“D”

IV

1. Symbols: The doll, first a baby (with shoes), is then used as (a) a hand extension (finger?); (b) a genital extension (penis or bodily content?).

Of defensive arrangements the following were recognizable: at the beginning and at the end of the hour self-protection by means of regressive M-adherence and denial of interest in toys and Ps; during the pushing episode, protection of extremity by the use of an (overcompensatory?) extension. The defense arrangement breaks down as Mary is overcome by the impulse to push and by some phantasy of the loss of the extension. We may therefore say:

2. Mary seems to be full of mischief (so far expressed as aggressive pushing), but is afraid of her impulses because she may damage her hand or lose something in the genital region if she does not restrict her sphere of expression and keep close to her mother.

3. The contact offered neither the opportunity not the appropriate moment for the administration of a therapeutic interpretation. If the mother had not interrupted (a behavior which throws some light on her part in the child’s anxiety situations) Ps would have tried to get in some kind or verbal contact with the child.

2. Interview with Mother

 

In a conversation with M the child’s total situation at the time of her visits to the nursery is discussed. M relates a fact which she had forgotten to tell me before: Mary had been born with a sixth finger which had been removed when she was approximately half a year old. Just prior to the outbreak in the play group Mary had frequently asked about the scar on her hand and had received the answer that it was “just a mosquito bite.” The mother admits, however, that the child in somewhat younger years could easily have been present when her operation was discussed. Around the time of her anxiety Mary had been equally insistent in her sexual curiosity, a fact which speaks for the possible importance at that time of a “scar” association between the actually lost finger and the mythical lost penis.

Her curiosity had received a severe blow when, shortly before the outbreak of anxiety, her father, irritable because of an impending legislative decision, had shown impatience with her during her usual morning visit to him in the bathroom and had shoved her out of the room. She had liked to watch the shaving process and had also frequently on recent occasions (to his annoyance) asked about his genitals. It must be taken into account here that a strict adherence to a certain routine situation in which she could do, say, and ask the same thing over and over again always had been a necessary condition for Mary’s inner security.

As to the child’s physical condition at these particular times, it appears that bad dreams with violent kicking in sleep (which M tries to check by holding her tight and awakening her) and foul breath on awakening had been attributed by one physician to a bad condition of the tonsils. Another physician, however, had denied this. The mother and the first physician had engaged in a heated discussion (before Mary) as to whether she needed an immediate operation. Before we evaluate all these factors (which add the association “operation” to that of “scar” and explain both an increase adherence to M during F’s irritable absent-mindedness and an increased fear of doctor-possibilities), we shall report Mary’s second contact in order to see which of all these factors her further play will single out as subjectively relevant.

“A”

I

MOTHER

Mary again smiles bashfully at me, again turns her head away, holding on to M’s hand and insisting that M come with her into the room. Once in the room, however, she lets her mother’s hand go and as M and Ps sit down she begins to play peacefully and with concentration.

“A”

II

BUILDING A HOUSE WITH BLOCKS

Mary goes to the corner where the blocks are on the floor. She selects two blocks and arranges them in such a way that she can stand on them each time she comes to the corner to pick up other blocks. She carries the blocks to the middle of the room, where she has put a toy cow, and builds a very small house. For about 15 minutes she is completely absorbed in the task of arranging the house so that it is strictly rectangular and at the same time fits tightly about the cow. She then adds several blocks to the long side of the house in the following way (Figure 3).

At the point marked X she adds a sixth extension, shifting it several times to other places, but finally returning it definitely to X.

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Figure 3

“B”

II

1. Today Mary peacefully concentrates on microcosmic play with a certain maternal quality of care and order. There is no climax of excitement, and the play ends on a note of satiation.

2. Her play has as subject (a) the building of a close-fitting stable for a toy cow; (b) adorning the stable building with six wings (five plus one).

3. Though M is present, Mary does not seem moved by impulses of adherence. She builds freely in the middle of the room, moving to the corner and back without hesitation.

Play again begins with an autocosmic extension—namely creating a base for the feet—and then is microcosmic throughout. The block configuration suggests, first, the female protective mode; second, a hand with a sixth finger or a foot with a sixth toe.

“C”

II

The mother has remained in the room, not “good technique,” but before this can be changed, Mary has concentrated so deeply on her play that it seems better to let her finish it.

Mary, with all her rigidity, balances well standing on the two blocks and bending down. The fact that she has to create a foot extension (protection? overcompensation?) for herself before picking up blocks reminds us of the fact that during the previous contact she had to add an extension (the doll) to her hand before she pushed the objects in the room. Both these acts suggest, of course, the association: scar, operation.

The house is built with a special expression of maternal “care.” The five wings, to which (after some doubt as to where to put it) a sixth is added, again remind one of the amputation of her sixth finger.

But this time, although again beginning with the representation of the extension of an extremity, Mary’s play does not lead into an aggressive outbreak (and the subsequent representation of a catastrophe). It finds satiation in the building of a female protective configuration. There is a pervading femininity about today’s behavior which serves to underscore in retrospect and by contrast the danger dramatized during the first contact, namely, the loss from the genital region of an object used for agressive pushing. The interesting combination of a handlike configuration with one which we are used to interpret as symbolizing the female organs of procreation furthermore suggests that a masturbation threat (harm to hand or genital if in contact) may be one of the specific experiences to which the little girl is reacting with anxiety.

“D”

II

1. Symbols. (a) blocks—protection—extension of feet—; (b) blocks—building—female protective configuration around animal—safe body content; (c) blocks—extensions of building—six fingers to a hand.

2. Defensive arrangement. Maternal herself and master of the microsphere, Mary restores her body’s inviolability by representing as restituted the loss alluded to during the first contact: her feet are extended (protected?); the content of her female body (baby) is well protected; the sixth finger is returned to the hand. The play ends on a note of satiety.

“A”

III

GAME WITH PS

Suddenly Mary looks teasingly at Ps, laughs, takes M’s hand and pulls her out of the room, saying, “Mommy, come out.”

Ps waits for a while then looks out into the waiting room. He is greeted with a loud and triumphant “Thtay in there!” Ps withdraws, whereupon Mary closes the door with a bang. Two further attempts on the part of Ps to leave his room are greeted in the same way.

(After a while, Ps opens the door slightly, quickly pushes the toy cow into the other room, makes it squeak and withdraws it again. Mary is beside herself with pleasure and insists that the game be repeated again and again until, finally, it is time for her to go home.

When she leaves she looks at Ps directly, shakes hands in a natural way, and promises to “come back”).

“B”

III

1. After being satiated with peaceful building, Mary suddenly and teasingly turns to me to initiate a game. During the game it is noticeable that, in spite of her aggressive hilarity, she does not tend (as she did during the first contact) toward overdoing aggressiveness and then with-drawing from it; Mary is in the real spirit of the game up to the time she has to leave.

2. The game has a content: A man (Ps) is teasingly locked into his room alone.

3. This game is macrocosmic indeed. Mary is the master, not only of both the waiting room and my office (and the connecting door), but also of her mother and especially of me. She takes M out of my space and locks me into it.

4. “Thtay in there” are the first words she has ever addressed to me. They are said clearly and in a loud voice.

“C”

III

Mary’s provocative behavior came very suddenly and with determination, as if something in her had waited for the moment when she would be free enough to initiate this game. What does it mean? The day before I had asked the mother to leave the room in the middle of the hour. Has Mary anticipated the repetition of this, and has she arranged her triumphant going out of the room with M in place of my sending M out without Mary? The situation does not seem covered by this possible interpretation.

The words which Mary uses when initiating the game somehow resemble the words which the mother told me the father had used when locking the child out of the bathroom during his days of irritation. “Stay out of here,” had been the father’s angry words. “Thtay in there” is probably linked with it, although in addition to the transference to me a double reversal had taken place: from the passive to active (it it she who gives orders), and in regard to the vector (she “encloses” instead of being excluded). One remembers now that from the moment Mary came into my room at the beginning of the first contact she showed a somewhat coquettish and bashful interest in me. Since it can be expected that she would transfer to me (the man with the toys) a conflict which disturbed her usually playful relationship to her father, it seems possible that in this game she is repeating with active mastery (“You thtay in there”) the situation of exclusion of which she has been a passive victim at home (“Stay out of here”). (This possibility came to me only after I had reacted to her play provocation, which, of course, I was prepared to do as soon as she would have chosen the moment and the theme. By my play acts I unconsciously took the role of the “good father” in a specific, symbolic way.)

“D”

III

1. Arrangement. After having assumed the good mother role (mother identification) and having protected and restored her body (restitution), Mary is transferring to me the role of the bad father (father transference) in a rearrangement of the situation which created the conflict between them (reversal of active into passive).

2. We do not know why the second contact was peaceful. It often happens that once excessively fearful doctor-expectations are disproved (they are, of course, more easily disproved in less neurotic children), the problems which had been previously presented in all their horrors appear in the form of restitutions: peaceful and playful identification with her mother, protection and restitution of her body in play, and the teasingly revengeful restitution of the play relationship to her father in transference. The child, as it stands at the end of the second contact, has indicated that she wants to be sure of her mother as a haven of protection, of her father as an interesting masculine playmate, and of her body as an inviolable whole in spite of the (at the time intrusive) impulses it expresses and the bodily dangers (operation) experienced and anticipated.

“E”

III

After a play contact which gave the therapist some first insight and the patient some long needed partial play satisfaction, there remain the following therapeutic questions: how normal for her age are the child patient’s problems, how much essential stability and adaptability has she betrayed, and how much support can she expect from her environment?

4. Etiological Speculations

We may now inquire into the factors in Mary’s life to which our attention has been drawn by her play. Now, as at any deeper point of clinical investigation, we seek to gain insight into changes in the following three segments of the patient’s life and into their particular functional relation; namely, into the coincidence in time and the mutual aggravation of (a) changes in the physiological sphere as they are brought about by decisive epigenetic steps in growth and maturation, or by some special disbalancing factor such as sickness or accident; (b) changes in the constellation or the emotional temperature in the environment; (c) changes in the person’s conception of his status in the world, i.e., a subjectivation of causal judgment in terms of guilt, inferiority, projected intentions, etc.

We find in a disturbed adult’s life history that a set of conscious and unconscious ideas (a “complex”) is subjectifying his experiences, making all changes mutually aggravating, bringing about continuous libidinal disequilibrium and making the individual the easy “traumatic” victim of specific types of occurrences. Usually the “complex” dates far back—and, indeed, we can observe in still undisturbed children that it is one or the other normal maturational crisis, with its complex of wishful and fearful expectations, during which (given a certain lack of psychosomatic or social support) experiences of a specific type or combination become traumatic: perception is subjectified, anxiety increases, defensiveness stiffens.

Once the mechanisms of psychological homeostasis have been upset for a long time and the individual finally is forced to seek help from a representative of a healing method, content and morphology of his sickness show such a multiple relation to an endless number of factors seemingly making one another pathogenic that unlimited material is provided for the discussion of whether the condition has a physiological or psychological basis. Usually, reality forces a simple solution: whatever method by right or might can claim the patient, is able to secure a selection of data and, by interjecting its curative agent, is successful in breaking the vicious circle of pathogenic factors will also determine the only “evidence” of the circle’s “beginning” which anybody will ever have.

