76

disposition consists in an abnormal narrowing of the field of con-
sciousness (in consequence of hereditary degeneration), which leads
to the neglect of whole series of perceptions, and in serious courses
of this development, to the destruction of the ego, and to an organi-
zation of secondary personalities. Accordingly, after the subtraction
of the hysterically organized psychic groups, the rest of the ego
would also be less functionally capable than the normal ego. And
as a matter of fact, Janet actually maintains that this ego, which
is burdened in all hysterics by psychic stigmata, is condemned to
monoideism, and is incapable of the ordinary volitional activity of
life. It is my opinion that Janet has here unjustly raised the end-
results of the hysterical change of consciousness to the rank of
primary conditions of hysteria. This theme is worthy of a more
thorough discussion in another place; but such functional inferiority
was not observed in Mrs. von N. During the period of her most
severe illness she was, and remained, capable of participating in the
management of a large industrial undertaking, she never lost sight of
the education of her children, and kept up a correspondence with
mentally superior persons. In brief, she attended to all her duties
so. well that no one had any inkling of her illness. I would think,
however, that such behavior would result in a palpable amount of
psychic overexertion, and could not perhaps be maintained for a long
time, and in our case had to lead to an exhaustion or to a secondary
“misère psychologique.” It is probable that such disturbances of her
functional capacity began to make themselves already noticeable
when I first saw her, but at all events, there existed a severe hysteria
for many years before these symptoms of exhaustion manifested
themselves.

OBSERVATION III. MISS LUCIE R. (FREUD)

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 complained of new symptoms
which this experienced physician could no longer refer to local affec-
tions. 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 superintendent living

77

in the suburbs of Vienna. She was an English lady of rather delicate
constitution, anemic, and with the exception of her nasal trouble was
in good health. Her first statements concurred with those of her physi-
cian. She suffered from mild depression and lassitude, and was tor-
mented by subjective sensations of smell. Of hysterical signs, she
showed a quite distinct 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. Tac-
tile sensation was absent, and the perception of this sense organ was
abolished for specific as well as for other stimuli, such as ammonia or
acetic acid. The purulent nasal catarrh was just then in a period of
improvement.

On first attempting to understand this case we felt that subjective
sensations of smell must represent recurrent hallucinations interpreting
persistent hysterical symptoms, that the mild depression was perhaps the
affect belonging to the trauma, and that 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
her memory as sensations of smell. Perhaps it would have been more
correct to consider the recurring hallucinations of smell with the accom-
panying depression as equivalents of hysterical attacks. For the nature
of recurrent hallucinations really makes them unsuitable for the rôle
of chronic symptoms, which was hardly the question in this rudimentary
case. But it was absolutely necessary that the subjective sensations of
smell should show a specialization that could correspond to a very
definite and real objective origin.

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 was 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 conver-
sation 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 Lucie R., she did not lapse into
the somnambulic state. I, therefore, was obliged to forego somnambu-
 

78

lism, and the analysis was made while she was in a state which did not
perhaps differ 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 somnambulic state, hypnotism
would then be the most powerful therapeutic agent.” In Bernheim’s
clinic it almost seemed that such an art really existed, and that it could
be learned from Bernheim. 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. Whenever a patient did not sink into the somnambulic
state after one or two attempts, I possessed no means to force him into
it. However, the percentage of somnambulists in my experience was
far below that claimed by Bernheim.

Thus, I had the choice either to refrain from 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 hypnotism was, which did not cor-
respond to somnambulism, for every line of suggestibility is independent
of the other, and nothing prejudices the evocation of catalepsy, auto-
matic 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 patient’s 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 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 am convinced that many of my colleagues who
use psychotherapy know how to get out of such difficulties more skil-
fully than I, they can, therefore, act differently. I, however, believe
that if through the use of a word one can so frequently become embar-
rassed, it is better to avoid the word and the embarrassment. Wherever
the first attempt did not produce either somnambulism or a degree of
hypnotism with pronounced 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 attaining this “concentration.”
With little effort I obtained as profound a degree of hypnotism as was
possible.

