originally a most energetic character, often of extraordinary obstinacy, as a rule intellectually gifted above the average. For the most part he has attained a desirable stage of ethical development, is overconscientious and more than usually correct. You can imagine that it takes no inconsiderable piece of work to find one’s way through this maze of contradictory characteristics and symptoms. Indeed, for the present our only object is to understand and to interpret some symptoms of this disease.
Perhaps in reference to our previous discussions, you would like to know the position of present-day psychiatry to the problems of the compulsion neurosis. This is covered in a very slim chapter. Psychiatry gives names to the various forms of compulsion, but says nothing further concerning them. Instead it emphasizes the fact that those who show these symptoms are degenerates. That yields slight satisfaction, it is an ethical judgment, a condemnation rather than an explanation. We are led to suppose that it is in the unsound that all these peculiarities may be found. Now we do believe that persons who develop such symptoms must differ fundamentally from other people. But we would like to ask, are they more “degenerate” than other nervous patients, those suffering, for instance, from hysteria or other diseases of the mind? The characterization is obviously too general. One may even doubt whether it is at all justified, when one learns that such symptoms occur in excellent men and women of especially great and universally recognized ability. In general we glean very little intimate knowledge of the great men who serve us as models. This is due both to their own discretion and to the lying propensities of their biographers. Sometimes, however, a man is a fanatic disciple of truth, such as Emile Zola, and then we hear from him the strange compulsion habits from which he suffered all his life.38
Psychiatry has resorted to the expedient of speaking of “superior degenerates.” Very well — but through psychoanalysis we have learned that these peculiar compulsion symptoms may be permanently removed just like any other disease of normal persons. I myself have frequently succeeded in doing this.
I will give you two examples only of the analysis of compulsion symptoms, one, an old observation, which cannot be replaced by anything more complete, and one a recent study. I am limiting myself to such a small number because in an account of this nature it is necessary to be very explicit and to enter into every detail.
A lady about thirty years old suffered from the most severe compulsions. I might indeed have helped her if caprice of fortune had not destroyed my work — perhaps I will yet have occasion to tell you about it. In the course of each day the patient often executed, among others, the following strange compulsive act. She ran from her room into an adjoining one, placed herself in a definite spot beside a table which stood in the middle of the room, rang for her maid, gave her a trivial errand to do, or dismissed her without more ado, and then ran back again. This was certainly not a severe symptom of disease, but it still deserved to arouse curiosity. Its explanation was found, absolutely without any assistance on the part of the physician, in the very simplest way, a way to which no one can take exception. I hardly know how I alone could have guessed the meaning of this compulsive act, or have found any suggestion toward its interpretation. As often as I had asked the patient: “Why do you do this? Of what use is it?” she had answered, “I don’t know.” But one day after I had succeeded in surmounting a grave ethical doubt of hers she suddenly saw the light and related the history of the compulsive act. More than ten years prior she had married a man far older than herself, who had proved impotent on the bridal night. Countless times during the night he had run from his room to hers to repeat the attempt, but each time without success. In the morning he said angrily: “It is enough to make one ashamed before the maid who does the beds,” and took a bottle of red ink that happened to be in the room, and poured its contents on the sheet, but not on the place where such a stain would have been justifiable. At first I did not understand the connection between this reminiscence and the compulsive act in question, for the only agreement I could find between them was in the running from one room into another — possibly also in the appearance of the maid. Then the patient led me to the table in the second room and let me discover a large spot on the cover. She explained also that she placed herself at the table in such a way that the maid could not miss seeing the stain. Now it was no longer possible to doubt the intimate relation of the scene after her bridal night and her present compulsive act, but there were still a number of things to be learned about it.
In the first place, it is obvious that the patient identifies herself with her husband, she is acting his part in her imitation of his running from one room into the other. We must then admit — if she holds to this role — that she replaces the bed and sheet by table and cover. This may seem arbitrary, but we have not studied dream symbolism in vain. In dreams also a table which must be interpreted as a bed, is frequently seen. “Bed and board” together represent married life, one may therefore easily be used to represent the other.
The evidence that the compulsive act carries meaning would thus be plain; it appears as a representation, a repetition of the original significant scene. However, we are not forced to stop at this semblance of a solution; when we examine more closely the relation between these two people, we shall probably be enlightened concerning something of wider importance, namely, the purpose of the compulsive act. The nucleus of this purpose is evidently the summoning of the maid; to her she wishes to show the stain and refute her husband’s remark: “It is enough to shame one before the maid.” He — whose part she is playing — therefore feels no shame before the maid, hence the stain must be in the right place. So we see that she has not merely repeated the scene, rather she has amplified it, corrected it and “turned it to the good.” Thereby, however, she also corrects something else — the thing which was so embarrassing that night and necessitated the use of the red ink — impotence. The compulsive act then says: “No, it is not true, he did not have to be ashamed before the maid, he was not impotent.” After the manner of a dream she represents the fulfillment of this wish in an overt action, she is ruled by the desire to help her husband over that unfortunate incident.
Everything else that I could tell you about this case supports this clue more specifically; all that we otherwise know about her tends to strengthen this interpretation of a compulsive act incomprehensible in itself. For years the woman has lived separated from her husband and is struggling with the intention to obtain a legal divorce. But she is by no means free from him; she forces herself to remain faithful to him, she retires from the world to avoid temptation; in her imagination she excuses and idealizes him. The deepest secret of her malady is that by means of it she shields her husband from malicious gossip, justifies her separation from him, and renders possible for him a comfortable separate life. Thus the analysis of a harmless compulsive act leads to the very heart of this case and at the same time reveals no inconsiderable portion of the secret of the compulsion neurosis in general. I shall be glad to have you dwell upon this instance, as it combines conditions that one can scarcely demand in other cases. The interpretation of the symptoms was discovered by the patient herself in one flash, without the suggestion or interference of the analyst. It came about by the reference to an experience, which did not, as is usually the case, belong to the half-forgotten period of childhood, but to the mature life of the patient, in whose memory it had remained unobliterated. All the objections which critics ordinarily offer to our interpretation of symptoms fail in this case. Of course, we are not always so fortunate.
And one thing more! Have you not observed how this insignificant compulsive act initiated us into the intimate life of the invalid? A woman can scarcely relate anything more intimate than the story of her bridal night, and is it without further significance that we just happened to come on the intimacies of her sexual life? It might of course be the result of the selection I have made in this instance. Let us not judge too quickly and turn our attention to the second instance, one of an entirely different kind, a sample of a frequently occurring variety, namely, the sleep ritual.
A nineteen-year old, well-developed, gifted girl, an only child, who was superior to her parents in education and intellectual activity, had been wild and mischievous in her childhood, but has become very nervous during the last years without any apparent outward cause. She is