We hope to approach such problems from a new angle through the study in normal or only temporarily disturbed children of those periods of lowered physiological resistance, those types of lowered environmental support, and those mechanisms of attempts at adjustment which, if occurring together, represent a combination producing traumatic strain.

Mary’s disclosure of her personality in her present stage of maturation and state of anxiety shows her generally somewhat timid: in all her aggressiveness she likes to have the retreat to her mother well covered. She is rigid in the sense that changes of routine are in themselves upsetting. On the other hand, she is playfully mischievous and psychosexually girlish. There is no doubt that Mary is dramatic (an interesting hysterical contrast to some of her compulsive traits), lovable, playful, outgoing, coquettish if master of the situation; stubborn, babyish, and shut-in when disturbed.

Physiological changes: maturational. Mary’s age and play suggest that she may be considered to be in the stage of childhood characterized (in both sexes) by a rapidly increasing power of locomobility, expanding curiosity, and genital sensuality, which in psychoanalytic literature is called the phallic stage and for which the author, in order to take into account certain developmental facts, has used the terms “locomotor-phallic” or “intrusive stage” (3).

The intrusive stage, in analogy to other stages, emphasizes sometimes silently, sometimes more noisily the following developmental potentialities:

1. The impulse of intrusion (epigenetically emerging with added vigor from the inventory of given impulses), the urge to force one’s way into the object of interest and passion.

2. The sensual (libidinal) experiences of increased locomotor pleasure and (often masturbatory) indulgence in phantasies of intrusive conquest.

3. A channel for the release (catharsis) of surplus tension from various sources in relatively excessive activity, of an aggressive, curious, and masturbatory character.

4. Specific trial and error experiments in regard to how far one can go in physically and socially forcing one’s way into the sphere of others.

5. A complex of omnipotence and impotence phantasies depicting the child either in the unlimited execution of the intrusive mode, and the unlimited mastery over its phantasy object (omniscient master of the universe, conquering the mysterious, taking revenge on giant enemies, etc.), or as the victim of other masters.

6. A new focus for the expectation of danger (developmental fear), i. e., an intolerance toward all interferences which may bring frustration to 1, 2, and 3, and danger to the organs involved. If increased by constitutional or environmental factors this intolerance may lead to an abnormal intensity or prolongation of 3 (i.e., excessive aggressiveness or masturbation) and severe anxiety and rage in the face of attempts to break it.

7. Reaction formations, i.e., changes in the personality which can be understood as permanent defensive reactions of the ego against those aspects of 1–5 which can be neither quite outgrown nor successfully used in socially approved action patterns.

To the future of the personality this stage (like all the others) provides a source of experiential wealth and power as well as of danger.

8. The personality is strengthened and enriched by (a) the successfully socialized use (sublimation) of the new impulse for such growing abilities and aspirations as are in accord with ego and environment: outgoingness and energy, courage in the face of the unknown, etc.; (b) by reliable reactive virtues binding some of the excessive energy and the unsuitable modes of the stage, such as self-restraint, protective attitudes, etc.

9. The danger consists in the potential developmental fixation which may build the basis for a future (periodic or permanent) developmental regression, such as the sadomasochistic dealing with partners in love or work. Reaction formations while creating virtues under certain conditions may imply excessive and permanent inhibition of intrusive types of action, repression of corresponding thoughts and past experiences or more radical measures such as the “turning against oneself” of intrusive acts and thoughts, i.e., masochistic fantasies, often with organic concomitants, or with the provocation of bad treatment by others.

In every developmental stage there is a period when a momentary fixation threatens to become incompatible with progression—the most common kernel of neurotic episodes in childhood. Such neurotic episodes are, of course, similar in content and form to the manifestations of chronic neurotics.

The study of neuroses has shown us that special educational interferences with the general mode of the intrusive stage (such as Victorian tendencies to place special limitations on many forms of locomotor and curious expansiveness, and to react with disciplinary selectivity to sexual curiosity) result in a fixation on the idea of genital intrusion, making the genitals the subject of excessive cathartic acts or that of excessive curiosity and often the consequently excessive repression of both. Such fixation brings with it a prolonged emphasis on the idea and the fear of intruding and on the idea and fear of being intruded upon and, consequently, fears for the inside of the body (as a goal of intrusion) and for extremities and penis as the organs of intrusive aggressiveness. Such a body of fearful expectations becomes, then, a ready factor in the traumatic nature of corresponding experiences.

It must be obvious that this stage offers special problems to the girl. Led by the intersexual experiences of younger organisms, she too has reached a period of stronger intrusive tendencies, often observed as tomboyishness. During this period clitoral masturbation and phantasies of having or achieving a penis (with all the locomotor and mental prerogatives ascribed to it) are not infrequently admitted. We know that in certain types and under certain cultural conditions this wish remains dangerously determining for life, while often, in a way much less well known, the locomotor-phallic complex seems easily and, so to speak, noiselessly subordinated to the wish for a baby and all the prerogatives connected with this possibility. But the physiological and psychological conditions which the girl must accept while imagining for the first time becoming the object of intrusive impulses and developing and libidinizing the (not necessarily unaggressive or passive) impulses of inception make the problem of female masochism a cardinal one—for personality as well as for culture. Of the mature man and the mature woman we expect that both the sadistic and the masochistic aspects of sexual intrusion have been subordinated to a satisfactory mutuality. This ideal of sexual maturity presupposes the successful liquidation of the phantasies and fears of the intrusive stage, during which to the bewildered child “cruel” and “sexual” often seem synonyms (3).

Mary, as little as she told us so far, has revealed something of the conflict of the girl who does not know whether she wants to be a boy or a boy’s girl—although she has done so with more grace and humor than we could expect from the chronic victims of this conflict.

We also understand that during her first contact Mary indicated to us that she had associated the intrusive impulses of the stage just outlined with the idea of “danger to the extremities”—an association probably preconsciously emphasized by the allusions to her lost finger and the imminent danger of an operation. However, during her second contact she dramatizes the development of a female identification and mastery of the fears of the intrusive stage.

In regard to the necessary attachment to one or both of her parents of these impulses and fears (“Oedipus Complex”) we can only say that the therapist in this case naturally attracted the father-transference; there seems to be little doubt as to the importance at this time of the child’s father as a partner in teasing games and as an object of sexual curiosity. The child’s flight to her mother is by no means free of ambivalence, as further observation would quickly reveal.

Physiological changes: special physiological condition. Mary has not been sleeping well of late. She has severe panics (or tantrums) in her sleep, during which she yells, “No, no, no!” Whatever it may be that she is dreaming about, she awakens with a foul breath and there is a suspicion that the state of her throat causes irritation and contraction even if there is no indication for a tonsillectomy. She has heard of the possibility of an operation, which she seems to have associated with the loss of her finger.

Environmental changes. The sudden addition to her sphere of experience of the play group puts Mary for the first time in her life in the hands of an adult other than a near relative and into a play situation with boys (at home there is only an older sister). Both her maturational state and the idea of an operation as associated with the loss of the finger must give the observation of sexual differences (in children) at this moment, even if it has been observed before, a sudden specific pathogenic importance.

At home it seems to be the father’s irritability which the child, not knowing the cause, must have misunderstood and connected with the place where it was first experienced (or because of obvious associations most intensely experienced); namely, the bathroom. Thus this experience, too, has been incorporated into the field of mutually specific factors.

We shall now offer a tentative diagrammatical summary, (a) comprising the interrelation of the historical, maturational, special physiological, and environmental changes with the impulses, ideas, and fears which we suspect of forming parts of the anxiety content; and (b) leading us back to the behavior items which “told us” of these impulses, ideas, and fears (Table 1).

What I have said about Mary represents the “mental note” which the psychoanalyst would make tentatively at the end of the two contacts. Some parts of the note would stand out in more clarity than others; however, we would expect him to have the courage to modify even his “clear impressions” if further observations demanded it.

As for Mary, the contacts were interrupted by a vacation period, after which the observer left Boston. Therefore Mary’s situation was carefully discussed with her understanding parents, who accepted (and partly themselves suggested) the following recommendations. Mary’s curiosity in regard to both her scar and her genitals required a truthful attitude. She needed to have other children and especially boys visit her for play at her home. The matter of the tonsils called for the decision of a specialist, which could then be candidly communicated to the chid. It did not seem wise to awaken and hold her during her nightmares; perhaps she needed to fight her dreams out, and there would be opportunity to comfort her when she awoke spontaneously. The child needed much locomotor activity; playful instruction in rhythmic movements might help her to overcome some rigidity with her extremities which, whatever the cause, presumably has been increased since she heard for the first time about the amputation of her finger.

A conversation with the parents a half year after the contacts described in this report did not seem to indicate the immediate necessity for further psychoanalytic observation. A tonsillectomy had proved unnecessary; the nightmares had ceased; Mary was making free and extensive use of the new play companions provided in and near her home. For various circumstantial reasons, she had, however, not visited the original play group again. She had asked for Ps often, wanting to know the color of the train he had taken when leaving town.

When Mary, a while later, paid Ps a short visit, she was entirely at home and asked Ps in a clear, loud voice about the color of his train. She addressed M and Ps alternately and entered Ps’s room without anxiety. Her play immediately centered on the cow again, which, with loving words, was given a tight-fitting stable.

TABLE 1 DIAGRAMMATIC SUMMARY

The diagonal (A-G) shows the historical, maturational, and environmental changes which seem to be of acute importance in the patient’s present life situation.

Downward and to the left of the diagonal (AB-FG) the possibly and probably resulting emotional emphases are shown. Emphasis AB is the result of the mutual aggravation of change A and B; AC that of Λ and C; etc.

Upward and to the right of the diagonal (ab—fg) the play acts are shown which made us aware of the actuality and motivating power of the ideas and emotions shown in AB-FG: ab points to AB, ac to AC, etc. However, play acts are “overdetermined”, i.e., correspond to several ideas and emotions.

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D. ORALITY IN A BOY OF FOUR

Dick was brought to our attention by a physician from a nearby town who occasionally attended the meetings of our Yale study group. His mother, the physician’s patient, had complained for the last year or so of a “queer trait” in her little boy; encouraged by our work, the physician, an extraordinarily good observer, familiar with the principles of psychoanalysis, decided to try her eye on the child’s play. She invited the little boy, who had never seen her, to come to her office to play and reported to us the five contacts, the first three of which will be given here.

Dick on his fourth birthday was a physically healthy, attractive, and intelligent child who had a good appetite and slept well. However, he was often dreamy and withdrawn and, with strange indifference, would express rather queer fears and concepts. His parents, warned by outsiders, began to fear that “some day he might withdraw completely and not come out of it.” They had had this in mind for some time when suddenly, at four years and two months of age, he calmly refused to speak for 24 hours and for some days after would only whisper. Such “spells” recurred.

It had started during a big family dinner. An uncle’s completely bald head fascinated Dick. Innocently, he remarked, “You haven’t any hair on your head.” The adults smiled in embarrassment and hoped he would think of something else, but a few moments later he addressed the bald-headed man again. “Have you no comb at your house?” After more such remarks Dick’s grandmother took him aside and told him that he was “not to talk about this any more.” The child, without any display of emotion, became silent and remained silent for 24 hours, except for some whispered remarks in school the next morning.

