evening - the governess,
the cook, another servant-girl, myself and my brother, who was
eighteen months younger than me. The young women were talking, and
I suddenly became aware of Fräulein Lina saying: "It
could be done with the little one; but Paul" (that was I)
"is too clumsy, he would be sure to miss it." I did not
understand clearly what was meant, but I felt the slight and began
to cry. Lina comforted me, and told me how a girl, who had done
something of the kind with a little boy she was in charge of, had
been put in prison for several months. I do not believe she
actually did anything wrong with me, but I took a great many
liberties with her. When I got into her bed I used to uncover her
and touch her, and she made no objections. She was not very
intelligent, and clearly had very strong sexual cravings. At
twenty-three she had already had a child. She afterwards married
its father, so that to-day she is a Frau Hofrat. Even now I often
see her in the street.

  
¹
Dr. Alfred Adler, who was formerly an
analyst, once drew attention in a privately delivered paper to the
peculiar importance which attaches to the
very first
communications made by patients. Here is an instance of this. The
patient’s opening words laid stress upon the influence
exercised over him by men, that is to say, upon the part played in
his life by homosexual object-choice; but immediately afterwards
they touched upon a second
motif
, which was to become of
great importance later on, namely, the conflict between man and
woman and the opposition of their interests. Even the fact that he
remembered his first pretty governess by her surname, which
happened to be a man’s first name, must be taken into account
in this connection. In middle-class circles in Vienna it is more
usual to call a governess by her first name, and it is by that name
that she is more commonly remembered.