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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.”

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At first that did not sound like nervousness, but it soon became
probable that it might well be a substitutive designation for an anxiety
attack. Out of the whole complex of sensations she stressed unduly one
of the factors, the difficulty of breathing.
“Sit down and describe to me how such a state of ‘difficulty in
breathing’ feels.”
“It suddenly comes upon me. There is first a pressure on my eyes.
My head becomes so heavy and it hums so that I can hardly bear it,
and then I become so dizzy that I believe I am falling, and then my
chest begins to press together so that I cannot get my breath.”
“And do you feel nothing in the throat?”
“The throat becomes laced together as if I choked.”
“And you feel nothing else in the head?”
“Yes, it hammers as if it would split.”
“Yes, and doesn’t that frighten you?”
“I always feel, ‘Now, I must die,’ and I am otherwise courageous,
I go everywhere alone, into the cellar and down over the whole moun-
tain, but on the day that I have this attack, I do not trust myself
anywhere. I always believe that someone stands behind me and
suddenly grabs me.”
It was really an anxiety attack, and to be sure, initiated by the signs
of an hysterical aura, or better expressed, it was an hysterical attack,
the content of which was anxiety. Might it not have an additional
content?
“When you have the attack, do you always think of the same thing,
or do you see something before you?”
Perhaps we have here found a way by which we can advance quickly
to the nucleus of the situation.
“Do you recognize the face? I mean is it a face which you have
really once seen?”
“No.”
“Do you know how you got these attacks?”
“No.”
“When did you first get them?”
“The first time two years ago when I was still with my aunt on
the other mountain. She had an inn there before; we have now been
here for a year and a half, but they always come again.”
Should I attempt an analysis here? To be sure, I did not dare to
transplant hypnosis to this height, but perhaps we will succeed with simple
conversation. I must have been fortunate in my guessing. I have
often seen anxiety in young girls as a result of fear which strikes the
virginal mind when the world of sexuality reveals itself to it for the
first time.³²⁾

³²⁾I shall quote here the case where I first recognized this causal relation.
I treated a young woman for a complicated neurosis, who repeatedly refused
to admit that she contracted her anxiety in her married life. She argued that
already as a girl she had suffered attacks of anxiety which ended with fainting.

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I, therefore, said: “If you do not know it, I will tell you what I
believe is the cause of your attacks. At that time, two years ago, you
had seen or heard something which embarrassed you much, something
that you would rather not have seen.”

Thereupon, she exclaimed: “Heavens, yes, I caught my uncle with
my cousin Francisca!”

“What is the story about this girl? Will you tell it to me?”

“One can tell everything to a doctor. You may know, therefore,
that my uncle, the husband of my aunt, whom you saw, at that time,
kept an inn with my aunt on the mountain. Now they are divorced
and it is my fault that they are divorced, because through me it became
known that he had something to do with Francisca.”

“Yes, how did you come to discover this?”

“It was this way. Two years ago, two gentlemen once came up
the mountain and wanted to get something to eat. My aunt was not at
home and Francisca, who always did the cooking, could not be found
anywhere. Nor could we find my uncle. We looked for them every
where until the boy, Alois, my counsin, said “In the end Francisca
will be found with father.” Then we both laughed, but we thought
nothing bad thereby. We went to the room where my uncle lived and
that was locked. That seemed peculiar. Then Alois said: “On the
path there is a window from which you can look into the room. We
got on the path, but Alois would not go to the window. He said he
was afraid. Then, I said ‘You stupid boy; I will go. I am not afraid
of anything.’ Nor did I think of anything bad. I looked in, the room
was quite dark, but then I saw my uncle and Francisca, and he was
lying on her.”

“Well?”

“I immediately left the window and leaned against the wall and got
the difficulty in breathing which I have had since then. My senses left
me. My eyes closed tight and my head hammered and hummed.”

“Did you tell it to your aunt immediately on the same day?”

“Oh, no, I said nothing.”

“But why were you so frightened when you found them both
together? Did you understand anything? Did you know what had
happened?”

“Oh, no. At that time I understood nothing. I was only sixteen
years old. I do not know what frightened me.”

“Fräulein Katharina, if you could now recall what went through your
mind at the time that you got the first attack, what you thought at
that time, it would help you.”

But I remained firm in my conviction. When we became better acquainted,
she one day suddenly said, “Now, I will also tell you whence my anxiety
states came as a young girl. At that time I slept in a room next to my
parents; the door was open and a night light was burning on the table. There
I saw a number of times how my father went into my mother’s bed and I heard
something which excited me very much. Thereupon, I got my attacks.”