But as I gave up the use of somnambulism, I perhaps deprived myself
of that prerequisite without which the cathartic method seemed inap-
plicable. For the latter is based on the assumption that in the altered
state of consciousness the patients have at their disposal recollections
and associations which do not apparently exist in their normal conscious

79

CASE HISTORIES

state, and that wherever there is no somnambulic broadening of con-
sciousness, it must also be impossible to bring about those causal relations
which the patient gives the doctor as something unknown to him, that
is, those pathogenic recollections “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 demonstrate that the recollections of somnambulism are only
manifestly forgotten in the waking state and can be readily reproduced
by some urging, accompanied by hand pressure, which is supposed to
mark another conscious state. He, for instance, imparted to a somnam-
bulist the negative hallucination that he was no longer present, and
then attempted to make himself noticeable to her by the most manifold
and inconsiderate 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 stop there, he insisted 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. Whenever I reached a point where to my
question, “Since when have you had this symptom?”, or “Where does
it come from?”, I received 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 between my hands and said, “Through the pressure of
my hands it will come into your mind, the moment that I stop the
pressure you will see something before you, or something will flash
through your mind which you must note, it is that which 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 Lucie 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
how to proceed in my investigations and enabled me to do all such
analyses without somnambulism. Gradually, 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, that he probably had the right
thought, but that he did not believe it and repudiated it, that I would
repeat the procedure as often as he wished, and that every time he
would see the same thing. Indeed, I was always right; the patients
had not as yet learned to let their criticism rest. They repudiated the
emerging recollection 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 communication

80

by pressing the head three or four times I got such an 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 a position to assert that this forgetting is often
intentional and desired, but it is always only manifestly successful.

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

The insignificant choice which one has in searching for numbers
and dates especially allows us to take to our aid the familiar axiom of the
theory of aphasia, namely, that recognition is a lesser accomplishment
of memory than spontaneous recollection.

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 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. Cecilia N.)
it could be ascertained 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 lightly touch upon this theme. The conclusion which I
wish to draw from all these experiences is that the pathogenic important
experiences with all their concomitant circumstances are faithfully
retained in memory, even where they seem forgotten, as when the patient
seems unable to recall them.³⁰

³⁰As an example of the technique mentioned above, that is, of investigating
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 her 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 knew was 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

81

After this long but unavoidable digression, I now return to the
history of Miss Lucie R. As aforesaid, she did not sink into somnam-
bulism when an attempt was made to hypnotize her, but lay calmly in

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 con-
nection 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 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 impression 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 the invitation 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
factor which just then provoked this recollection, and accidentally 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 took possession of you.”

Still, I was not satisfied; perhaps there was something else which provoked
or strengthened the hysterical disposition in a hitherto normal girl. My suppo-
sitions were directed to the menstrual indisposition as an appropriate factor,
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 decided with certainty 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 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 mecha-
nism of this hysterical attack readily viewed. To be sure, the result was
gained after painstaking labor. It necessitated on my side full confidence in
the technique and in the individual leading ideas, in order to reawaken such
details of forgotten experiences after twenty-one years in a sceptical and really
awakened patient. But then everything coincided.

82

a degree of mild suggestibility, her eyes constantly closed, the features
immobile, the limbs without motion. I asked her whether she remem-
bered on what occasion the smell perception of burned pastry origi-
nated.—“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 handwrit-
ing, I recognized 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 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 burned. Since then,
I have been troubled by this odor, it is really always present, but is more
marked during emotional 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 affectionate?”—“Yes, but I just got the
letter from my mother.”—“I can’t understand in what way the affec-
tion 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 was the matter with your mother? Was she
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 house-
keeper, the cook, and the French maid seemed to be under the impres-
sion that I was too proud for my position. 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 children), 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 to be a mother to them, and this promise I broke when
I offered my resignation.”

The analysis of the subjective sensation of smell seemed complete.
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

83

decision. Her mother’s letter naturally recalled the motives of this deci-
sion because she thought of returning to her mother. The conflict of
the affects raised this factor 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 suf-
fered 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 was no
acceptable reason why this series of excitement and this conflict of
affects should have led to hysteria. Why did it not remain on a normal
psychological basis? In other words, what justified the conversion
under discussion? Why did she not recall the scenes themselves instead
of the sensations connected with them which she preferred as symbols
for her recollection? Such questions might seem superfluous and
irrelevant when dealing with old hysterics in whom the mechanism of
conversion is habitual, but this girl acquired hysteria for the first time
through this trauma, or at least through this slight distress.

