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 abol-
ished for specific as well as for other stimuli, such as ammonia
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

THE CASE OF MISS LUCY R.

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 forebore 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 recollec-
tions “which are lacking from the memory of the patients in their
usual psychic states or only exist in a most condensed state” (pre-
liminary communication).

un-
zug

X

My memory helped me out of this embarrassment. I, myself,
saw Bernheim adduce proof that 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 halluci-
nation 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.

X

zug

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. Grad-
ually 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, and 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

THE CASE OF MISS LUCY R.

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 enumerat-
ing 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 faith-
fully retained in memory, even where they
seem forgotten, as when the patient seems unable to recall them.¹

Sugges

¹As an example of the technique mentioned above, that is, of investigat-
ing in a non-somnambu-
lic 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 (agorapho-
bia, fear of
death, etc.). Like many patients of that type she had a disinclina-
tion 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