rather gruffly that he or she go back in order to rectify the omission, even though it be an elegant gentleman or a lady in all her finery. This gives an impression of misapplied pedantry. I have, in fact, occasionally discredited myself by such a demand, since the individual concerned was one of those who cannot touch even a door knob, and prefer as well to have their attendants spared this contact. But most frequently I was right, for he who conducts himself in this way, and leaves the door from the waiting room into the physician’s consultation room open, belongs to the rabble and deserves to be received inhospitably. Do not, I beg you, defend him until you have heard what follows. For the fact is that this negligence of the patient’s only occurs when he has been alone in the waiting room and so leaves an empty room behind him, never when others, strangers, have been waiting with him. If that latter is the case, he knows very well that it is in his interest not to be listened to while he is talking to the physician, and never omits to close both the doors with care.
This omission of the patient’s is so predetermined that it becomes neither accidental nor meaningless, indeed, not even unimportant, for, as we shall see, it throws light upon the relation of this patient to the physician. He is one of the great number of those who seek authority, who want to be dazzled, intimidated. Perhaps he had inquired by telephone as to what time he had best call, he had prepared himself to come on a crowd of suppliants somewhat like those in front of a branch milk station. He now enters an empty waiting room which is, moreover, most modestly furnished, and he is disappointed. He must demand reparation from the physician for the wasted respect that he had tendered him, and so he omits to close the door between the reception room and the office. By this, he means to say to the physician: “Oh, well, there is no one here anyway, and probably no one will come as long as I am here.” He would also be quite unmannerly and supercilious during the consultation if his presumption were not at once restrained by a sharp reminder.
You will find nothing in the analysis of this little symptomatic act which was not previously known to you. That is to say, it asserts that this act is not accidental, but has a motive, a meaning, a purpose, that it has its assignable connections psychologically, and that it serves as a small indication of a more important psychological process. But above all it implies that the process thus intimated is not known to the consciousness of the individual in whom it takes place, for none of the patients who left the two doors open would have admitted that they meant by this omission to show me their contempt. Some could probably recall a slight sense of disappointment at entering an empty waiting room, but the connection between this impression and the symptomatic act which followed — of these, his consciousness was surely not aware.
Now let us place, side by side with this small analysis of a symptomatic act, an observation on a pathological case. I choose one which is fresh in my mind and which can also be described with relative brevity. A certain measure of minuteness of detail is unavoidable in any such account.
A young officer, home on a short leave of absence, asked me to see his mother-in-law who, in spite of the happiest circumstances, was embittering her own and her people’s existence by a senseless idea. I am introduced to a well preserved lady of fifty-three with pleasant, simple manners, who gives the following account without any hesitation: She is most happily married and lives in the country with her husband, who operates a large factory. She cannot say enough for the kind thoughtfulness of her husband. They had married for love thirty years ago, and since then there had never been a shadow, a quarrel or cause for jealousy. Now, even though her two children are well married, the husband and father does not yet want to retire, from a feeling of duty. A year ago there happened the incredible thing, incomprehensible to herself as well. She gave complete credence to an anonymous letter which accused her excellent husband of having an affair with a young girl — and since then her happiness is destroyed. The more detailed circumstances were somewhat as follows: She had a chambermaid with whom she had perhaps too often discussed intimate matters. This girl pursued another young woman with positively malicious enmity because the latter had progressed so much further in life, despite the fact that she was of no better origin. Instead of going into domestic service, the girl had obtained a business training, had entered the factory and in consequence of the short-handedness due to the drafting of the clerks into the army had advanced to a good position. She now lives in the factory itself, meets all the gentlemen socially, and is even addressed as “Miss.” The girl who had remained behind in life was of course ready to speak all possible evil of her one-time schoolmate. One day our patient and her chambermaid were talking of an old gentleman who had been visiting at the house, and of whom it was known that he did not live with his wife, but kept another woman as his mistress. She does not know how it happened that she suddenly remarked, “That would be the most awful thing that could happen to me, if I should ever hear that my good husband also had a mistress.” The next day she received an anonymous letter through the mail which, in a disguised handwriting, carried this very communication which she had conjured up. She concluded — it seems justifiably — that the letter was the handiwork of her malignant chambermaid, for the letter named as the husband’s mistress the self-same woman whom the maid persecuted with her hatred. Our patient, in spite of the fact that she immediately saw through the intrigue and had seen enough in her town to know how little credence such cowardly denunciations deserve, was nevertheless at once prostrated by the letter. She became dreadfully excited and promptly sent for her husband in order to heap the bitterest reproaches upon him. Her husband laughingly denied the accusation and did the best that could be done. He called in the family physician, who was as well the doctor in attendance at the factory, and the latter added his efforts to quiet the unhappy woman. Their further procedure was also entirely reasonable. The chambermaid was dismissed, but the pretended rival was not. Since then, the patient claims she has repeatedly so far calmed herself as no longer to believe the contents of the anonymous letter, but this relief was neither thoroughgoing nor lasting. It was enough to hear the name of the young lady spoken or to meet her on the street in order to precipitate a new attack of suspicion, pain and reproach.
This, now, is the case history of this good woman. It does not need much psychiatric experience to understand that her portrayal of her own case was, if anything, rather too mild in contrast to other nervous patients. The picture, we say, was dissimulated; in reality she had never overcome her belief in the accusation of the anonymous letter.
Now what position does a psychiatrist take toward such a case? We already know what he would do in the case of the symptomatic act of the patient who does not close the doors to the waiting room. He declares it an accident without psychological interest, with which he need not concern himself. But this attitude cannot be maintained toward the pathological case of the jealous woman. The symptomatic act seems no great matter, but the symptom itself claims attention by reason of its gravity. It is bound up with intense subjective suffering while objectively it threatens to break up a home; therefore its claim to psychiatric interest cannot be put aside. The first endeavor of the psychiatrist is to characterize the symptom by some distinctive feature. The idea with which this woman torments herself cannot in itself be called nonsensical, for it does happen that elderly married men have affairs with young girls. But there is something else about it that is nonsensical and incredible. The patient has no reason beyond the declaration in the anonymous letter to believe that her tender and faithful husband belongs to this sort of married men, otherwise not uncommon. She knows that this letter in itself carries no proof; she can satisfactorily explain its origin; therefore she ought to be able to persuade herself that she has no reason to be jealous. Indeed she does this, but in spite of it she suffers every bit as much as she would if she acknowledged this jealousy as fully justified. We are agreed to call ideas of this sort, which are inaccessible to arguments based on logic or on facts, “obsessions.” Thus the good lady suffers from an “obsession of jealousy” that is surely a distinctive characterization for this pathological case.
Having reached this first certainty, our psychiatric interest will have become aroused. If we cannot do away with a delusion by taking reality into account, it can hardly have arisen from reality. But the delusion, what is its origin? There are delusions of the most widely varied content. Why is it that in our case the content should be jealousy? In what types of persons are obsessions liable to occur, and, in particular, obsessions
