14

CHAPTER II.

THE CASE OF MISS LUCY R.

Towards the end of 1892 a friendly colleague recommended to
me a young lady whom he had been treating for chronic recurrent
purulent rhinitis. It was later found that the obstinacy of her
trouble was caused by a caries of the ethmoid. She finally com-
plained of new symptoms which this experienced physician could
no longer refer to local affections. She had lost all perception of
smell and was almost constantly bothered by one or two subjective
sensations of smell. This she found very irksome. In addition
to this she was depressed in spirits, weak, and complained of a
heavy head, loss of appetite, and an incapacity for work.

This young lady visited me from time to time during my office
hours—she was a governess in the family of a factory superin-
tendent living in the suburbs of Vienna. She was an English
lady of rather delicate constitution, anemic, and with the ex-
ception of her nasal trouble was in good health. Her first state-
ments concurred with those of her physician. She suffered
from depression and lassitude and was tormented by subjective
sensations of smell. Of hysterical signs, she showed a quite dis-
tinct general analgesia without tactile impairment, the fields of
vision showed no narrowing on coarse testing with the hand, the
nasal mucous membrane was totally analgesic and reflexless,
tactile sensation was absent, and the perception of this organ was
abolished for specific as well as for other stimuli, such as am-
monia or acetic acid. The purulent nasal catarrh was then in
a state of improvement.

On first attempting to understand this case the subjective sen-
sations of smell had to be taken as recurrent hallucinations in-
terpreting persistent hysterical symptoms. The depression was
perhaps the affect belonging to the trauma and there must have
been an episode during which the present subjective sensations
were objective. This episode must have been the trauma, the
symbols of which recurred in memory as sensations of smell.
Perhaps it would be more correct to consider the recurring

15

hallucinations of smell with the accompanying depression as
equivalents of hysterical attacks. The nature of recurrent hallu-
cinations really makes them unfit to take the part of continuous
symptoms, and this really did not occur in this rudimentarily de-
veloped case. On the other hand it was absolutely to be expected
that the subjective sensations of smell would show such a special-
ization as to be able to correspond in its origin to a very definite
and real object.

This expectation was soon fulfilled, for on being asked what
odor troubled her most she stated that it was an odor of burned
pastry. I could then assume that the odor of burned pastry really
occurred in the traumatic event. It is quite unusual to select
sensations of smell as memory symbols of traumas, but it is
quite obvious why these were here selected. She was afflicted
with purulent rhinitis, hence the nose and its perceptions were
in the foreground of her attention. All I knew about the life
of the patient was that she took care of two children whose
mother died a few years ago from a grave and acute disease.

As a starting point of the analysis I decided to use the “odor
of burned pastry.” I will now relate the history of this analysis.
It could have occurred under more favorable conditions, but as
a matter of fact what should have taken place in one session was
extended over a number of them. She could only visit me during
my office hours, during which I could devote to her but little of
my time. One single conversation had to be extended for over
a week as her duties did not permit her to come to me often from
such a distance, so that the conversation was frequently broken
off and resumed at the next session.

On attempting to hypnotize Miss Lucy R. she did not merge
into the somnambulic state. I therefore was obliged to forego
somnambulism and the analysis was made while she was in a
state not perhaps differing much from the normal.

I feel obliged to express myself more fully about the point
of the technique of my procedure. While visiting the Nancy
clinics in 1889 I heard Dr. Liébault, the old master of hypnotism,
say, “Yes, if we had the means to put everybody into the somnam-
bulic state, hypnotism would then be the most powerful thera-
peutic agent.” In Bernheim’s clinic it almost seemed that such
an art really existed and that it could be learned from Bernheim.

16

But as soon as I tried to practice it on my own patients I noticed
that at least my powers were quite limited in this respect. When
ever a patient did not merge into the somnambulistic state after
one to three attempts I possessed no means to force him into it.
However, the percentage of somnambulists in my experience were
far below that claimed by Bernheim.

