Three Case Histories

Sigmund Freud

• Publisher: Touchstone
• Year: 2008
• ISBN:
  9781439108116
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

These histories reveal not only the working of the unconscious in paranoid and neurotic cases, but also the agility of Freud's own mind and his method for treating the disorders. Notes upon a case of obessional neurosis (1909)
Pscyhoanalytic notes upon an autobiographical account of a case of paranoia (dementia paranoides) (1911)
From the history of an infantile neurosis (1918)

FROM THE HISTORY
OF AN
INFANTILE NEUROSIS1 (1918)

I
Introductory Remarks

The case upon which I propose to report in the following pages (once again only in a fragmentary manner) is characterized by a number of peculiarities which require to be emphasized before I proceed to a description of the facts themselves. It is concerned with a young man whose health had broken down in his eighteenth year after a gonorrhoeal infection, and who was entirely incapacitated and completely dependent upon other people when he began his psychoanalytic treatment several years later. He had lived an approximately normal life during the ten years of his boyhood that preceded the date of his illness, and got through his studies at his secondary school without much trouble. But his earlier years were dominated by a severe neurotic disturbance, which began immediately before his fourth birthday in the shape of anxiety-hysteria (animal phobia), then changed into an obsessional neurosis with a religious content, and lasted with its offshoots as far as into his tenth year.

Only this infantile neurosis will be the subject of my communication. In spite of the patient’s direct request, I have abstained from writing a complete history of his illness, of his treatment, and of his recovery, because I recognized that such a task was technically impracticable and socially impermissible. This at the same time removes the possibility of demonstrating the connection between his illness in infancy and his later and permanent one. As regards the latter I can only say that on account of it the patient spent a long time in German sanatoriums, and was at that period classified in the most authoritative quarters as a case of “manic-depressive insanity.” This diagnosis was certainly applicable to the patient’s father, whose life, with its wealth of activity and interests, was disturbed by repeated attacks of severe depression. But in the son, I was never able, during an observation which lasted several years, to detect any changes of mood which were disproportionate to the apparent psychological situation either in their intensity or in the circumstances of their appearance. I have formed the opinion that this case, like many others which clinical psychiatry has labelled with the most multifarious and shifting diagnoses, is to be regarded as a condition following upon an obsessional neurosis which has come to an end spontaneously, but has left a defect behind it after recovery.

My description will therefore deal with an infantile neurosis which was analysed not while it actually existed, but only fifteen years after its termination. This state of things has its advantages as well as its disadvantages in comparison with the alternative. An analysis which is conducted upon a neurotic child itself must, as a matter of course, appear to be more trustworthy, but it cannot be very rich in material; too many words and thoughts have to be lent to the child, and even so the deepest strata may turn out to be impenetrable to consciousness. An analysis of a childhood disorder through the medium of recollection in an intellectually mature adult is free from these limitations; but it necessitates our taking into account the distortion and refurbishing to which a person’s own past is subjected when it is looked back upon from a later period. The first alternative perhaps gives the more convincing results; the second is by far the more instructive.

In any case it may be maintained that analyses of children’s neuroses can claim to possess a specially high theoretical interest. They afford us, roughly speaking, as much help towards a proper understanding of the neuroses of adults as do children’s dreams in respect to the dreams of adults. Not, indeed, that they are more perspicuous or poorer in elements; in fact, the difficulty of feeling one’s way into the mental life of a child makes them a particularly difficult piece of work for the physician. But nevertheless, so many of the later deposits are wanting in them that the essence of the neurosis springs to the eyes with unmistakable distinctness. In the present phase of the battle which is raging round psychoanalysis the resistance to its findings has, as we know, taken on a new form. People were content formerly to dispute the reality of the facts which are asserted by analysis; and for this purpose the best technique seemed to be to avoid examining them. That procedure appears to be slowly exhausting itself; and people are now adopting another plan—of recognizing the facts, but of eliminating, by means of twisted interpretations, the consequences that follow from them, so that the critics are defended against the objectionable novelties as efficiently as ever. The study of children’s neuroses exposes the complete inadequacy of these shallow or high-handed attempts at re-interpretation. It shows the predominant part that is played in the formation of neuroses by those libidinal motive forces which are so eagerly disavowed, and reveals the absence of any aspirations towards remote cultural aims, of which the child still knows nothing, and which cannot therefore be of any significance for him.

Another characteristic which makes the present analysis noteworthy is connected with the severity of the illness and the duration of the treatment. Analyses which lead to a favourable conclusion in a short time are of value in ministering to the therapeutist’s self-sufficiency and substantiate the medical importance of psychoanalysis; but they remain for the most part insignificant as regards the advancement of scientific knowledge. Nothing new is learnt from them. In fact they only succeed so quickly because everything that was necessary for their accomplishment was already known. Something new can only be gained from analyses that present special difficulties, and to the overcoming of these a great deal of time has to be devoted. Only in such cases do we succeed in descending into the deepest and most primitive strata of mental development and in gaining from there solutions for the problems of the later formations. And we feel afterwards that, strictly speaking, only an analysis which has penetrated so far deserves the name. Naturally a single case does not give us all the information that we should like to have. Or, to put it more correctly, it might teach us everything, if we were only in a position to make everything out, and if we were not compelled by the inexperience of our own perception to content ourselves with a little.