Naturally, the parents were worried about such a radical reaction to an everyday occurrence such as the prohibition against talking about a seemingly unimportant matter. On the other hand, it was hard to judge the “seriousness” of Dick’s reaction, for he seemed neither stubborn, nor worried, nor angry; he simply was far away, apparently uninterested in a means of communication which had proved so troublesome.

One remembered then that on several occasions Dick had been a radical representative of the biblical saying “If thine eye offend thee, pluck it out”—or rather its infantile form, “If thine eye offend thy parents, pluck it out.” There had been, for example, a time (it was during one of his mother’s pregnancies) when he was very proud of and liked to display and brag about his “nice fat tummy.” Its unproductivity devaluated the possession of this part of his body, whereupon he remarked that he was going to throw it out of the window and was found pressing it against a hot radiator “to burn it off.” Similarly, after one of his little sisters had been born and had taken supremacy in the family’s attention, he seemed ready to cast away all the prerogatives of his age and sex. He began to creep, to use baby talk, and even to want his clothes and his belongings to be called “little.” Again, he not only tried to deny a devaluated possession, this time his genitals, but was found attempting “to pull them off,” and finally asked his distraught parents to do him this service.

It would be hard to say exactly whether and where all this transgresses the range of variations and episodic peculiarities of normal child behavior. To his intimate observers, Dick seemed to experiment with reality in a somewhat less playful and more deeply preoccupied way than most children do. He was interested in parts of the body (the “tummy” of a pregnant woman, the penis) which are of outstanding importance in some cases, but are missing in others without apparent disadvantage for either well-being or prestige. This preoccupation with missing things could take possession of him to such a degree that the majority of his remarks and questions during a given period would indicate a concept of the world in which missing things were not the exception but the rule and the dominant aspects. After he had been frightened by the sight of eyeglasses, he asked everyone, including perfect strangers, whether their eyes came out. After he had discovered that a certain old man had false teeth, he asked the same question about everybody’s teeth. When he saw a sculptured bust, he remarked that it had “no feet”; on entering a room, he pointed to what looked to him like holes in the ceiling before he noticed anything else. To him, a person did not “have” a tummy or an arm, but “wore” them; an expression which clearly implied the suspicion that these parts could be taken off like clothes.

Thus, at times, his body image seemed to lack a certain integrity. But while his calmness suggested that this lack was simply the remnant of an earlier age—i.e., represented a maturational deficiency—his usual display of intelligence contradicted this interpretation. Consequently, it was necessary to assume that the boy experienced (or pretended to experience) rather something of a disintegration of his body image.

An attempt to test Dick’s intelligence had the following result:

In many instances the child appeared to be concentrating on the task at hand. At other times he seemed almost like a sleepwalker. The very much longer time required for the third trial of the Sequin form board may be attributed to the fact that two or three times he simply became fixated on a block and was unable to continue the activity. When a key was held out to him and he was asked to name it, he seemed to look right through it; several minutes later it was presented to him again and he quickly and easily gave the name. His successful responses (at the age of 44 months) were, for the most part, at the three-and-one-half and the four-year levels. One certainly has the impression that this is a potentially able child. [When brought in during one of his phases of not speaking,] he was very aloof and did not speak a word. He was fascinated by the bridge of blocks built for his own little car and smiled willingly, but would not try one himself; he sat down once or twice; but each time became uneasy and immediately pushed the chair away from him. He looked out of the window a good deal and remained in a teasing mood so that no satisfactory developmental picture could be obtained. He resented all efforts to help him and pushed the examiner’s hand away. In general, he looked at everything with a curious combination of attention, and dreaminess. He was not eager to leave, but went passively when told to go.

That Dick really had a most emotional interest in the integrity of the objects to whose defects he referred casually became obvious when, during his spells of silence or whispering, he could be observed creating a private world in which he could inquire about missing things and be sure to get a comforting answer. Thus he could be overheard asking himself, “Has that car got a spare tire?” and answering himself, “Yes, it has, Dick.” This (normal if transient) method of dealing with observable fact he used also in matters of conscience. “Dick, you must not do that.—But I want to do it.—It is better not to do it.—But I am going to do it.” Whereupon the “adult” voice seemed to be giving in.

Dick seemed genuinely afraid that certain radiators were going to bite him, and it will be one of the tasks of our play analysis to find out why certain radiators seem to him to be animal-like, others not. This manifest fear that something inanimate might have a hidden mouth to bite him corresponded to the only recurrent dream he liked to report, namely of a certain being to whom he gave a strange name and of which he could only say that it had “no mouth.” Incidentally, he spoke about dreams as if they were real. Visiting a friend, he would say, “I was here last night and played with you.” We know that many children indicate that at least in answer to certain suggestive questions they are unable to differentiate verbally between dream and reality. What interests us about this child is that he preferred to talk about such borderline experiences, often to the exclusion of all other topics. Cars often seemed to be animate beings for him. “It is too bad that motorcars have to sleep out in the street.” For some time he has been differentiating also between men-cars and lady-cars, basing the distinction partly on types of cars which were driven by men or women of his acquaintance. This differentiation, however, overlapped with the one applied to all objects and based on their “yes” or “no” aspects, namely, whether they have a hole (a sink for him is a “no thing”) or outstanding parts (a comb is a manifold “yes thing”).

All-or-nothing people, who seem ready literally to pluck out the eye which offends them, are hard to deal with. When asked to keep it they may insist with equal radicalness on using it. Thus when Dick’s parents noticed that to the detriment of his development he had decided to become in all physical and mental respects the likeness of his sister, they initiated a campaign for masculinity, insisting that to have a penis was practical and desirable and nothing to be ashamed of. He took them at their word. He exhibited his penis and, this prohibited, began to shout around his word for penis in a voice the masculinity of which left nothing to be desired; he began to lift the skirts of little girls and finally annoyed adult women visitors by looking at them from the frog’s eye-view. The fact that the shouting of the word for penis occurred and was prohibited shortly before he met and annoyed the man who had no hair explains some of the intensity of his reaction to the grandmother’s prohibition. For him, to have a thing, to show it, and to use the word for it meant three inseparable aspects of its possession. It was obviously intolerable to him that after he had tried in vain to be everything people seemed to like better than a little boy (namely, a pregnant mother, a little girl, etc.) he should meet even more powerful interferences when acting on the suggestion that he become a boy. Not only did he, as we have heard, begin to whisper, but he also wrapped his head in a sheet at night, tried to force his head into a toilet, etc. Biting became the dominant idea in his play; he threatened to bite not only his sister, but also himself, and actually was observed biting a dog’s tail.

From such scant material, which gives the mother’s complaints (somewhat ordered by us according to areas of expression rather than chronologically), we derive the following preliminary outline of Dick’s personality: He is overcome by his drives at one moment, by prohibiting forces at the next; each time, however, an all-or-none attitude takes possession of him; similarly he changes his roles of identification easily, although each time radically and completely. Thus in his subjective as well as his objective world he keeps roles changeable, and parts detachable, introjects easily and projects easily. What danger he may be trying to ward off (if what we describe are defensive mechanisms, and not merely regression and disintegration) is only hinted at in the content of his phobia: He is threatened by a being with a mouth, which in his dreams (according to the undistorted wish-fulfilling character of children’s dreams) appears without a mouth. Mouth and throat become the “zonal” emphasis in a world of dangerous have-nots (have holes) and detachable parts: he has spoken of biting ever since his last experiment in masculinity—at the height of the phallic phase—failed.

We cannot publish a detailed chronological life history of this child. Whatever historical data come to our mind as we observe the child’s play will be reported in that context. We must concentrate on tracing the outline in playful and fearful acts of a doubting and often despairing infantile mind which has been unable so far to settle down to a clear differentiation of certain borderlines of individual and social existence. We shall see him concerned with the differentiation between male and female, between ego and object, between animate and inanimate, between bodily coherence and fluctuating environment, etc. As psychoanalytic experience and theory would lead us to expect such basic uncertainty will prove to be linked with an oral complex, i.e., the fixation on an easy regression to the wishes and fears of one of the incorporative stages. Beyond showing how this reveals itself in the child’s play, we will avoid drawing diagnostic or prognostic conclusions from childhood material we are just learning to approach.

Whether the fault lies with the circumstances under which this material was won, or its inner affinity to the early stages of personality development, it is hard to present and doubtless even more difficult to read. The patient reader, it is hoped, will reach some point which can serve him as a bridge from his adult thinking to that of a disturbed infantile mind—and to that of stubborn observers who cannot bring themselves to dismiss “queer” material as meaningless.

The circumstances of observation and the nature of the material make the following methodological changes necessary:

1. An account of the sequence of the child’s acts will not be attempted. Instead, an inventory of behavior items (according to the classifications: toys, “life-sized” objects, people) will be given for each contact. Only occasionally will a reference be made which places an act nearer to the beginning or the end of a contact.

2. Except where a coherent plot becomes discernible there will be no attempt to account regularly for the ideational content in the patient’s fleeting play.

3. In order to familiarize the reader with the character of this patient’s play the inventory of the first three hours is given in toto before the single items are taken up for analysis.

1. Inventory of First Three Contacts

a. First contact. Dick, who has never seen the physician before, seems from the very start to accept her in a matter-of-fact way. Pressing into her room, he only asks in a casual way, “Are your eyes all right?” and then eagerly, “Where are the toys?”—He immediately piles all the toys (except for a large truck with doors) into one box and carries them to the couch.—His mother, who comes after him to ask if it will be all right for her to go away, has to repeat her question before he gives a casual, rather impatient “Yes.” She says goodbye, but he pays no further attention to her.

(1). Toys. Dick takes or points to a number of toys, and with one exception merely makes remarks about them instead of playing with them. He looks from all possible angles at the toy cars, his head close to them, and repeatedly makes the following remarks. “They have no spare tires.” “Are they broken off?” “Did they ever have them?” “They are not meant to have spare tires, are they?” “It’s all right, they don’t need them.” “Don’t you touch them.” “I don’t like those cars.” “I don’t want to play with them.”

He treats the red wrecker with a satisfied smile. “This car has two spare tires.” “I like this one.” He associates to it: “Mother’s car has a spare tire.”

“There is no water in the toilet.” “We will leave the cover up.” “We had batter put it down again.” “I don’t have to go to the toilet.” “Don’t put any water in it.”

Dick has left only one toy in the toy closet, a big red truck with doors. Near the end of the hour he says, “I can’t have it, can I?” The physician says he can play with any of the toys. “No,” he says, and closes the closet door. Later he takes the truck out, opens its back doors, shuts them, and puts the truck back, saying, “You mustn’t touch it.”

He builds a garage for two cars; puts doors on it and two roofs; is pleased with it. After a little, he opens the doors with the intention of putting in two cars, then knocks the whole structure down, saying, “I don’t need it.”

(2). Big objects. Dick says, “Does the chair come off?” The physician thinks he means the swivel top and replies, “No.” Dick says, “Yes, it does,” and demonstrates by lifting the chair. “The table comes off too. You were kidding me when you said it didn’t, weren’t you?” (He lifts the table.)