Thus I had my choice, either to forbear using the cathartic
method in most of the cases suitable for it, or to venture the
attempt without somnambulism by using hypnotic influence in
light or even doubtful cases. It made no difference of what
degree (following the accepted scales of hypnotism) the hypno-
tism was which did not correspond to somnambulism, for every
direction of suggestibility is independent of the other and noth-
ing is prejudicial towards the evocation of catalepsy, automatic
movements and similar phenomena for the purpose of facilitating
the awakening of forgotten recollections. I soon relinquished
the habit of deciding the degree of hypnotism, as in a great
number of cases it incited the patients’ resistance, and clouded the
confidence which I needed for the more important psychic work.
Moreover, in mild grades of hypnotism I soon tired of hearing,
after the assurance and command, “You will sleep, sleep now!”
such protests as, “But, Doctor, I am not sleeping.” I was then
forced to bring in the very delicate distinction, saying, “I do not
mean the usual sleep, I mean the hypnotic—you see, you are
hypnotized, you cannot open your eyes”; or, “I really don’t
want you to sleep.” I, myself, am convinced that many of my
colleagues using psychotherapy know how to get out of such
difficulties more skilfully than I; they can proceed differently.
I, however, believe that if through the use of a word one can so
frequently become embarrassed, it is better to avoid the word
and the embarrassment. Wherever the first attempt did not pro-
duce either somnambulism or a degree of hypnotism with pro-
nounced bodily changes, I dropped the hypnosis and demanded
only “concentration.” I ordered the patient to lie on his back
and close his eyes as a means of reaching this “concentration.”
With little effort I obtained as profound a degree of hypnotism
as was possible.

But inasmuch as I forbore using somnambulism, I perhaps
robbed myself of a preliminary stipulation without which the

17

cathartic method seems inapplicable. For it is based on the
fact that in the altered state of consciousness the patients have at
their disposal such recollections and recognize such connections
which do not apparently exist in their normal conscious state.
Wherever the somnambulic broadening of consciousness lacks
there must also be an absence of the possibility of bringing about
a causal relation which the patient cannot give to the doctor as
something known to him, and it is just the pathogenic recol-
lections “which are lacking from the memory of the patients
in their usual psychic states or only exist in a most condensed
state” (preliminary communication).

My memory helped me out of this embarrassment. I, myself,
saw Bernheim adduce proof thata the recollections of somnam-
bulism are only manifestly forgotten in the waking state and can
be readily reproduced by slight urging accompanied by hand
pressure which is supposed to mark another conscious state. He,
for instance, imparted to a somnambulist the negative hallucina-
tion that he was no more present, and then attempted to make
himself noticeable to her by the most manifold and regardless
attacks, but was unsuccessful. After the patient was awakened
he asked her what he did to her during the time that she thought
he was not there. She replied very much astonished, that she
knew nothing, but he did not give in, insisting that she would
recall everything; and placed his hand on her forehead so that
she should recall things, and behold, she finally related all that
she did not apparently perceive in the somnambulic state and
about which she ostensibly knew nothing in the waking state.

This astonishing and instructive experiment was my model. I
decided to proceed on the supposition that my patients knew
everything that was of any pathogenic significance, and that all
that was necessary was to force them to impart it. When I
reached a point where to the question “Since when have you this
symptom?” or, “Where does it come from?” I receive the
answer, “I really don’t know this,” I proceeded as follows: I
placed my hand on the patient’s forehead or took her head be-
tween my hands and said, “Under the pressure of my hand it
will come into your mind. In the moment that I stop the
pressure you will see something before you, or something will
pass through your mind which you must note. It is that which

18

we are seeking. Well, what have you seen or what came into
your mind?”