As regards these fertile difficulties the case I am about to discuss left nothing to be desired. The first years of the treatment produced scarcely any change. Owing to a fortunate concatenation, all of the external circumstances nevertheless combined to make it possible to proceed with the therapeutic experiment. I can easily believe that in less favourable circumstances the treatment would have been given up after a short time. Of the physician’s point of view I can only declare that in a case of this kind he must behave as “timelessly” as the unconscious itself, if he wishes to learn anything or to achieve anything. And in the end he will succeed in doing so, if he has the strength to renounce any short-sighted therapeutical ambition. It is not to be expected that the amount of patience, adaptability, insight, and confidence demanded of the patient and his relatives will be forthcoming in many other cases. But the analyst has a right to feel that the results which he has attained from such lengthy work in one case will help substantially to reduce the length of the treatment in a subsequent case of equal severity, and that by submitting on a single occasion to the timelessness of the unconscious he will be brought nearer to vanquishing it in the end.

The patient with whom I am here concerned remained for a long time unassailably intrenched behind an attitude of obliging apathy. He listened, understood, and remained unapproachable. His unimpeachable intelligence was, as it were, cut off from the instinctual forces which governed his behaviour in the few relations of life that remained to him. It required a long education to induce him to take an independent share in the work; and when as a result of this exertion he began for the first time to feel relief, he immediately knocked off the work in order to avoid any further changes, and in order to remain comfortably in the situation which had been thus established. His shrinking from an independent existence was so great as to outweigh all the vexations of his illness. Only one way was to be found of overcoming it. I was obliged to wait until his attachment to myself had become strong enough to counterbalance this shrinking, and then played off this one factor against the other. I determined—but not until trustworthy signs had led me to judge that the right moment had come—that the treatment must be brought to an end at a particular fixed date, no matter how far it had advanced. I was resolved to keep to the date; and eventually the patient came to see that I was in earnest. Under the inexorable pressure of this fixed limit his resistance and his fixation to the illness gave way, and now in a disproportionately short time the analysis produced all the material which made it possible to clear up his inhibitions and remove his symptoms. All the information, too, which enabled me to understand his infantile neurosis is derived from this last period of the work, during which resistance temporarily disappeared and the patient gave an impression of lucidity which is usually attainable only in hypnosis.

Thus the course of this treatment illustrates a maxim whose truth has long been appreciated in the technique of analysis. The length of the road over which an analysis must travel with the patient, and the quantity of material which must be mastered on the way, are of no importance in comparison with the resistance which is met with in the course of the work, and are only of importance at all in so far as they are necessarily proportional to the resistance. The situation is the same as when to-day an enemy army needs weeks and months to make its way across a stretch of country which in times of peace was traversed by an express train in a few hours and which only a short time before had been passed over by the defending army in a few days.

A third peculiarity of the analysis which is to be described in these pages has only increased my difficulty in deciding to make a report upon it. On the whole its results have coincided in the most satisfactory manner with our previous knowledge, or have been easily embodied into it. Many details, however, seemed to me myself to be so extraordinary and incredible that I felt some hesitation in asking other people to believe in them. I requested the patient to make the strictest criticism of his recollections, but he found nothing improbable in his statements and adhered closely to them. Readers may at all events rest assured that I myself am only reporting what I came upon as an independent experience, uninfluenced by my expectation. So that there was nothing left for me but to remember the wise saying that there are more things in heaven and earth than are dreamed of in our philosophy. Any one who could succeed in eliminating his pre-existing convictions even more thoroughly could no doubt discover even more such things.

II
General Survey of the Patient’s
Environment and of the History
of the Case

I am unable to give either a purely historical or a purely thematic account of my patient’s story; I can write a consecutive history neither of the treatment nor of the disease, but I shall find myself obliged to combine the two methods of presentation. It is well known that no means has been found of in any way introducing into the reproduction of an analysis the sense of conviction which results from the analysis itself. Exhaustive verbatim reports of the proceedings during the hours of analysis would certainly be of no help at all; and in any case the technique of the treatment makes it impossible to draw them up. So analyses such as this are not published in order to produce conviction in the minds of those whose attitude has hitherto been recusant and sceptical. The intention is only to bring forward some new facts for investigators who have already been convinced by their own clinical experiences.

I shall begin, then, by giving a picture of the child’s world, and by telling as much of the story of his childhood as could be learnt without any exertion; it was not, indeed, for several years that the story became any less incomplete and obscure.

His parents had been married young, and were still leading a happy married life, upon which their ill-health was soon to throw the first shadows. His mother began to suffer from abdominal disorders, and his father from his first attacks of depression, which led to his absence from home. Naturally the patient only came to understand his father’s illness very much later on, but he was aware of his mother’s weak health even in his early childhood. As a consequence of it she had relatively little to do with the children. One day, not later than his fourth year, while his mother was seeing off the doctor to the station and he himself was walking beside her, holding her hand, he overheard her lamenting her condition. Her words made a deep impression upon him, and later on he applied them to himself. He was not the only child; he had a sister, about two years his elder, lively, gifted, and precociously naughty, who was to play an important part in his life.