From the analysis of similar cases I already knew that in the process
of hysterical development, one psychic determinant is indispensable;
namely, that some idea must intentionally be repressed from consciousness
and excluded from associative elaboration.

In this intentional repression I also find the reason for the conver-
sion of the sum of excitement, be it partial or total. The sum of excite-
ment 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 feeling, the incompatibility of one
of the repressible ideas with the ruling ideational-mass of the ego. The
repressed idea then avenges itself by becoming pathogenic.

From this I concluded that Miss Lucie R. had lapsed into that
moment of hysterical conversion, which must have been one of the pre-
requisites of that trauma which she intentionally wished to leave in the
dark, and which she took pains to forget. On considering her attach-
ment for the children and her sensitiveness towards the other persons
of the household, there remained but one interpretation 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 unwit-
tingly, that she really nurtured 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

84

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.”³¹

“Why did you not wish to admit it to yourself? Were you ashamed
because you loved a man?”—“Oh, no, I am not unreasonably 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 family, and if anybody should have 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 any-
thing else, and despite her waiting and persevering no other confidential
heart-to-heart talk followed, she decided to crowd it out of her mind.
She quite agreed with me that the look which she noticed during 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 condi-
tion, but for a time it did not take place. She continued depressed and
moody—a course of hydrotherapy which I prescribed for her at the same
time refreshed her somewhat in the morning. The odor of burned
pastry did not entirely disappear; though it became rarer and feebler,
it appeared, as she said, only when she was very much excited.

The continuation of this memory symbol led me to believe that besides
the principal scene it also represented many smaller side traumas and

³¹Another and better description of this peculiar state in which one knows
something 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 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 I was not in the least diverted from my
definite purpose by what I saw when, as a matter of fact, this perception should
have deflected me from my purpose. I did not become conscious of this contra-
diction nor did I notice anything of the affect of the repulsion which was
undoubtedly responsible for the fact that this perception did not attain any
psychic validity. I was struck with that 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.

85

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 Christmas
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 it appeared as such.

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 particular 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 plas-
tically vivid, that she was of the “visual type.” Indeed, under the pressure
of my hands a picture came into her mind—at first, only slowly and
fragmentarily. It was the dining room in which she waited with the
children for the arrival of the gentlemen from the factory 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 special-
ized.”—“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
to the second floor as usual.”—“Well?”—“There really is something
unusual, I now recognize the scene. As the children 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, which acted as
a trauma, and left the memory symbol. But why was this scene so

86

effective? I then asked her which scene happened first, this one or the
one of the burned pastry— “The last scene happened 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 man in such a manner, who was a dear friend and a guest; it
could have been said more clamly.”— “Then you were really affected
by your master’s impetuosity? Were you perhaps ashamed of him, or
did you think, ‘If he could become so impetuous towards an old friend
and 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 impetu-
osity? ”— “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
of 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, con-
trolled himself and said nothing to the lady, but when she left, he was
very angry at the unfortunate governess. He said that he held her
responsible for this kissing; that it was her duty not to tolerate it;
that if it ever happened again, he would entrust the education of his chil-
dren to someone else. This occurred while she believed herself loved,
and waited for a repetition of that serious and friendly talk. This epi-
sode shattered 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 more considerate.”—It was evi-
dently 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 Lucie 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 situations, and
that the governess of the children had now become the bride of her
master. But she soon dissipated all my suppositions by saying, “Noth-
ing new has happened. You really do not know me. You have always
seen me while I was sick and depressed. Usually I am always cheerful.
On awaking yesterday morning my burden was gone and since then
I have felt 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

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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.

Epicrisis

I would not like to underestimate the aforesaid case even though
it only represents a minor and light hysteria with but few symptoms.
On the contrary, it seems to me instructive that even such a slight
neurotic affliction should require so many psychic determinants, and
on 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 they have the
suitable experiences for it. It should be well noted that I do not
speak of a hysteria which may be independent of all predisposition;
such form probably does not exist, but we speak of such a predis-
position only after the person became hysterical, as nothing pointed
to it before. A neuropathic disposition as commonly understood is
something different. It is determined even before the disease by a
number of hereditary burdens, or by a sum of individual psychic
abnormalities. As far as I know, none of these two factors could
be demonstrated in the case of Miss Lucie R. Her hysteria may,
therefore, be called acquired, and by and large presupposes nothing
more than a very marked susceptibility to acquire hysteria, a char-
acteristic about which we know scarcely anything. In such cases
the greatest emphasis lies in the nature of the trauma and naturally
in connection with the reaction of the person to the trauma. It is
an indispensable condition for the acquisition of hysteria, that there
should arise a relation of incompatibility between the ego and an
idea that comes in contact with it. I hope to be able to show in
another place how a variety of neurotic disturbances originate from
the different procedures which the “ego” pursues in order to free
itself from that incompatibility. The hysterical form of defense, for
which a special adaptation is required, consists in a conversion of
the excitement into physical innervation. The gain brought about
by this process consists in the crowding out of the unbearable idea
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 more or less
distinctly connects itself with these reminiscences. The situation