On applying this method for the first time (it was not in the
case of Miss Lucy R.) I was surprised to find just what I wanted,
and I may say that it has since hardly ever failed me, it always
showed me the way to proceed in my investigations and enabled
me to conclude all such analyses without somnambulism. Gradu-
ally I became so bold that when a patient would answer, “I see
nothing,” or “Nothing came into my mind,” I insisted that it
was impossible. They probably had the right thought but did
not believe it and repudiated it. I would repeat the procedure
as often as they wished, and every time they saw the same thing.
Indeed, I was always right; the patients had not as yet learned
to let their criticism rest. They repudiated the emerging recol-
lection or fancy because they considered it as a useless intruding
disturbance, but after they imparted it, it was always shown that
it was the right one. Occasionally after forcing a communica-
tion by pressing the head three or four times I got such answer
as, “Yes, I was aware of it the first time, but did not wish to
say it,” or, “I hoped that it would not be this.”

By this method it was far more laborious to broaden the
alleged narrowed consciousness than by investigating in the
somnambulic state, but it made me independent of somnambulism
and afforded me an insight into the motives which are frequently
decisive for the “forgetting” of recollections. I am in position
to assert that this forgetting is often intentional and desired. It
is always only manifestly successful.

It appeared to me even more remarkable that apparently long
forgotten numbers and dates can be reproduced by a similar
process, thus proving an unexpected faithfulness of memory.

The insignificant choice which one has in searching for num-
bers and dates especially allows us to take to our aid the familiar
axiom of the theory of aphasia, namely, that recognition is a
slighter accomplishment of memory than spontaneous recol-
lection.

Hence to a patient who is unable to recall in what year, month
or day a certain event took place, enumerate the years during
which it might have occurred as well as the names of the twelve
months and the thirty-one days of the month, and assure him

19

that at the right number or name his eyes will open themselves
or that he will feel which number is the correct one. In most
cases the patients really decide on a definite date and frequently
enough (as in the case of Mrs. Cäcilie N.) it could be ascer-
tained from existing notes of that time that the date was correctly
recognized. At other times and in different patients it was
shown from the connection of the recollected facts that the dates
thus found were incontestable. A patient, for instance, after a
date was found by enumerating for her the dates, remarked,
“This is my father’s birthday,” and added “Of course I expected
this episode [about which we spoke] because it was my father’s
birthday.”

I can only slightly touch upon this theme. The conclusion
which I wished to draw from all these experiences is that the
pathogenic important experiences with all their concomitant cir-
cumstances are faithfully retained in memory, even where they
seem forgotten, as when the patient seems unable to recall them.¹⁾

¹As an example of the technique mentioned above, that is, of investigat-
ing in a non-somnambulic state or where consciousness is not broadened,
I will relate a case which I analyzed recently. I treated a woman of
thirty-eight who suffered from an anxiety neurosis (agoraphobia, fear of
death, etc.). Like many patients of that type she had a disinclination to
admit that she acquired this disease in her married state and was quite
desirous of referring it back to early youth. She informed me that at
the age of seventeen when she was in the street of her small city she had
the first attack of vertigo, anxiety, and faintness, and that these attacks
recurred at times up to a few years ago when they were replaced by her
present disease. I thought that the first attacks of vertigo, in which the
anxiety was only blurred, were hysterical and decided to analyze the
same. All she knows is that she had the first attack when she went out
to make purchases in the main street of her city.—“What purchases did
you wish to make?”—“Various things, I believe it was for a ball to which
I was invited.”—“When was the ball to take place?”—“I believe two days
later.”—“Something must have happened a few days before this which
excited you, and which made an impression on you.”—“But I don’t know,
it is now twenty-one years.”—“That does not matter, you will recall it.
I will exert some pressure on your head and when I stop it you will
either think of or see something which I want you to tell me.” I went
through this procedure, but she remained quiet.—“Well, has nothing
come into your mind?”—“I thought of something, but that can have no
connection with it.”—“Just say it.”—“I thought of a young girl who is
dead, but she died when I was eighteen, that is, a year later.”—“Let us