He looks at the radiator in an intently exploratory way, eyeing the two ends with some anxiety, and says, “There is no water coming out, is there? How does it work?” The physician offers to turn on the steam. He seems alarmed and cries, “Don’t do it!” The physician says, “Tell me what you want to know about radiators.” Dick presses against the physician’s knees and says in a confidential manner, “I want to know about yellow radiators.”

Near the end of the hour Dick says to the physician, “You mustn’t take your dress off. I will spank you if you do.”

b. Second (short) contact. Dick again presses eagerly into the room the minute the door is opened and goes instantly to the toys. His acts and words are almost identical with those of the first contact with the difference that he handles the cars with more freedom and only once or twice comments on the lack of spare tires.

About the girl doll he says: “She has no pants on. She has to go to the toilet. You make her sit on the toilet. She is all through.” He puts her in front of the basin to wash her hands, then puts her in the bath tub. (Her dress is sewed on.) “She is a naughty girl to be in the tub in her dress. She mustn’t take her dress off.”

c. Third contact.

(1). Toys. About the cars Dick says over and over: “Do they have spare tires? Are they broken off?” He points to little knobs and calls them spare tires.—He says, “Have all wreckers two spare tires? I want to break them off.”

He sets the bathroom set up several times, each time hesitating to play with it. His eyes wander to the dolls, but he turns away again. Finally, near the end of the hour, he announces: “The little girl needs a bath; she is sick.” He asks the physician to let the water run into the tub; he seems pleased and excited.

He opens the truck doors and says, “I’d better shut them.” He opens them again and puts half a dozen toys in. He removes them again.

Dick again builds a garage with closed doors and runs a small car against the door as if it wanted to enter. The physician remarks, “The car can’t go through the closed door, can it?” Dick opens the door, runs a car in and out and in again, leaves it for a while, then takes it out again and abandons the garage with the doors open.

(2). Big objects. About the carvings on the arms of the chair Dick says: “They aren’t feet, are they? They won’t come off, will they?—they look like your hands.”

“I am afraid it will bite me.” The physician asks, “Who?” Dick replies, with glee, “The radiator downstairs.”

(3). Physician. Pressing against the physician’s knees, he points to big gold buttons (resembling large raspberries) on her dress and says several times: “I want to bite them.” The physician asks, “Do you like to bite things?” He replies, “Yes, I like to bite sister. I am going to bite sister when I go home today.”—Shortly afterward he says, “I want to eat my dinner. Have you any crackers?” Then he asks: “People can’t go down people’s lanes, can they?” The physician says, “You mean the red lane?” He replies, “The yellow lane. Sister calls it a red lane. I call it a yellow lane.—Yellow is my favorite color.”

2. First Contact: Analysis

“A”

I

PHYSICIAN

Dick, who has never seen the physician before, seems from the very start to accept her in a matter-of-fact way. Pressing into her room, he only asks in a casual way, “Are your eyes all right?” and then eagerly, “Where are the toys?”

II

TOYS

He immediately piles all the toys (except for a large truck with doors) into one box and carries them to the couch.

III

MOTHER

His mother, who comes after him to ask if it will be all right for her to go away, has to repeat her question before he gives a casual, rather impatient “Yes.” She says goodbye, but he pays no further attention to her.

“B”

I, II, III

No hesitance on seeing a stranger (doctor) is manifested. His mother’s departure is even urged with slight impatience. His interest in the physician is fleeting and temporary. All his eagerness is directed toward having all the toys at once.

In the macrosphere we thus see an exclusion of the mother, a passing by the doctor, an eager intrusion into the strange room; in the microsphere, and eager collection of all the toys (with the exclusion of one large truck) in one place.

The sentence, “Are your eyes all right?” is D’s individual way of saying, “How do you do.”

“C”

I, II, III

The impatience with which Dick leaves his M behind is in striking contrast to the usual mother adherence displayed by children brought for observation. One is immediately reminded of his reported tendency to deny pronouncedly his interest in persons, objects, or parts of himself to which he had clung the moment before.

His first likewise pronouncedly “casual” interest in Ps, then, concerns a part of her body which to his mind (how seriously we don’t know) could “come off.” This remark recalls an episode: A barber not long ago happened to inflict a slight cut on Dick’s ear, whereupon the boy would go to barbers only on the condition that they did not wear eyeglasses, as if to imply that persons who have detachable parts are more apt to mutilate others. It may be in keeping with such an idea that he feels safer with a doctor if her eyes are “all right.” However, all this seems, for the moment, overshadowed by his eagerness to see the toys.

“A”

IV-VIII

TOYS

Dick takes or points to a number of toys, and with one exception merely makes remarks about them instead of playing with them.

He looks from all possible angles at the toy CARS, his head close to them, and repeatedly makes the following remarks: “They have no spare tires.” “Are they broken off?” “Did they ever have them?” “They are not meant to have spare tires, are they?” “It’s all right, they don’t need them.” “Don’t you touch them.”

“I don’t like those cars.” “I don’t want to play with them.”

He treats the red WRECKER with a satisfied smile. “This car has two spare tires.” “I like this one.”

He associates to it: “Mother’s car has a spare tire.”

“There is no water in the toilet.” “We will leave the cover up.” “We had better put it down again.” “I don’t have to go to the toilet.”

“Don’t put any water in it.”

(Dick has left only one toy in the toy closet, a big red TRUCK with doors.) Near the end of the hour: “I can’t have it, can I?” (The physician says he may play with any of the toys.) “No.” Closes the closet door.

Later he takes the truck out, opens its back doors, shuts them, and puts the truck back. “You mustn’t touch it.”

He BUILDS A GARAGE for two cars; puts doors on it and two roofs; is pleased with it. After a little, he opens the doors with the intention of putting in two cars, then knocks the whole structure down, saying, “I don’t need it.”

“B”

IV-VIII

Dick reveals his interest and withdrawal in the following scale of approaches and avoidances.

Having piled up all the toys most eagerly, he does not play with them. He shifts his interest from one to the other, only to discard most toys with one or more remarks of a negative character.

He is positive about (“likes”) only the red wrecker (which has two spare tires where other cars have none) and associates to it his mother’s car (the only reference to an object outside of the playroom).

He manipulates but does not play with the truck with two doors (which had been the only toy left behind in the closet).

He really plays only for a moment at building a two-door garage which, however, he destroys immediately.

At the same time he establishes a verbal adherence to the physician. In addition to referring to missing parts, he protests his disinclination to play with the toys and insists that such play is prohibited, either assumedly by the physician or expressly by himself.

“C”

IV-VIII

Dick’s curve of interest and withdrawal recalls the strength of his initial attachment (eager incorporation) to persons and objects, and his seemingly unemotional dismissal and easy change of them.

As he wants to have all the toys but does not take the time to play with them, he insists on continuously talking with the physician without listening to her answers. His one-sided pursuit of a problem becomes most obvious where he dismisses as irrelevant permissions given by Ps and goes on establishing prohibitions. Thus, in spite of his confidential adherence and urgent inquisitiveness, Dick seems to be quite out of touch with the physician, while for the latter, it is hard to know not only what he means but also how seriously he is interested in what he means. Referring at random to the objects at hand, he is obviously speaking of some situation other than the one he presently shares with the physician.

A first hint as to what he may refer to is given in his questions in regard to parts coming off objects and to prohibited acts. These two classes of ideas in almost identical formulations are represented in the questions he asked his mother in rapid succession when she tried to assure him that his penis once and for all belonged to him: “Does sister have a penis?” “Did she lose it?” “Will she have one later?” “Did she do anything naughty to it?”

His assurances that the cars “aren’t meant to have spare tires,” that “they are all right,” and “don’t need them,” correspond, then, to the answers the mother reports having given the boy: “Girls are meant to be the way they are,” etc.

His whole attitude makes it probable that whatever he wants to discuss here is related to a conversation he had with an adult. That “the cars are all right” as well as the prohibitions “not to touch them” is brought forward in the way of a now reassuring, now admonishing adult. As we saw, he not only discards Ps’s permission to play with (her) truck, but at the same time treats her as if she were not of age.

Thus, first eagerly interested in the toys, he gradually and individually denies his interest in any of them (except the wrecker with the double spare tires) and instead assumes the role of the adult who knows well that the play is forbidden, while the physician becomes a naughty girl with bad intentions. Are these intentions projected, i.e., do they represent his original play intensions? In any event, in creating this arrangement with an adult Dick goes one step further than he did in the monologues (overheard by M) and which he was two people all in one, the prohibiting adult and the stubborn child. He now assigns the infantile role totally to the physician while he becomes the prohibiting adult.

“D”

IV-VIII

The tentative nature of the first references to symbolic equations has been emphasized above. We are therefore stating them boldly here, going out from what seems to us the key to the patient’s system of symbols.

Symbols. If small cars without spare tires are associated with small human bodies with missing parts (girls, sisters), a truck and a garage are larger bodies and potential receptacles for smaller bodies (women, mothers).

Arrangement. Dick, afraid to play because of the meaning the toys have for him, denies his interest in them; he takes unto himself the attitude of the selecting, prohibiting, and reassuring adult and assumes (projects?) naughty intentions in the physician.

“A”

IX, X, XI

Life-sized objects: Chair, Table, Radiator. “Does it come off? (CHAIR) (Physician thinks he means the swivel top and says “No.”) “Yes, it does.” He demonstrates by lifting the chair.

“The table comes off too. You were kidding me when you said it didn’t, weren’t you?” (He lifts the table.)

Looks at RADIATOR in an intently exploratory way, eyeing the two ends with some anxiety: “There is no water coming out, is there? How does it work?”(Physician offers to turn on the steam.) He seems alarmed, “Don’t do it!”

(Physician: “Tell me what you want to know about radiators.”) Dick presses against the physician’s knees and says in a confidential manner, “I want to know about yellow radiators.”

“B”

IX, X, XI

On the whole, as we saw, avoiding microcosmic play, Dick gives a more courageous interest to some life-sized objects. He does not discard them as he did the smaller objects, but elatedly proves by lifting them that two of these objects (chair, table) “come off.” However, when shifting his interest to the radiator, he withdraws: “Don’t do it.”

Thus in his general attempt at showing himself the courageous master of the macrosphere (i.e., of life-sized objects and of the physician) he fails when confronted with the radiator, which has apertures and a watery, noisy inside. When speaking of this, Dick develops a more intimate bodily adherence to the physician than he does during the rest of the contact.

Verbally, he “kids” her in the macrosphere as in the microsphere he has disciplined and reassured her.

“C”

IX, X, XI

In IV—VIII we understood Dick’s first reference to the small toys to mean that parts are missing, have “come off.” He now demonstrates to the physician that life-sized objects “come off” in toto. These objects have four legs, one similarity with animals. The radiator’s similarity with animals rests on the fact that he has a (warm, noisy, water-filled) inside and apertures for intake and release. Dick dares to touch chair and table, but not the radiator.

This brings to mind the explanation Dick’s mother had for his radiator phobia. It appeared, she reported, after a nurse had kidded Dick to the effect that a certain radiator (it was yellow and had four legs) would jump at him and bite him. Probably she used this as a threat in connection with some misdemeanor on his part.