As far back as he could remember he was looked after by a nurse, an uneducated old woman of peasant birth, with an untiring affection for him. He served her as a substitute for a son of her own who had died young. The family lived on a country estate, from which they used to move to another for the summer. The two estates were not far from a large town. There was a break in his childhood when his parents sold the estates and moved into the town. Near relatives used often to pay them long visits upon one estate or the other—brothers of his father, sisters of his mother and their children, his grandparents on his mother’s side. During the summer his parents used to be away for a few weeks. In a screen-memory he saw himself with his nurse looking after the carriage which was driving off with his father, mother, and sister, and then going peaceably back into the house. He must have been very small at that time.1 Next summer his sister was left at home, and an English governess was engaged, who became responsible for the supervision of the children.

In his later years he was told many stories about his childhood.2 He knew a great deal himself, but it was naturally disconnected both as regards date and subject-matter. One of these traditions, which was repeated over and over again in front of him on the occasion of his later illness, introduces us to the problem with whose solution we shall be occupied. He seems at first to have been a very good-natured, tractable, and even quiet child, so that they used to say of him that he ought to have been the girl and his elder sister the boy. But once, when his parents came back from their summer holiday, they found him transformed. He had become discontented, irritable, and violent, took offense at every possible occasion, and then flew into a rage and screamed like a savage; so that, when this state of things continued, his parents expressed their misgivings as to whether it would be possible to send him to school later on. This happened during the summer while the English governess was with them. She turned out to be an eccentric and quarrelsome person, and, moreover, to be addicted to drink. The boy’s mother was therefore inclined to ascribe the alteration in his character to the influence of this Englishwoman, and assumed that she had irritated him by her treatment. His sharp-sighted grandmother, who had spent the summer with the children, was of opinion that the boy’s irritability had been provoked by the dissensions between the Englishwoman and the nurse. The Englishwoman had repeatedly called the nurse a witch, and had obliged her to leave the room; the little boy had openly taken the side of his beloved “Nanya” and let the governess see his hatred. However it may have been, the Englishwoman was sent away soon after the parents’ return, without there being any consequent change in the child’s unbearable behaviour.

The patient had preserved his memory of this naughty period. According to his belief he made the first of his scenes one Christmas, when he was not given a double quantity of presents—which were his due, because Christmas Day was at the same time his birthday. He did not spare even his beloved Nanya with his importunities and sensibilities, and even tormented her more remorselessly perhaps than any one. But the phase which brought with it this change in character was inextricably connected in his memory with many other strange and pathological phenomena which he was unable to arrange in a temporal sequence. He threw all the incidents that I am now about to relate (which cannot possibly have been contemporaneous, and which are full of internal contradictions) into one and the same period of time, to which he gave the name “still upon the first estate.” He thought they must have left that estate by the time he was five years old. He could recollect, then, how he had suffered from a fear, which his sister exploited for the purpose of tormenting him. There was a particular picture-book, in which a wolf was represented, standing upright and striding along. Whenever he caught sight of this picture he began to scream like a lunatic that he was afraid of the wolf coming and eating him up. His sister, however, always succeeded in arranging so that he was obliged to see this picture, and was delighted at his terror. Meanwhile he was also frightened by other animals as well, big and little. Once he was running after a beautiful big butterfly, with striped yellow wings which ended in points, in the hope of catching it. (It was no doubt a “swallow-tail.”) He was suddenly seized with a terrible fear of the creature, and, screaming, gave up the chase. He also felt fear and loathing of beetles and caterpillars. Yet he could also remember that at this very time he used to torment beetles and cut caterpillars to pieces. Horses, too, gave him an uncanny feeling. If a horse was beaten he began to scream, and he was once obliged to leave a circus on that account. On other occasions he himself enjoyed beating horses. Whether these contradictory sorts of attitudes towards animals were really in operation simultaneously, or whether they did not more probably replace one another, but if so in what order and when—to all these questions his memory could offer no decisive reply. He was also unable to say whether his naughty period was replaced by a phase of illness or whether it persisted right through the latter. But, in any case, the statements of his that follow justified the assumption that during these years of his childhood he went through an easily recognizable attack of obsessional neurosis. He related how during a long period he was very pious. Before he went to sleep he was obliged to pray for a long time and to make an endless series of signs of the cross. In the evening, too, he used to make the round of all the holy pictures that hung in the room, taking a chair with him, upon which he climbed, and used to kiss each one of them devoutly. There was another fact that was utterly inconsistent with this pious ceremonial—but perhaps...

Table of contents

• Cover
• Title Page
• Contents
• Introduction
• Notes Upon A Case Of Obsessional Neurosis 1909
• I. Extracts from the Case History
• II. Theoretical
• Psychoanalytic Notes Upon an Autobiographical Account of a Case of Paranoia (Dementia Paranoides) (1911)
• From the History of an Infantile Neurosis (1918)
• List of Books and Papers Referred to in the Text