20

After this long but unavoidable digression I now return to the
history of Miss Lucy R. As aforesaid, she did not merge into
somnambulism when an attempt was made to hypnotize her, but
lay calmly in a degree of mild suggestibility, her eyes constantly
closed, the features immobile, the limbs without motion. I asked
her whether she remembered on what occasion the smell percep-
tion of burned pastry originated.—“Oh, yes, I know it well. It
was about two months ago, two days before my birthday. I
was with the children (two girls) in the school room playing and
teaching them to cook, when a letter just left by the letter carrier
was brought in. From its postmark and handwriting I recog-
nized it as one sent to me by my mother from Glasgow and I
wished to open it and read it. The children then came running
over, pulled the letter out of my hand and exclaimed, ‘No you
must not read it now, it is probably a congratulatory letter for

adhere to this. What was the matter with your friend?”—“Her death
affected me very much, because I was very friendly with her. A few
weeks before another young girl died, which attracted a great deal of
attention in our city, but then I was only seventeen years old.”—“You
see, I told you that the thought obtained under the pressure of the hands
can be relied upon. Well now, can you recall the thought that you had
when you became dizzy in the street?”—“There was no thought, it was
-
vertigo.”—“That is quite impossible, such conditions are never without
accompanying ideas. I will press your head again and you will think of
it. Well, what came to your mind?”—“I thought, ‘now I am the third.’ ”
—“What do you mean?”—“When I became dizzy I must have thought,
now I will die like the other two.”—“That was then the idea, during the
attack you thought of your friend, her death must have made a great im-
pression on you.”—“Yes, indeed, I recall now that I felt dreadful when I
heard of her death, to think that I should go to a ball while she lay dead,
but I anticipated so much pleasure at the ball and was so occupied with
that I did not wish to think of this sad event.” (Notice
here the intentional repression from consciousness which caused the
reminiscences of her friend to become pathogenic.)
The attack was now in a measure explained, but I still needed the
occasional moment which just then provoked this recollection, and acci-
dentally I formed a happy supposition about it.—“Can you recall through
which street you passed at that time?”—“Surely, the main street with
its old houses, I can see it now.”—“And where did your friend live?”—
“In the same street. I had just passed her house and was two houses
farther when I was seized with the attack.”—“Then it was the house
which you passed that recalled your dead friend, and the contrast which
you then did not wish to think about that again took possession of you.”

21

THE CASE OF MISS LUCY R.

your birthday and we will keep it for you until then.’ While the
children were thus playing there was a sudden diffusion of an
intense odor. The children forgot the pastry which they were
cooking and it became burned. Since then I have been troubled
by this odor, it is really always present but is more marked during
excitement.”

“Do you see this scene distinctly before you?”—“As clearly
as I experienced it.”—“What was there in it that so excited
you?”—“I was touched by the affection which the children
displayed towards me.”—“But weren’t they always so affection-
ate?”—“Yes, but I just got the letter from my mother.”—“I
can’t understand in what way the affection of the little ones and
the letter from the mother contrasted, a thing which you appear
to intimate.”—“I had the intention of going to my mother and
my heart became heavy at the thought of leaving those dear
children.”—“What is the matter with your mother? Was she
so lonesome that she wanted you, or was she sick just then and
you expected some news?”—“No, she is delicate but not really sick,
and has a companion with her.”—“Why then were you obliged
to leave the children?”—“This house had become unbearable to
me. The housekeeper, the cook, and the French maid seemed
to be under the impression that I was too proud for my position.

Still I was not satisfied, perhaps there was something else pro-
voked or strengthened the hysterical disposition in a hitherto normal girl.
My suppositions were directed to the menstrual indisposition at an appro-
priate moment, and I asked, “Do you know when during that month you
had your menses?”—She became indignant: “Do you expect me to know
that? I only know that I had them then very rarely and irregularly.
When I was seventeen I only had them once.”—“Well let us enumerate
the days, months, etc., so as to find when it occurred.”—She with cer-
tainty decided on a month and wavered between two days preceding a
date which accompanied a fixed holiday.—Does that in any way correspond
with the time of the ball? She answered quietly: “The ball was on this
holiday. And now I recall that I was impressed by the fact that the only
menses which I had had during the year occurred just when I had to go to
the ball. It was the first invitation to a ball that I had received.”