It seems possible, therefore, that Dick in his first contact is introducing us to two aspects of one and the same problem, (a) can small objects (children) lose parts “which they need,” (b) have big objects (animals? adults?) the intention of suddenly jumping at you (and biting)? These questions appear in a conversational context which betrays deep mistrust in and the anxious wish to experiment with adults’ prohibitions, assurances, and jokes: His dealing with small objects seemed to lead back to a reassuring conversation with his mother, his dealing with big objects to refer to the nurse’s threat.

“D”

IX, X, XI

1. Symbols. Chair, table, radiator; four-leggedness, occasional four-leggedness, apertures, warm touch, inner noise: Bodies which move and bite.

2. Years ago a nurse had said a radiator would bite him. “She is only kidding,” his mother had reassured him. This episode is represented with displacement (chair, table, which do come off, instead of radiator), reversal from passive into active (the physician is kidded and is shown that certain objects do come off), and denial (of his fear). The arrangement fails in the case of a radiator, the original object of his phobia. We see: Dick believed in the nurse’s threat more than in his mother’s reassurances.

“A”

XII

PHYSICIAN

Near the end of the hour, to physician: “You mustn’t take your dress off. I will spank you if you do.”

“B”

XII

After the short bodily adherence, Dick’s interest in physician again appears fleeting, surprising, teasing. She is small and inclined to uncover herself; he is big, and assumes the punishing tone of an adult.

“C”

XII

During the first contact Dick’s verbalized interest in the physician’s body has proceeded from an organ extension (eyeglasses), which we assume to stand for the part they cover (eyes), to the clothes, which may be taken off, revealing the whole body. This reflects two of the three foci of interest in inanimate objects, namely, the partial focus, “coming-off” parts of small objects; and the total one: the “coming off” of big objects.

A third focus—namely, the “insides” of larger objects which could enclose the smaller ones—has not appeared in relation to the physician’s body. But we have noticed that all the extreme moments of the contact referred to receptacles. It was the big truck that was completely ignored at the beginning of the contact when Dick was so eager to get all the toys (—and to ignore mother and physician). His only play concerned the two-door garage which he destroyed, and open anxiety was obvious only when the working inside of the radiator was referred to.—(Has his fear of certain radiators originally been the fear of woman’s bodies? If yes, why?)

“D”

XII

Symbols. As there is a symbolic equation between toy cars and children, there is one between life-sized objects with four legs and animals or adults. The danger threatening the small beings is that something may “come off” them; the danger going out from big beings is that they may move and (at least so says his radiator phobia) bite.

Arrangement. The warning given the innocent physician not to take her dress off, again uses the projective-introjective arrangement which typified the whole hour. He speaks as if she were intending to do the “naughty” thing he has in mind. This is as far as the transference has developed during the first contact.

“E”

XII

If we review Dick’s behavior with objects so far, we find three themes represented: (1) it is not permissible to touch small cars (children) with missing parts (genitals); (2) it is not permissible to touch big cars and other receptacles (women) which can harbor small cars (children); (3) it is dangerous to touch large inanimate objects (animals, women?) that have apertures and an inside. In order to see the dangerous ideas behind the avoided objects and acts we may connect tentatively: 1 and 2: a girl is being born from within a mother; 1 and 3: missing parts on small bodies have been bitten off by a dangerous big object; 2 and 3: inanimate and animate receptacles are female; both have insides and dangerous apertures.

3. Second (Very Short) Contact: Analysis

“A”

I

REPETITIONS

Dick again presses eagerly into the room the minute the door is opened and goes instantly to the toys. His acts and words are almost identical with those of the first contact with the difference that he handles the cars with more freedom and only once or twice comments on the lack of spare tires.

II

GIRL DOLL AND BATHROOM

“She has no pants on. She has to go to the toilet. You make her sit on the toilet. She is all through.”

Puts her in front of the basin to wash her hands; then puts her in the bath tub. (Her dress is sewed on.) “She is a naughty girl to be in the tub in her dress. She mustn’t take her dress off.”

“B”

This is the longest interest Dick attached to any one toy so far. Ideational content: Dirty, naughty, exhibitionistic girl is taken care of and reproved. Microcosmically the girl is put into a receptacle (an act symbolically avoided the day before). This is done in cooperation with the physician.

“C”

Like Mary in her second hour, Dick is somewhat changed. The physician’s impression is that he seems to accept in their existing form the cars without spare tires, an impression that goes well with his maternal play with the girl doll. He is motherly today, perhaps an identification with the physician who the day before disproved his fearful expectations and proved not to be a doctor but a maternal friend.

On the one hand, the girl dolly seems to be pretty naughty—whether she does or does not take off her dress. She has inherited the naughtiness which during the first contact appeared partly in denials and was partly projected on the physician.

“D”

Arrangement. Dick and physician are united in the maternal care for a naughty child. According to our expectations (which Mary did not disappoint) this more concentrated microcosmic interlude should free some expansive energy for a clearer macrocosmic representation of Dick’s wishes.

4. Third Contact: Analysis

“A”

I

TOYS

Over and over: “Do they (CARS) have spare tires? Are they broken off?” Points to little knobs and calls them spare tires.

“Have all WRECKERS two spare tires? I want to break them off.” Sets BATHROOM SET up several times, each time hesitating to play with it. His eyes wander to the dolls, but he turns away again. Finally, near the end of the hour, he announces: “The little girl needs a bath, she is sick.” Asks Ps to let water run into the tub, seems pleased and excited.

Opens TRUCK doors. “I’d better shut them.” Opens them again and puts half a dozen toys in. Removes them again.

Dick again builds a GARAGE with closed doors and runs a small car against the door as if it wanted to enter. (Physician remarks, “The car can’t go through the closed door, can it?”) Dick opens the door, runs a car in and out and in again, leaves it for a while, then takes it out again and abandons the garage with doors open.

“B”

I

Dick’s interest, though still fleeting and finally always discarded, remains with each item for one positive or aggressive statement or move beyond the first contact’s self-imposed limits. The little have-not cars still have knobs that suggest the possibility there may have been or there some day may be more; while the proud wrecker tempts him to break off his double parts.—Toys are put into the truck, cars without spare tires into a garage, and a (sick) girl into the bath tub. Verbally there is an increase in positive statement.

“C”

I

Before he again disposes of the toys in his usual fleeting, listless way, Dick adds something positive or aggressive to his repetitions, as the following comparison shows:

 

FIRST CONTACT

THIRD CONTACT

Cars “They have no spare tires.”

“Little knobs are spare tires.”

Wrecker “He has two spare tires.”

“I want go break them off.”

Truck “I must shut it.”

Puts toys in.

Bathroom “Don’t put any water in it.”

“Let water run into the tub.”

Garage Destroys structure before putting cars in.

Runs a car in. (Does not destroy the garage.)

 

The evaluation of the car knobs, in the generally more hopeful atmosphere of this hour and if viewed in the context of the other symbolical treatment of toy cars, corresponds to a typical self-comforting infantile reaction to the observation of sexual differences: Little boys and girls often expect a penis to be growing inside the girl (the clitoris providing the girl with a tangible hope) while little boys expect all nipples to become breasts. Both vain hopes contain, as is so often the case, some biological truth. The hopeful reference to these knobs is, then, a belated symbolical expression of that one idea in the conversation with his mother which had not been taken care of in the first contact, namely, the question “Will she [sister] have a penis later?”

It is interesting that this item, in the context of a general slight expansion of Spielraum* in this hour occurs in connection with a temptation to devaluate the overcompensatory red car by making him lose what was his distinction. Dick’s inclination to sacrifice his proudest possessions (tummy, penis) in order to avoid friction and to atone for his aggressiveness against his sister must come to mind. (We remember he had tried to pull off his penis at the end of a supermasculine period when he had been told he was “hurting the girls’ feelings.”) This suggests a defense mechanism of equalization.

“A”

II

CHAIR, RADIATOR

About carvings on CHAIR’S arms: “They aren’t feet, are they? They won’t come off, will they?—They look like your hands.”

I am afraid it will bite me.” (“Who?”) With glee: “The RADIATOR downstairs.”

“B”

II

In the macrosphere (as in the microsphere) Dick’s increasingly gleeful interest remains long enough with the subject to reveal further dangerous associations, (a) The association between a potentially detachable part of one of the life-sized objects (the chair’s “hands”) and a part of the physician’s body is frankly pointed out; (b) the expectation of being bitten by a radiator is mentioned for the first time “with glee.”

“C”

II

During the first hour it was already obvious that there was a correspondence between the spontaneous remarks made about the life-sized objects and those addressed to the physician, the idea of the big organism with dangerous intentions being the connecting association. It is in keeping with the aggressive expansion in the microsphere that in the macrosphere a connection is created between an inanimate, life-sized object and the physician’s body. The first contact gave reason to suspect that the transference was developing along this line. (Remember Dick’s first question: were the physician’s eyes all right—which meant—or did they come off?)

The exalted feeling of “living dangerously” which accompanies today’s adventurous expansion (in the microsphere it was represented by the idea of his wrecking the red wrecker) is climaxed in the queer pleasurable anticipation of the very event which is the center of his phobia, namely, to be bitten by the radiator. It is this glee in Dick which was always one of the most difficult traits to understand. There is little obvious “masochism” in it; rather a playful question in view of the dangers of bisexuality: how would it be if the sexes could be interchanged—what would one lose, what win?

“A”

III

PHYSICIAN

Pressing against the physician’s knees, he points to big, gold buttons (resembling large raspberries) on her dress and says several times: “I want to bite them.” (“Do you like to bite things?”) “Yes, I like to bite sister. I am going to bite sister when I go home today.”

Shortly afterwards: “I want to eat my dinner. Have you any crackers?”

Shortly afterwards: “People can’t go down people’s lanes, can they?” (“You mean the red lane?”) “The yellow lane. Sister calls it a red lane. I call it a yellow lane.—Yellow is my favorite color.”

“B”

III

This is the longest and most serious concentration on the physician’s person reported so far. With verbal frankness two themes are clearly revealed: a biting wish toward her “buttons” and a consideration of the question of whether one person can be swallowed by another. Spatially, then, both the themes which were first dramatized with inanimate objects have found their way to the human organism: parts of a whole being bitten by a whole; a whole being swallowed by a whole. Verbally the statements are clear and frank; he gives a direct answer to question, while he associates one of the home problems, his playful wish to bite his sister.

“C”

III

The expansion in positive statements makes him reveal a wish toward the physician’s dress: to bite her buttons. If we confront this statement (as we did the preceding ones) with the corresponding remark during the first hour, we find opposed: First hour “Don’t take your dress off”—This hour: “I want to bite the buttons.” The impression is that this expresses an oral interest in the physician’s breast (see E) although the surprising clearness of the statement can be expected either to hide an as yet undiscernible factor or to lead to bad consequences, such as a belated disruption.

At home Dick has voiced for weeks a wish to “bite his sister’s tummy.” If we remember that he talked first of his “nice fat tummy” when his mother was pregnant (and that his tummy became devaluated after an unproductive hospitalization for a tonsillectomy) we realize that tummy once meant the bulging aspects of femininity and probably included the breasts as the outside of that big inside out of which the babies come, the very idea which we felt he symbolically approached and avoided from the start.