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thus produced can no longer be changed, for the resistance which
would have striven for the adjustment of the affect was eliminated
through repression and conversion. Thus, 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
process at the command of the ego. There are many cases in which
it must be admitted that the defense against the increased excite-
ment through the production of hysteria 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
of more advantage to the individual.

Accordingly, the real traumatic moment is that in which the
conflict thrusts itself upon the ego and the latter decides to banish
the incompatible idea. Such banishment does not annihilate the
opposing idea, but merely crowds it into the unconscious. When
this process occurs for the first time, it forms a nucleus, or a point
of crystallization for the formation of a new psychic group separated
from the ego, around which, in the course of time, everything col-
lects which is in accord with the opposing idea. The splitting of
consciousness in such cases of acquired hysteria is thus desired and
intentional, and is often initiated by at least one arbitrary act. But
as a matter of fact, something different happens than the individual
expects, he would like to eliminate an idea as though it never came
to pass, but he only succeeds in isolating it psychically.

The traumatic factor in the history of our patient corresponds
to the scene created by her master on account of the kissing of the
children. For the time being this scene remained without any pal-
pable effects, perhaps it initiated the depression and sensitiveness,
but I leave this open; the hysterical symptoms, however, commenced
later in moments which can be designated as “auxiliary,” and which
may be characterized by the fact that in them there was a simul-
taneous inter-fusion of both separated groups just as in the broadened
somnambulic consciousness. The first of these factors in which the
conversion took place in Miss Lucie 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 factors coalesce and the conversion occurs
directly under the influence of the trauma.

The second auxiliary factor repeated almost precisely the mecha-

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nism of the first. A strong impression transitorily reëstablished
the unity of consciousness, and the conversion took the same route
that was opened to it the first time. It is interesting to note that
the symptom which occurred second concealed the first so that the
latter could not be distinctly perceived until the former was elimi-
nated. The reversal of the succession of events, to which also the
analysis had to be adapted seemed 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 remarkable
that the success did not run parallel with the accomplished work,
the cure resulted suddenly only after the last part was accomplished.

OBSERVATION IV. Miss KATHARINA (FREUD)

During the vacation of 189– I made an excursion to the High Tauern
(Eastern Alps) in order to forget medicine for a while, and especially
the neuroses. I almost succeeded when one day I deviated from the
main street to climb an out of the way mountain, which was famous
for a beautiful view and for its well kept inn. After exhaustive wander-
ing, I reached the top, and after refreshment and rest, I sat there sunk
in the reflection of an enchanting view. I was so forgetful of myself
that at first I was loath to refer to myself the question: “Is the gentle-
man a doctor?” The question was, however, directed to me by a girl
of about 18 years. who had displayed a sulky expression while serving
my meal, and who was addressed by the hostess as “Katharina.” Judg-
ing by her dress and bearing, she could not be a servant, but most
probably was a daughter or a relative of the hostess.

Having regained my senses, I said “Yes, I am a doctor. How
do you know that?”

“You registered in the guestbook, and then I thought if the doctor
now had a little time … , you see I am nervous, and I have already
consulted a doctor in L. … , who also gave me something, but it
has not done me any good.”

Well, I was back in the midst of neuroses, for it could hardly be
anything else in this large and robust girl with the morose features.
It interested me that neuroses should flourish so well at a height of over
2,000 meters, and I, therefore, continued questioning her.

The conversation which then developed between us I shall now
reproduce as it impressed itself upon my memory. I shall also endeavor
to reproduce her peculiar expressions.

“What are you complaining of?”

“I have so much difficulty in breathing. Not always, but sometimes
it catches me so that I believe I am choking.”