The combination of the events can now be readily constructed and the
mechanism of this hysterical attack readily viewed. To be sure the result
was gained after painstaking labor. It necessitated on my side full con- fidence in the technique and individual directing ideas in order to re-
awaken such details of forgotten experiences after twenty-one years in
a sceptical and awakened patient. But then everything agreed.

22

They united in intriguing against me and told the grandfather of
the children all sorts of things about me, and when I complained
to both gentlemen I did not receive the support which I expected.
I then tendered my resignation to the master (father of the chil-
dren) but he was very friendly, asking me to reconsider it for
two weeks before taking any definite steps. It was while I was
in that state of indecision that the incident occurred. I thought
that I would leave the house but have remained.”—“Aside from
the attachment of the children is there anything particular which
attracts you to them?”—“Yes, my mother is distantly related to
their mother and when the latter was on her death bed I promised
her to do my utmost in caring for the children, that I would not
forsake them, and be a mother to them, and this promise I broke
when offering my resignation.”

The analysis of the subjective sensation of smell seemed com-
pleted. It was once objective and intimately connected with an
experience, a small scene, in which contrary affects conflicted,
sorrow at forsaking the children, and the mortification which
despite all urged her to this decision. Her mother’s letter
naturally recalled the motives of this decision because she thought
of returning to her mother. The conflict of the affects raised
this moment to a trauma and the sensation of smell which was
connected with it remained as its symbol. The only thing to be
explained was the fact that out of all the sensory perceptions
of that scene, the perception of smell was selected as the symbol,
but I was already prepared to use the chronic nasal affliction as
an explanation. On being directly questioned she stated that
just at that time she suffered from a severe coryza and could
scarcely smell anything but in her excitement she perceived the
odor of burned pastry, it penetrated the organically motivated
anosmia.

As plausible as this sounded it did not satisfy me; there seemed
to be something lacking. There was no acceptable reason where-
fore this series of excitements and this conflict of affects should
have led to hysteria? Why did it not all remain on a normal
psychological basis? In other words, what justified the conver-
sion under discussion? Why did she not recall the scenes them-
selves instead of the sensations connected with them which she
preferred as symbols for her recollection? Such questions

23

might seem superfluous and impertinent when dealing with old
hysterias in whom the mechanism of conversion was habitual, but
this girl first acquired hysteria through this trauma, or at least
through this slight distress.

From the analysis of similar cases I already knew that where
hysteria is to be newly acquired one psychic determinant is in-
dispensible; namely, that some presentation must intentionally be
repressed from consciousness and excluded from associative
elaboration.

In this intentional repression I also find the reason for the
conversion of the sum of excitement, be it partial or total. The
sum of excitement which is not to enter into psychic association
more readily finds the wrong road to bodily innervation. The
reason for the repression itself could only be a disagreeable feel-
ing, the incompatibility of one of the repressible ideas with the
ruling presentation-
mass of the ego. The repressed presentation
then avenges itself by becoming pathogenic.

From this I concluded that Miss Lucy R. merged into that
moment of hysterical conversion, which must have been under the
determinations of that trauma which she intentionally left in the
darkness and which she took pains to forget. On considering her
attachment for the children and her sensitiveness towards the
other persons of the household, there remained but one interpreta-
tion which I was bold enough to impart to her. I told her that
I did not believe that all these things were simply due to her
affection for the children, but that I thought that she was rather
in love with her master, perhaps unwittingly, that she really nur-
tured the hope of taking the place of the mother, and it was for
that reason that she became so sensitive towards the servants
with whom she had lived peacefully for years. She feared lest
they would notice something of her hope and scoff at her.

She answered in her laconic manner: “Yes, I believe it is so.”
— “But if you knew that you were in love with the master, why
did you not tell me so?”— “But I did not know it, or rather, I
did not wish to know it. I wished to crowd it out of my mind,
never to think of it, and of late I have been successful.”²

²A better description of this peculiar state in which one knows some-
thing and at the same time does not know it, I could never obtain. It
can apparently be understood only if one has found himself in such a

24

“Why did you not wish to admit it to yourself? Were you
ashamed because you loved a man?”—“O, no, I am not un-
reasonably prudish; one is certainly not responsible for one’s
own feelings. I only felt chagrined because it was my employer
in whose service I was and in whose house I lived, and toward
whom I could not feel as independent as towards another. What
is more, I am a poor girl and he is a rich man of a prominent fam-
ily, and if anybody should have had any inkling about my feelings
they would have ridiculed me.”