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CASE HISTORIES

told how she once made a tour with him in the winter into the valley,
when they stayed overnight at an inn. He remained in the inn drink-
ing and playing cards, while she, becoming sleepy, retired early into the
room which they occupied together. She did not sleep soundly when
he came up, but then she fell asleep again only to awake suddenly and
“feel his body” in bed. She jumped up, reproached him: “What are
you up to, uncle? Why don’t you remain in your bed?” He attempted
to joke about it, and said, “Go, you stupid goose, be quiet. You don’t
even know how good this is.” “I don’t want anything good from you.
You don’t even let me sleep.” She remained standing at the door, ready
to flee out to the path, until he stopped and fell asleep. Then, she
returned to bed and slept until morning. From the mode of her defense
it would seem that she did not recognize the attack as sexual. Being
asked whether she knew what he was up to, she answered “At that
time, no,” but it became clear to her much later. She was irritated
because she was disturbed in her sleep, and because she had never heard
of such things.

I had to report this event in detail because it has great importance
for everything that is to follow.—She then related other experiences
of later times, how she had to defend herself against him in an inn
when he was very drunk, etc. But to my question whether she had
experienced on these occasions anything similar to the difficulty in breath-
ing which happened later, she answered with certainty that she had
experienced the pressure on the eyes and in the chest on each occasion,
but not as strongly as at the scene of the discovery.

Immediately after the conclusion of this series of memories she began
to relate a second series, which treated of events wherein her atten-
tion was called to something between her uncle and Francisca. She
related how she and the whole family once spent a night in their clothing
on a haystack. She was awakened, as a result of some noise, and she
believed that she observed that the uncle, who was lying between her
and Francisca, moved away and Francisca changed her position. She
spoke of how at another time she spent the night in the village, N. She
and her uncle were in one room and Francisca next door to them.
During the night she suddenly awoke and saw a long, white form at
the door in the act of turning the door knob:

“Heavens, uncle, is that you? What are you doing at the door?”—
“Be quiet, I am only looking for something.”—“But, you can only go
out by the other door.”—“I just made a mistake,” etc.

I asked her whether at that time she had any suspicions. “No, I
thought nothing about it. It struck me as peculiar, but I made nothing
out of it.”—Whether she had anxiety on this occasion?—She believed
yes, but at the present time she was not so sure of it.

After she finished these two series of stories, she stopped. She
looked as if changed. The sulky, suffering features were vivified, her
look was cheerful, she felt lighter and elated. Meanwhile, the under-
standing of her case dawned upon me; what she related last, seemingly

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without any plan, explains excellently her behavior at the scene of the
discovery. At that time she carried with her two series of experiences
which she recalled, which she did not understand, and which did not
help her in drawing any conclusion. At the sight of the pair in the
act of coitus, she immediately connected the new impression with these
two series of reminiscences, she began to understand and simultaneously
to reject. There then followed a short period of elaboration, “the incuba-
tion,” and thereupon came the conversion symptoms, the vomiting as
a substitute for the moral and physical disgust. With this the riddle
was solved. She was not disgusted at the sight of the two, but at a
reminiscence which this sight awakened in her and explained everything.
This could only be the memory of the nightly attack when she “felt
her uncle’s body.”

After this confession was finished, I said to her: “Now I know
what you thought at the time that you looked into the room. You
thought ‘Now, he does with her what he wished to do with me on that
night and the other time.’ It disgusted you, because you recalled the
feeling how you awakened in the night and felt his body.”

She answered: “It is very probable that this disgusted me and that
I thought of it at that time.”

“Just tell me exactly now that you are a grown up girl and know
everything.”

“Yes, now certainly.”

“Tell me exactly what did you really feel that night of his body?”
But she gave me no definite answer. She smiled perplexed, as if con-
vinced, and like one who must admit that as we have now come to the
bottom of the thing, there is nothing more to be said about it. I can
imagine the kind of tactile sensation which she later learned to inter-
pret. Her features, too, seemed to express that she agreed with my
assumption. But I could not penetrate any deeper into her. At all
events, I owe her gratitude for the fact that it was so much easier to
talk with her than with the prudish ladies of my city practice, for whom
all the naturalia are turpia.

With this the case would be explained, but wait, whence came the
hallucination of the head, which returned in the attack and which
inspired her with fear? I asked her about it. As if this conversation
had also broadened her understanding, she answered promptly: “Yes,
I know that now. The head is the head of my uncle. I recognize it
now, but I did not at the time. Later, when all the quarrels were taking
place, the uncle expressed a senseless rage against me. He always said
that it was all my fault. If I had not blabbered, it would have never
come to a divorce. He always threatened that he would do something
to me, and when he saw me from a distance, his face became tense
with rage and he ran at me with a raised hand. I always ran away
from him and always had the greatest anxiety that he might grab me
without my seeing him. The face which I then always saw was his
face in a rage.”