“D”

III

1. Symbols: Little knobs on cars—potential (detachable) organs (penis, nipples) on girl’s body.

Buttons on physician’s dress—nipples on woman’s body (which one wishes to bite).

image

Life-sized, four-legged objects—female organisms (by whom one expects to be bitten or swallowed).

Arrangement: After having microcosmically arranged during the second contact for the little girl to be the naughty child and for the physician and himself to be identified in standards and function in regard to such children, Dick dares to rearrange the whole inventory outlined during the first contact, (a) He establishes equality of equipment among the sexes: the knobs of the have-nots will become sizable parts, the spare tires of the have-too-muches can be broken off. (b) The cars are put into the truck, the sick girl into the bath; of this the system of symbolic equation used so far admits only one interpretation: the small sister is put back into the mother, (c) People cannot be swallowed by others; he is not afraid of the radiator (the nurse was only fooling).

(Are these conditions under which he can express [in transference] his biting impulses toward his mother’s body?)

“E”

III

1. On the afternoon of the day of this contact, Dick’s nursery school teacher makes an observation which indicates that the interest in the female breast actually is uppermost in the patient’s mind on this day and is on the surface of his consciousness, although already subject to the defense mechanism (introjection of prohibition) which we saw especially active during the first contact: Dick asked the teacher whether the buttons on her dress could be unbuttoned. Then he pulled her dress apart without unbuttoning it; he “seemed eager and tense.” When the dress opened a little, he suddenly withdrew and said, “No, I can’t look in.”

2. The dominating conception in all this play seems to be: there are haves and have-nots in the biological world (yes-things and no-things) and these two groups, in various forms of intercourse, make use of their various extensions and inlets. This mutual use seems to imply a danger to the inviolability of the body as a whole: The mouth can suck and bite the breast, the penis force itself into the body, the baby swell the “tummy” and force its way out of it. These possibilities appear doubly dangerous if one is ignorant or incredulous of the inner or outer laws which are said to inhibit adult bodies from destroying one another and, on the other hand, possessed by impulses—in this case an overwhelming compulsion to think and talk of biting and an equally overwhelming fear of being bitten and robbed.

3. One could have made an interpretational statement to the child at this point, indicating that behind his kidding terrifying ideas were hidden; that these secret ideas had given a traumatic reality to the nurse’s “kidding”; that it would be worthwhile talking over what he meant by biting and what the nurse had meant, etc.

5. Fourth and Fifth Contact

After the third contact, in which he had just revealed to the physician certain wishes and fears concerning the biting and swallowing of one human being by another, Dick contracted croup. If not genetically meaningful, this event must have secondarily assumed an unfortunate meaning, namely oral (throat) punishment for him. When, ten days later, he arrived for his fourth contact, we find him whispering, shrinking from self-expression, and armed against temptations as well as punishment. It takes only one more contact, however, to bring him back on the road toward further oral revelations. In order to let his extreme form of shrinking, self-limitation, and encasement stand out against another unfolding of his biting fantasies (which are now familiar to us) we shall briefly contrast, without detailed analysis, the most interesting corresponding items of the two contacts.

6. Fourth Contact: Analysis

“A”

Dick is not as eager as usual to enter the room. He has not taken his heavy snow suit off, seems extremely pale and apathetic and speaks only in whispers.

The physician suggests that he take off his snow suit and offers her help. He refuses, whispering, “I will keep them on anyhow. I can sit out here until I take them off.” From time to time he smiles at the physician, but stops as soon as she smiles back.

After a while he enters the room with all his clothes on. When asked whether he is hot, he whispers, “I don’t want to take them off; just my sweater.” Takes cap off so that sweater can be taken off; puts cap on again and keeps it on; he is plainly hot and uncomfortable for the duration of the contact. For the most part he wanders around, or moves back and forth on knees.

At one point he suddenly becomes more active; puts all square BLOCKS IN A ROW, end to end, and producing aphonic noises shoves the line of blocks along the floor by pushing the rear blocks.

Then he builds a GARAGE, runs the little red wrecker into it, and shoves the line of blocks so that they block the garage and, lying on his stomach and whispering, gazes into it.

Looks under GIRL DOLL’S skirts and examines her sleeves. Puts her in the bath tub, then on the floor. Puts BOY DOLL beside her. Puts boy in tub. Puts a block in front of the tub.

Lying on back, examines TRUCK intently. Suddenly in a loud, clear voice: “That isn’t a truck!” He points to a little wheel that hangs down from the underside of the truck. (Physician asks, “What is it then?”) Whispering again: “It isn’t anything.”

“A”

His interest is first concentrated on himself and on keeping himself enveloped in clothes and excluded from the physician’s room. Then in sudden moves, while still keeping himself in a fortress of clothes, he is playing for moments with more concentration and more independence than ever before. He does not destroy or discard, but (whispering) watches his play arrangements. Autocosmically enveloped and without voice, he puts the wrecker in the garage and the boy into the tub and blocks both with blocks.

Verbal. Whispering and aphonic noises. The statement, “I can sit out here until I take them off” contains a self verdict in complete identification with an illusory adult judge. The only loud statement contains a complete negation: A truck with a spare wheel isn’t a truck—it isn’t anything.

“C”

The interrogation and bodily adherence to the physician are broken in this hour. Withdrawn into himself and enveloped in his clothes, he is able to concentrate on longer independent microcosmic play than before. The play is, in a certain sense, narcissistic in that he represents in the microsphere what happens in the autosphere: the objects of interest (himself, wrecker, boy-doll) are encased.

(Is he afraid the physician will examine his throat? The past has not given him any reason to expect this, nor has he himself ever treated the observer as a “doctor.”)

“D”

 

AUTOSPHERE

MACROSPHERE

MICROSPHERE

1. Head covered with cap. Body enveloped in clothes.
Voice covered by whispering

Detained in waiting room.

Beloved red wrecker and boy doll in receptacles with exit blocked.

The boy is unborn (not the girl).

 

2. Arrangement. Dick today is completely identified with the voice of conscience. In the first hour he had projected all guilt content onto Ps, in the second hour onto the girl doll. In the third hour he had admitted aggressive wishes while already offering atonement. He now arrives at a deadlock of complete self-restriction and revengeful stubbornness: If I am not going to take my clothes off, I cannot enter the room and play. Therefore, I am not going to take them off. Dick’s mother reports that she had blamed his carelessness in running around with too few clothes for his croup. The self-encasement of this contact, therefore, seems overdetermined, a queer mixture of self-annihilation (punishment for last hour’s references to the physician’s body and implicitly his mother’s body), security in self-restriction (he cannot do any harm) and stubborn, vengeful overobedience (I am not supposed to have few clothes on.—I shall have too many on). That the overdetermination is necessary to produce the performance is obvious from the fact that this extreme behavior does not occur at home (where his sickness spoke for him) but at the physician’s office. It allows us to see some of the components of those “whispering” episodes because of which Dick was brought for treatment: the pious overdoing of a prohibition both as a defense against temptation and a veiled vengeful satisfaction. The whole mischievous energy pent up in such dramatized self-restriction becomes obvious in the following “criminal” features of the fifth contract.

7. Fifth Contact

“A”

Enters room, lively, talkative, with hand (through clothes) on genital. “The floor doesn’t come off, does it?”

“You [PHYSICIAN] haven’t any penis.” (“That’s right.”) “Ladies haven’t.” “Sister hasn’t any penis.”

“I’ll show you mine.” Exhibits himself.

“You undress the GIRL [DOLL]. You bite her tummy, her hand, her arm, her head, her feet, her behind.”

(Pointing to FATHER DOLL): “I am going to take his hat off!”

“B”

The relationship between the microcosmic behavior of the day before and this contact’s macrocosmic behavior is clearly one of complete reversal. Whether or not his self-encasement was a relieving atonement for the weakness of the flesh or—as an infantile Nirvana—a triumph of that weakness, today he manically challenges the dangers which he fears most deeply. His questioning and teasing in regard to things which “come off” or part of which “come off” assume a truly macrocosmic form: at least the floor on which we stand won’t come off! Consequently the auto-cosmic fears only symbolically expressed in the previous contacts are now clearly referred to and disproved: I can touch and show my penis! Such safety assured, he not only does not shy away from the idea that girls have been robbed and are bitten by women but enjoys the idea.

It is interesting that it is in the context of such a disproval of autocosmic dangers that he pays attention, for the first time, to the father doll: he threatens to take off his hat (in dreams, according to Freud, a penis-symbol). Of further interest are the contemporaneousness of self-encasement and voicelessness in the fourth contact, and that of emancipation of voice and exhibitionism in the fifth. We remember that his first whispering spells occurred on the occasion of his being forbidden to talk about a man’s hairlessness; this happened shortly after he had been denied the right at the height of his phallic period to show his penis, to shout his word for penis, and to look underneath the girls’ skirts because “it hurt the girls’ feelings.” The voice which exhibited, as it were, the penis in word-magic and hurt the feelings of female beings had a phallic connotation in more than one sense: The shouting, it seems, had not only exhibitionistically conveyed the content penis, but also as a functional expression dramatized the intrusive mode (intensity of voice and probably phonetics of penis-synonym) with the sadistic connotation of hurting girls.

About the time of these contacts the writer met Dick under the following conditions. He went to Dick’s town in order to observe him in his play group. While searching for the teacher he suddenly heard strange shouts and terrified yells. Looking into a nearby room, which proved to be the toilet, he saw the boy (Dick) exhibiting his penis and at the same time shouting into the ear of a girl of approximately his age. The girl was in a panic, he in a strange state of compulsive acting without much affective participation. (Being visual rather than auditory, the observer remembers Dick’s facial expression but not the sounds of what he shouted.)

“D”

1. Symbols. Formerly symbolic ideas referring to the female lack of a penis and his own phallic pride appear undisguised. The modal synonymity between shouting and exhibiting and between missing part and bitten off part is expressed clearly.

2. Arrangement. Manic challenge, suppression of voice of conscience, denial of fears.

“E”

If the observation had been continued at this point, the challenging of the father figure would probably have proved to be the beginning of the revelation of a complex of ideas connecting his father with the radiator phobia. Other items which lead beyond the intended comparison between the fourth and the fifth contact have been omitted here.

Because in most case abstracts the reader is aware of the lack of detailed accounts transmitting the “feel” of the observational situation, we are concentrating here on a few detailed accounts at our disposal. The reader will now doubtless feel that his hard-won familiarity with Dick’s mind should be rewarded with an abstract of his further treatment and development. This cannot be given here. Dick was recommended for thorough child-analytic treatment, for which it was necessary to wait until his family’s impending move to a larger city. As this is being written the treatment is in process.

A second unsatisfactory aspect of a detailed clinical account would not have been improved by a continuation of our report. On closer observation clinical material becomes more elusive. Every moment of attention, every step in the analytic direction is apt to bring to light a new element which proves to have been all-pervasive from the beginning. Descriptive and analytic restatements are necessary; reconstructions and interpretations, as they gain in volume, change in structure.