After this I encountered no resistances in elucidating the origin
of this affection. She told me that the first years of her life in
that house were passed uneventfully. She fulfilled her duties
without thinking about unrealizable wishes. One day, however,
the serious, and very busy and hitherto very reserved master,
engaged her in conversation about the exigencies of rearing the
children. He became milder and more cordial than usual, he
told her how much he counted on her in the bringing up of his
orphaned children, and looked at her rather peculiarly. It was
in this moment that she began to love him, and gladly occupied
herself with the pleasing hopes which she conceived during that
conversation. However, as this was not followed by anything
else, and despite her waiting and persevering no other confiden-
tial heart-to-heart talk followed, she decided to crowd it out of
her mind. She quite agreed with me that the look in connection
with the conversation was probably intended for the memory of
his deceased wife. She was also perfectly convinced that her
love was hopeless.

After this conversation I expected a decided change in her con-
dition but for a time it did not take place. She continued de-
state. I have at my disposal a very striking recollection of this kind
which I can vividly see. If I make the effort to recall what passed
through my mind at that time my output seems very poor. I saw at that
time something which was not at all appropriate to my expectations, and
did not in the least divert me from my definite purpose. I
did not become conscious of this contradiction nor did I remark the affect
of the repulsion to which it was undoubtedly due that this perception did
not attain any psychic validity. I was struck with that form of blindness
in seeing eyes, which one admires so much in mothers towards their
daughters, in husbands towards their wives, and in rulers towards their
favorites.

25

pressed and moody—a course of hydrotherapy which I ordered
for her at the same time refreshed her somewhat mornings. The
odor of burned pastry did not entirely disappear; though it be
came rarer and feebler it appeared only, as she said, when she
was very much excited.

The continuation of this memory symbol led me to believe that
besides the principal scene it represented many smaller side trau
mas and I therefore investigated everything that might have been
in any way connected with the scene of the burned pastry. We
thus passed through the theme of family friction, the behavior
of the grandfather and others, and with that the sensation of
burned odor gradually disappeared. Just then there was a
lengthy interruption occasioned by a new nasal affliction which
led to the discovery of the caries of the ethmoid.

On her return she informed me that she received many Christ
mas presents from both gentlemen as well as from the household
servants, as if they were trying to appease her and wipe away
the recollection of the conflicts of the last months. These frank
advances made no impression on her.

On questioning her on another occasion about the odor of
burned pastry she stated that it had entirely disappeared, but
instead she was now bothered by another and similar odor like
the smoke of a cigar. This odor really existed before; it was
only concealed by the odor of the pastry but now appeared by
itself.

I was not very much pleased with the success of my treatment.
What occurred here is what a mere symptomatic treatment is
generally blamed for, namely, that it removes one symptom only
to make room for another. Nevertheless, I immediately set forth
to remove this new memory symbol by analysis.

This time I did not know whence this subjective sensation of
smell originated, nor on what important occasion it was objective.
On being questioned she said, “They constantly smoke at home,
I really don’t know whether the smell which I feel has any par
ticular significance.” I then proposed that she should try to
recall things under the pressure of my hands. I have already
mentioned that her recollections were plastically vivid, that she
was a “visual.” Indeed under the pressure of my hands a
picture came into her mind—at first only slowly and fragment-
 

26

arily. It was the dining room of the house in which she waited
for the children for the arrival of the gentlemen from the fac-
tory for dinner.—“Now we are all at the table, the gentlemen,
the French maid, the housekeeper, the children and I. It is the
same as usual.”—“Just keep on looking at that picture. It will
soon become developed and specialized.”—“Yes, there is a guest,
the chief accountant, an old gentleman who loves the children
like his own grandchildren, but he dines with us so frequently that
it is nothing unusual.”—“Just have patience, keep on looking
at the picture, something will certainly happen.”—“Nothing
happens. We leave the table, the children take leave and go with
us up to the second floor as usual.”—“Well?”—“It really is
something unusual, I now recognize the scene. As the children
take leave the chief accountant attempts to kiss them, but my
master jumps up and shouts at him, ‘Don’t kiss the children!’
I then experienced a stitch in the heart, and as the gentlemen
were smoking, this odor remained in my memory.”