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CASE HISTORIES

This information reminded me of the fact that the first symptom
of the hysteria, the vomiting, had disappeared, but that the anxiety
attack remained and was filled with a new content. Accordingly, we
dealt with an hysteria, a great part of which was abreacted. For soon
thereafter, she actually informed her aunt of her discovery.

Have you also related the other stories to your aunt, how he appeared
to you?

“Yes, not right away, but later when it was already a question of
divorce. My aunt then said: ‘We will keep that to ourselves. If he
makes any difficulties at the divorce, then we will bring it up.’ ”

I can understand that from that last period the exciting scenes in
the house piled up, when her ailment ceased to awaken her aunt’s interest,
who was now entirely taken up with her quarrel—that from exactly that
time of accumulation and retention, there remained the memory symbol.

I hope that our conversation has done some good to this girl, whose
sexual sensibilities were so prematurely traumatized. I did not see
her again.

Epicrisis

I have no objection to offer should anyone consider the history
of the solution of this case of hysteria as given in this case history
more as one of guessing than analysis. To be sure, the patient
accepted as probable everything I interpolated into her report, but
she was, nevertheless, in no position to recognize it as something
that she had experienced. It is my opinion that such recognition
on her part would have necessitated the use of hypnotism. If I
assume that I had guessed correctly and now attempted to reduce
this case to the scheme of an acquired hysteria, as shown in Case
History III; it is obvious that we should compare the two series
of erotic experiences with traumatic factors, the scene of the dis-
covery of the pair, with an auxiliary factor. The similarity lies in
the fact that in the first there originated a content of consciousness,
which, having been excluded from the mental activity of the ego,
remained preserved, while in the latter scene a new impression forced
an associative connection of this separately existing group with the
ego. On the other hand, there are also deviations, which cannot
be disregarded. The reason for the isolation is not the will of the
ego as in Case III, but rather the ignorance of the ego, which does
not yet know how to cope with sexual experiences. The case of
Katharina is typical in this respect, for in every hysteria based on
sexual traumas one finds that experiences from a fore-sexual period,
which produced no effect on the child, later, as memories, receive
traumatic force, when the young girl or the woman gains under-

96

standing of her sexual life. The splitting-off of psychic groups is,
as it were, a normal process in the development of adolescence, and
it is quite comprehensible that their later reception into the ego
offers advantageous occasions for psychic disturbances. Moreover, I
wish to give expression in this place to a doubt: whether the split-
ting of consciousness through ignorance is really different from the
one through conscious rejection, and whether adolescents do not
frequently possess more sexual knowledge than one supposes or than
they, themselves, believe.

A further deviation in the psychic mechanism of this case lies
in the fact that the scene of the discovery, which we have designated
as “auxiliary,” deserves also the name, “traumatic.” It exerted
influences through its own content, and not just through the awaken-
ing of the preceding traumatic experience; it unites the characters
of an “auxiliary” and a “traumatic” factor. However, I see no
reason for giving up in this coincidence an abstract separation, which
in other cases corresponds also to a temporal separation. Another
peculiarity of Katharina’s case, which was, however, known for some
time, is shown in the fact that in the conversion the production of
the hysterical phenomena did not immediately follow the trauma, but
only after an interval of incubation. Charcot had a predilection for
calling this interval the “period of psychic elaboration.”

The anxiety which Katharina showed in her attacks was hys-
terical, i.e., it was a reproduction of that anxiety, which appeared
at each of the sexual traumas. I am also desisting here from eluci-
dating the process which I have recognized regularly and pertinently
in an unusually large number of cases; namely, that the mere
presentiment of sexual relations in virginal persons, evokes an affect
of anxiety.

OBSERVATION V. MISS ELISABETH V. R. (FREUD)

In the fall of 1892 I was requested by a friendly colleague to examine
a young lady who had been suffering from pains in her legs for over two
years, so that she walked badly. He also added to his request that he had
diagnosed the case as hysteria, though none of the usual symptoms of the
neurosis could be found. He stated that he knew very little of the family,
but that the last few years had brought them much misfortune and little
pleasure. First the patient’s father died, then the mother underwent a
serious operation on her eyes, and soon thereafter a married sister
succumbed to a chronic cardiac affection following childbirth. Our
patient had taken an active part in all the afflictions, especially in the
nursing of the sick.