What is it then that we have set out to show: the emergence of an all-pervasive and only intra-individually logical (i.e., psychological) complex of ideas which alone gives the single reported behavior items symbolic or metaphoric meaning. Play acts of the kind Dick produced before our eyes are, of course, continually produced by other children in other situations, where they may mean something else or nothing beyond their face meaning. Small cars can “mean” small cars—within less fixed and less rigid configurations asserting themselves over shorter periods and through fewer areas of expression: The prolonged and expanded sacrifice of the “real meaning” of surrounding objects for the sake of their metaphoric meaning within a vicious circle of magic ideas is the mark of an emotional arrest.

Dick’s dominating ideas express an “oral complex.” He not only often speaks of biting; but betrays, in addition to the world of physical facts as he knows them to be, an image of a world in which the biting wish is universal, its magic consequences unavoidable. When he is in panic, it is because of a radiator that will bite; when he dreams, it is of a being without a mouth. When proud, he shouts; when depressed or oppressed, he whispers. In demonstrating the emergence of this complex in play contacts, we hope to have demonstrated how, with little interference from the side of the physician, the dynamic interplay of two pairs of psychological powerfields forces the complex to the surface, namely, the interplay of resistance and transference, and that of the level of fixation and the level of arrest.

To begin with the latter pair: The level of fixation is that system of ideas, wishes, fears, defense mechanisms, ways of thinking, differentiating, experiencing which belong to a certain earlier period of childhood and the magnetic power of which is apt to exert again its way of organizing experience and action whenever a consolidation on a higher level of experience and action seems blocked. In Dick’s case the fixation level is the second oral (biting) period. His level of arrest, on the other hand, is the intrusive stage, the developmental stage which proves unsurmountable to him. Dick is so hard to understand not only because his level of fixation is genetically an early, structurally a primitive one; the greatest difficulty arises from the fact that his inner world combines and synthesizes contents and principles of organization derived from both the level of fixation and the level of arrest. Thus we find phallic trends expressed in terms of the oral level (of fixation): i.e., his phallic-locomotor aggressiveness and the problems of sexual differentiation are represented as temptations to bite female persons and the fear of being bitten in turn. It is the intrusive mode which characterizes for him the functions of both the fixation zone (biting mouth, hurting voice) and the zone of arrest (the dangerous and endangered phallus). It could be argued that such irradiation of the intrusive problem had its center in the phallic stage and only regressively mobilized oral associations. Certain data which cannot be produced here suggest that intrusion was a problem from the start. However, as we would expect, the conflict of intrusion found its climax and caused a general arrest and disintegration at the intrusive stage.

Caught between the phallic and the oral complexes as though between Scylla and Charybdis, Dick is unable to see how he can avoid the point where these two complexes touch; namely in the idea of hurting a woman, thus both losing protection and provoking punishment. The concept of the world which he reveals and which is not understandable with ordinary adult logic is an attempt to synthesize the level of fixation and the level of arrest in order to derive a design for self-preservation.

In the contacts with the physician, then, this “private world” of the child only slowly asserted itself against a resistance which tried to isolate it by avoidances and to keep it in a symbolic and metaphoric disguise; only gradually was it represented in connection with the physician’s person. We have seen that the various aspects of this connection were transferred, in a certain disguise and with wishful changes, from former experiences with relations to other women (mother, nurse) and did not originate in the therapeutic situation, except in so far as woman doctor—nurse—and mother—situations have common attributes: they all favor associations such as: child’s unsatisfied interest in woman’s body, child’s secret wishes in regard to woman’s body, woman’s investigation of child’s body, threat to child’s body, etc.14

The inventory of symbols revealed in Dick’s developing play-manifestations rather clearly indicates the boy’s concern with situations in which biological haves are threatened by the oral eagerness of the have-nots. Beyond this, only further analysis would reveal the syntax which in the patient’s mind gives this inventory some kind of logical order. The reconstruction of what in the patient’s mind is the cause of, the condition for, the temporal successor or predecessor of other factors, and how such psychologic compares with the historical sequence of events is a task accomplished only with painful slowness. Up to now we know approximately what the patient is talking about; but we do not know what he is saying, i.e., whether he is reporting the past or imagining the future, and whether he is representing what he is doing in such a picture or what is being done to him.

One example of a possible historical reconstruction would be this: The boy saw his sister nursed. He felt strange urges and aggressive impulses, only parts of which probably stood out consciously, as wish for the mother’s breast, anger at the sister’s favored position, aggression against his mother, etc. Factors of his stage of development (intrusive, locomotor, phallic), of his constitution (oral? schizoid?) and of his personality development (projective and introjective mechanisms) gave this wish dangerous connotations. For example, unlike his sister, he had teeth, a fact which may have been actually pointed out to him. This would be a danger threatening his mother.15 However, his thoughts seemed also dangerous to his sister as it meant to take her nourishment away, an idea which fused with the other wish, namely, to send her back into the mother’s body. His projective, introjective ways of experiencing, then, intensified by the oral problem he was faced with, not only caused him to experience what mother and sister would feel if victimized by him, but also made him expect that they wanted to do to him what he wished to do to them.

It may have been during attempts to experiment with and to synthesize in play, theories, phantasies, and strange habits, such ideas of attacks and counter-attacks (in which he alternately identified himself with a dangerous mother and a small, toothless, penisless baby) that the nurse helped by her threat to create a focus for all his anxieties in a radiator phobia. The idea that the radiator could jump and bite appealed to an always easily mobilized primitive level of the boy’s mental life on which everything with noisy insides, a warm touch, pipe systems with water, etc., whether inanimate or animate, was somehow identical; while, like all objects of phobias, it also made more tangible, more impersonal, and more discussable, those vague and secret fears which could not be discussed with the protecting adults because they concerned just these adults: the radiator stands for what the child could expect the adult (mother) to do to him if she knew what he secretly wanted to do to her. On the other hand, while an unseen source of danger, this hypnotically attractive phobic object by no means created comfort, and the efforts at eradicating and denying the whole conflict could not relax. Dick dreams of a being which has no mouth at all and we recognized some of his phantasies as picturing a world in which there are no differences between the sexes and between big and little: everybody has and is everything and there need be no envy, no threat. Thus, beside a fear world in which vague dangers are pinned down to tangible objects and into a context with some kind of logical structure, we also see traces of a wish world, another synthetic product of the child’s despairing ego.

Other observers and the reader may have arrived at other possibilities of reconstruction. But if we ask at this point who is right, there is only one answer: the patient. Only continued work with him could narrow down possibilities to probabilities and bring about that psychological insight, the formulation of which creates the feeling of high probability in the experienced reader, and if transmitted to the patient, clears his vision into the past and vitalizes his expectation of the future.

E. DESTRUCTION AND RESTITUTION IN ANEPILEPTIC” BOY OF FOUR

With the following description we merely introduce the second phase of treatment, namely, the period following the decision to proceed with the psychoanalytic procedure proper, and the time of first interpretations. With the focus shifted, we shall abandon the detailed representation used so far.

Fred was entering the disquieting period of locomotor and sexual development usually associated with the age of four somewhat prematurely before his third birthday; we have tried to characterize this period briefly above. Mentally, his development ratio was 125; he was especially advanced in his verbal expression. Physically excellently developed and well nourished, he was easy to handle—especially if, as was often the case, he was given his own way. Certain sadistic characteristics mainly expressed in teasing and occasional tempers had been outspoken for years; but nothing would have induced either his parents or his pediatrician to suspect the clinical syndrome which now suddenly emerged, namely, “epilepsy.”

For some time Fred had seemed to try in provocative games and social experiments to see how far he could go in playfully hurting others and in suffering their reactions. Although he enjoyed exploring by play and error the outer limits for the manifestation of an obviously pressing aggressiveness, he had a low tolerance for situations in which he actually hurt somebody or was actually hurt by somebody. As his silent paleness seemed to indicate, such events forced him to suppress in too short a time and to turn against himself the overwhelming aggression for which he was trying to find a social form.

The tension created by these manifestations, which were neither in quantity nor in quality really abnormal, was heightened when one day his grandmother arrived in town for a long visit. She was even more anxious than his mother lest he hurt himself or get hurt; and special restraint was put on Fred’s activity because she was afflicted with a heart disease. Fred tried his best, but soon increasing complaints from the neighborhood indicated that he had found a new field of activity. When he hit a boy with a shovel, he was ostracized in the neighborhood. It was shortly after this social trauma that he again went too far in his teasing attacks on his mothers and, finally, on his grandmother.

One morning, in the presence only of the grandmother, he climbed on a windowsill and threatened to jump out of the window. Startled, the grandmother tried to reach him but fell on the floor, for the first time in his presence suffering one of her frequent heart attacks; she spent several months in bed, seemed to recover, but suddenly died. “When I saw him standing there, something hurt in here,” she had kept repeating over and over.

A few days after the old lady’s death, Fred’s mother saw him pile up his pillows before going to sleep, in a way in which his grandmother had done in order to feel more comfortable. In the morning, at the exact hour he had been awakened five days before by his mother’s crying over the grandmother’s death, he was heard making strange noises and found in a terrifying attack. His face was white, his eyes glassy; he frothed at the mouth and gagged. Finally, he shook all over and lost consciousness. To his mother he looked like her dying mother, but the hurriedly called physician diagnosed his symptoms as convulsions, ascribed them tentatively to bad tonsils, and administered an injection.

Soon two further attacks (usually beginning with the twitching of the face and subsequent clonic convulsions on the right side) followed at intervals of four weeks and six weeks respectively. The first attack lasted 20 minutes, the second 45. Immediately after the third, which lasted more than two hours, Fred was admitted to the hospital where he was diagnosed as an “idiopathic epileptic.” However, neurological examinations were entirely negative except immediately after the attack. Fred, they emphasized, was an excellently-developed and well-nourished boy of above average intelligence and remarkable sociability. Dismissed after a few days of rest and observation, Fred was free of attacks for several months until, after two relatively less violent seizures, he again had to be hospitalized because of an attack at the time of the anniversary of the grandmother’s death. The diagnosis appeared gradually modified as “Idiopathic epilepsy with psychic stimulus as precipitating factor” and the patient was recommended to the Department of Psychiatry and Mental Hygiene where he received treatment first from Dr. Felice Emery and then from this writer. During these treatments there were many minor (mostly staring) spells; major attacks occurred only five days after his psychiatrist “had gone on a long trip,” i.e., had moved to another town, and again, a year later, five days after the present writer had “gone to the Indians,” i.e., on a field trip.

I shall first report on the psychological development of the case and then quote a neurologist’s interpretation of the medical data in the light of our study.

Fred’s parents had tried to explain the grandmother’s disappearance by saying she had gone on a long trip. The boy, in spite of having seen the coffin and having witnessed the family’s mourning, accepted and clung to the version that the grandmother had not died at all. But children betray their knowledge of such over-eagerly accepted adult lies with an uncanny sense of humor. Thus, one day when his mother asked him for an object which he had mislaid he said, “I guess it has gone on a long trip.” During the same period in his nursery school he was noticed building coffin-shaped houses whose openings he would barricade in a way corresponding to a death configuration, generally observable in play and in rituals of primitive people. It seemed clear that the boy “knew” and that his knowledge (or what he tried to do to it) was the “psychic stimulus” the physicians were looking for.