This, therefore, was the second, deeper seated scene causing
the trauma and leaving the memory symbol. But why was this
scene so effective? I then asked her which scene happened first,
this one or the one with the burned pastry?—“The last scene hap-
pened first by almost two months.”—“Why did you feel the stitch
at the father’s interference? The reproof was not meant for
you.”—“It was really not right to rebuke an old gentleman in
such manner who was a dear friend and a guest, it could have
been said quietly.”—“Then you were really affected by your mas-
ter’s impetuosity? Were you perhaps ashamed of him, or have
you thought, ‘If he could become so impetuous to an old friend
guest over such a trifle, how would he act towards me if I were
his wife?’”—“No, that is not it.”—“But still it was about his
impetuosity?”—“Yes, about the kissing of the children, he never
liked that.” Under the pressure of my hands there emerged a
still older scene which was the real effective trauma and which
bestowed on the scene with the chief accountant the traumatic
effectivity.

A few months before a lady friend visited the house and on
leaving kissed both children on the lips. The father, who was
present, controlled himself and said nothing to the lady, but
when she left he was very angry at the unfortunate governess.

27

THE CASE OF MISS LUCY R.

He said that he held her responsible for this kissing; that it was
her duty not to tolerate it; that she was neglecting her duties
in allowing such things, and that if it ever happened again he
would entrust the education of his children to some one else.
This occurred while she believed herself loved and waited for a
repetition of that serious and friendly talk. This episode shat-
tered all her hopes. She thought: “If he can upbraid and
threaten me on account of such a trifle, of which I am entirely
innocent, I must have been mistaken, he never entertained any
tenderer feelings towards me, else he would have been consider-
ate.”—It was evidently this painful scene that came to her as the
father reprimanded the chief accountant for attempting to kiss
the children.

On being visited by Miss Lucy R. two days after the last
analysis I had to ask her what pleasant things happened to her.
She looked as though transformed, she smiled and held her head
aloft. For a moment I thought that after all I probably mistook
the conditions and that the governess of the children had now
become the bride of the master. But she soon dissipated all my
suppositions, saying, “Nothing new happened. You really do
not know me. You have always seen me while I was sick and
depressed. I am otherwise always cheerful. On awaking yes-
terday morning my burden was gone and since then I feel well.”
—“What do you think of your chances in the house?”—“I am
perfectly clear about that. I know that I have none, and I am
not going to be unhappy about it.”—“Will you now be able to get
along with the others in the house?”—“I believe so, because most
of the trouble was due to my sensitiveness.”—“Do you still love
the master?”—“Certainly I love him, but that does not bother
me much. One can think and feel as one wishes.”

I now examined her nose and found that the pain and the
reflex sensations had almost completely reappeared. She could
distinguish odors, but she was uncertain when they were very
intense. What part the nasal trouble played in the anosmia I
must leave undecided.

The whole treatment extended over a period of nine weeks.
Four months later I accidentally met the patient at one of our
summer resorts—she was cheerful and stated that her health
continued to be good.

28

EPICRISIS.

I would not underestimate the aforesaid case even though it
only represents a young and light hysteria presenting but few
symptoms. Moreover, it seems to me instructive that even such
a slight neurotic affliction requires so many psychic determinants,
and on a more exhaustive consideration of this history I am
tempted to put it down as an illustration of that form of hysteria
which even persons not burdened by heredity may acquire if their
experiences favor it. It should be well noted that I do not speak
of a hysteria which may be independent of all predisposition;
such form does not probably exist, but we speak of such a pre-
disposition only after the person became hysterical, as nothing
pointed to it before this. A neuropathic disposition as commonly
understood is something different. It is determined even before
the disease by a number of hereditary burdens, or a sum of indi-
vidual psychic abnormalities. As far as I know none of these
moments could be demonstrated in the case of Miss Lucy R.
Her hysteria could therefore be called acquired and presupposes
nothing except probably a very marked susceptibility to acquire
hysteria, a characteristic about which we know hardly anything.
The chief importance in such cases lies in the nature of the
trauma, to be sure in connection with the reaction of the person
to the trauma. It is an indispensable condition for the acquire-
ment of hysteria that there should arise a relation of incompati-
bility between the ego and some of its approaching presentations.
I hope to be able to show in another place how a variety of neu-
rotic disturbances originate from the different procedures which the
“ego” pursues in order to free itself from that incompatibility.
The hysterical form of defence, for which a special adaptation is
required, consists in converting the excitement into physical inner-
vation. The gain brought about by this process is the crowding
out of the unbearable presentation from the ego consciousness,
which then contains instead the physical reminiscences produced
by conversion—in our case the subjective sensation of smell—
and suffers from the affect which is more or less distinctly adher-
ent to these reminiscences. The situation thus produced is no
longer changeable, for changing and conversion annihilate the
conflict which helped towards the adjustment of the affect. Thus

29

the mechanism producing hysteria corresponds on the one hand
to an act of moral faint-
heartedness, on the other hand it presents
itself as a protective arrangement at the command of the ego.
There are many cases in which it must be admitted that the de-
fense of the increased excitement through the production of hys-
teria may actually have been most expedient, but more frequently
one will naturally come to the conclusion that a greater measure
of moral courage would have been an advantage to the indi-
vidual.

Accordingly the real traumatic moment is that in which the
conflict thrusts itself upon the ego and the latter decides to banish
it. Such banishment does not annihilate the opposing presenta-
tion but merely crowds it into the unconscious. This process,
occurring for the first time, forms a nucleus and point of crystal-
lization for the formation of a new psychic group separated from
the ego, around which, in the course of time, everything collects
in accord with the opposing presentation. The splitting of con-
sciousness in such cases of acquired hysteria is thus a desired
and intentional one, and is often initiated by at least one arbitrary
act. But literally, something different happens than the individ-
ual expects, he would wish to eliminate a presentation as though
it never came to pass but only succeeds in isolating it psychically.

The traumatic moment in the history of our patient corresponds
to the scene created by the master on account of the kissing of
the children. For the time being this scene remained without any
palpable effects, perhaps it initiated the depression and sensitive-
ness, but I leave this open—the hysterical symptoms, however,
commenced later in moments which can be designated as “auxil-
iary,” and which may be characterized by the fact that in them
there is a simultaneous flowing together of both separated groups
just as in the broadened somnambulic consciousness. The first
of these moments in which the conversion took place in Miss
Lucy R., was the scene at the table when the chief accountant
attempted to kiss the children. The traumatic memory helped
along, and she acted as though she had not entirely banished her
attachment for her master. In other cases we find that these
different moments come together and the conversion occurs di-
rectly under the influence of the trauma.

The second auxiliary moment repeated almost precisely the

30 PAPERS ON HYSTERIA AND OTHER PSYCHONEUROSES.

mechanism of the first. A strong impression transitorily re-
established the unity of consciousness and the conversion takes
the same route opened to it in the first. It is interesting to note
that the symptom occurring second concealed the first so that
it could not be distinctly perceived until the second was elimi-
nated. The reversal of the succession of events to which also the
analysis must be adapted seems to me quite remarkable. In a
whole series of cases I found that the symptoms which came
later covered the first, and only the last thing in the analysis
contained the key to the whole.

The therapy here consisted in forcing the union of the disso-
ciated psychic groups with the ego consciousness. It is remark-
able that the success did not run parallel with the accomplished
work, the cure resulted suddenly only after the last part was
accomplished.