Before every major or minor attack, Fred’s aggressiveness would increase. An object would fly out of his hands, sometimes creditably “without his being aware of it,” and strike somebody’s head. The usually affectionate and reverent boy at such times would indulge in violent attacks against parents and against God. “Did grandmother have a good heart when she was a child?” “The whole world is full of skunks.” “I don’t like you, mother.” “I hate God.” “I want to beat God.” “I want to beat heaven.” After the attack the boy would indicate that he had experienced his unconsciousness as death. He behaved as if he had been reborn, smiling, loving, obedient and reverent—an angelic child.

I shall first present excerpts from Dr. Felice Emery’s notes in order to contrast the transferences which the boy established to this woman psychiatrist and then to me. The following development in play of two dominant ideas [namely, “burning and attacking psychiatrist” and “building a castle”] reflects, it seems, the destructive-restitutive conflict in the boy’s mind.

1. Excerpts from the Patient’s First Ten Contacts with Woman Psychiatrist

I

Fred, asking psychiatrist to smoke a cigarette, becomes extremely interested in the way it slowly burns down. He asks Ps to smoke two more cigarettes and watches intently. “Why don’t you smoke the burning end?” he finally asks.

While watching Ps, he touches the telephone and she is forced to give him the instruction that the telephone is not an object at his disposal. Shortly afterward he suddenly reaches for the telephone and seeing that Ps is startled, he says teasingly, “I wasn’t going to touch it; I fooled you!”

II

“I’m going to make you smoke every time I come.” When Ps picks up a toy on the floor, he moves a screen so that it falls over her. In great excitement he crawls under the screen (which he calls a blanket), yelling, “I’m climbing up on top of you.” Then he tries to stand on the screen but breaks through, dropping one and a half feet. He crawls in and out through the hole and calls it a window.

In the afternoon, at home, wandering around in a daze “as if hypnotized,” he asks his mother what the difference between people and animals is and seems especially interested in animals which jump at others, such as tigers and dogs.

(He is coercive, aggressive, intrusive in thoughts and acts which imply: making Ps smoke the burning end of a cigarette, startling teasing, fooling her and climbing on top of her. A sexual meaning is discernible—underneath the screen he tries to climb “on top” of the psychiatrist calling the screen a “blanket.” Is he afraid of the animal, the tiger, in himself?)

III

“When I put the screen over you, were you all burning up?” “Was your house ever burnt up?” “My house was never burnt up.” “I want to go to the toilet.”

(Note the associations—sexual act: burning; burning body; burning house; also the urinary urge at this moment.)

At home, just before falling asleep, he again refers to an animal aggression. “Cats are made the same as dogs and dogs are made the same as cats.” “Can dogs climb trees?” “Why do they like to chase cats?”

IV

“I would like to set the whole building on fire” “I’m going to set fire to your skirt.”

“Let’s build a castle.”

(Note the association—setting fire to building: setting fire to psychiatrist’s skirt. In view of this repeated analogy, we may expect an analogy of—building a castle: building a body.)

In the evening, asking again where there are tigers, he says to his mother, “The night is attached to the day. The day is attached to the night. The sun is attached to the sky.”

(The constructive idea of building a castle has a counterpart in that of a coherent universe.)

V

“Could you smoke the cigarette from the wrong (burning) end?”

“I’m going to undress you. I’m going to burn you.”

“Let’s build a castle.”

VI

“I want to smoke” (takes one puff anxiously). “That’s enough.—Do firemen ever get on fire?”

Hits a cigarette with a bar. “Is it dead now?” (burning: dying) “What part of a cigarette burns?—What parts of a house burn?” (burning cigarette = dying cigarette; burned house = dying house?; burned body = dying body?)

Stamps his feet and yells, “I am not going to leave till you build a castle.”

VII

“You smoke a cigarette while you build a castle.” (The destructive and the constructive ideas merge; see VIII and IX.)

“Would you turn into ashes if you would burn?”

He throws a ball of Plasticine at Ps, yelling “I will hurt you and you will hurt me.” After she has “hurt” him, he puts the chair in front of her, “You are in jail.”

“Please walk with a creepy walk.”

“There was a lady who fell out of the hotel window and she broke her hands, her legs, her body, her head. Wasn’t that terrible?”

“We don’t need a castle today.”

(He wants Ps to walk in a creepy walk, which means to be an old woman, and he makes her hurt him and be put in prison. Is this the inversion in play of the fear which governs him, namely, that he will be put in jail [coffin, dark place, tomb] for having killed his grandmother by playfully threatening to jump out of the window?)

VIII

He hits the castle, with the words, “Does that hurt?” (Confirms the association—house: body.)

IX

“You smoke four cigarettes at once and build a castle that is round and has a door at each end.”

He tries to light a match by stroking Ps cheek and by placing a match in her nostril. “Let’s have a big flame.”

Three times Ps builds a castle and three times he steps on a table and jumps on the blocks. From there he tries to jump on Ps.

(Repetitions with “orgiastic” dimensions: four cigarettes burn; three castles are destroyed; he tries to jump on Ps and actually to set fire to her.)

On Day III, the first association of burning and coitus had been followed by the wish to go to the toilet. Ever since, the psychiatrist had noticed a certain genital excitability in the boy as manifested in his repeated sudden urge to urinate, and in his clutching his penis. She now gives him a first interpretation by way of asking him whether to burn something, to destroy something, and to scare or jump on a woman gives him sensations in his penis. She thus approaches what must be most unconscious and least communicable to him and, furthermore, can be assumed to be one of the outstanding etiological factors in his sickness, namely, the strong phallic-locomotor emphasis at the time of the grandmother’s death (and ever since).

To this question, Fred, surprised, reacts much like Dick. “I wish I were a little girl,” he says. Then, transferring this idea of partial self-destruction and self-victimization to the house, the representative in play of a restituted body, he points to one of the longer blocks on the castle and asks, “Why is this sticking out?” He pushes it back. “Will that hurt the castle?” “Have you got a saw? I want to saw this off.” He pushes a long block against it. “Does that hurt the castle?”

(He thus seems to experiment with the two aspects of the possession of a penis: who is hurt more, the male who loses it, or the female against whom it is used?)

Ps does not give him this explanation but merely remarks, “A castle made out of blocks falls apart rather easily. It is different from a person’s body which cannot fall apart in the same way.” “Why doesn’t it fall apart?” he asks. “Because the body has grown that way itself; every part is needed.” He doubts, not without reason: “You need your eyes. Will your eye drop out?” “No—your eye won’t drop out.” “When it gets black and blue—what happens then?” “If your eye gets black and blue it heals.”

In leaving Ps on this day, Fred says to his mother in an enthusiastic tone, “It’s the biggest castle we have ever built.”

(The castle was not bigger, but the interpretation had made the restitution more convincing.)

X

With this reassuring contact the themes of burning and building lose their central position in Fred’s play with the therapist. Another content, more clearly betraying the fear of the dead grandmother, takes their place.

(We consider the fact that the content changes and approaches pathogenic material more courageously a sign that the right interpretation took place at the right time.)

Fred now plays that an imaginary lady who is far away tries to call up 15 times a day. He wants Ps to go over to the house of that lady and break her telephone because the lady tries to call and to tell him that she is going to come and set him on fire or that she is going to send a policeman to arrest him. (We remember he had tried to set the psychiatrist on fire and in Hour VII had jailed her, asking her to “walk with a creepy walk.”) “We had better go off on a long journey so that when she comes she won’t find us here. We had better take twelve gallons of gas.”

While the imaginary overland connection to the lady takes the center of his play with the psychiatrist, at home his interest shifts to communication with heaven. “How does God tell you to be good? Heaven is higher than the clouds.” As if incidentally, he also for the first time begins to ask about his grandmother, what she would look like now, would she look old, etc.

Soon Ps thinks the time has come to talk about the grandmother. Using his suggestion to write his name on a blackboard, she asks for his father’s name, his mother’s name, his grandmother’s name, and when he pronounces the latter with special tenderness, she adds quietly, “Your grandmother died, didn’t she?” Fred explodes, “No, she didn’t die—she went away—didn’t she go away? Why did she die? She was sick in my house. Did she die in my house? Is she in my house now? Well, where is she? Do you mean that I will never see her again? Let me see her.”

Ps explains to him the impossibility of his wish and, in spite of his seeming to lose interest abruptly, insists on telling him that he must be thinking that he had done some harm to his grandmother. He answers decisively, “No—I didn’t do anything to her,” but then acts out his confession, as most children and some adults do: He climbs on the table (a conference table), stamps up and down the full length of it, and yells, “Who is making that noise? Can they hear it outside? What will they do if it disturbs them? If they did come in, I wouldn’t be quiet.” Then menacingly coming up to the end of the table where Ps is sitting, he suddenly crouches down, climbs into her lap, and says quietly and anxiously, “Why did I stop here?” Ps repeats her explanation.

In the evening of this day at home, the boy begins to mourn as if he had never heard before that his grandmother was dead. He cried incessantly, asked why the grandmother had died, and why they hadn’t taken her to the hospital to save her. “I would like to open grandmother’s grave and see what she looks like. I will bring all of the doctors in the world here to make her heart go again.” And then, with a scientific sublimation of the destructive impulse, he explained: “I would like to cut her body to pieces and see what it looks like inside.”

In the night he soiled himself. The next morning he didn’t remember what day it was or what time of the day, and after having vomited, he slept far into the day. To his mother he said, “Supposing you would break your neck, you know what I would do? I would put it together again.”

2.

Fred’s treatment was not completed when his first psychoanalyst left the city. She had been able to bring back to his memory the details of his grandmother’s death and to discuss with him the phallis-lo-comotor tension of his maturational stage, which had made him associate aggressive and phallic intentions as characterizing a bad boy. However, it was obvious that other sources of tension of the period in question had not been verbalized. Also, as the psychiatrist suggests, it may be that the playful aggression allowed to this child in analysis made the transference too realistic and permitted the accumulation in Fred of guilt feelings concerning the psychiatrist similar to those concerning the grandmother. In any event, after the psychiatrist had left town, Fred began to speak of her with the same words which he had always used to characterize his relationship to his grandmother (“Why has ‘my friend’ gone away?”), and had a severe epileptic attack (the first one since the beginning of the treatment) five days after the departure, thus repeating the pattern “dying five days after a beloved person whom one had attacked goes on a long journey.”

After this attack, I took Fred over for treatment. The difference in the transference became obvious soon. Fred had a period of what one might call an infantile homosexual panic. After the first hour with me, he insisted in retrospect that at the time of his latest hospitalization men nurses had taken his temperature all night and didn’t let him sleep. This of course did not correspond to the facts since he had been taken care of entirely by female nurses who had taken his temperature only once during the night. But to this phantasy there corresponded the first game he played with me during my first contact with him. Out of Plasticine he formed “snakes” or “worms” and tried to get behind me so that they could bite my buttocks. (Remember how, in his play with the woman psychiatrist in a similar twofold representation he had jailed the old lady, then phantasized that an old lady was going to jail him). Correspondingly, at home, his relationship to his father changed. He would without provocation repeat, “Don’t touch me, Daddy,” and especially when awakening from his nap he would experience and express moments of depersonalization—“I don’t want you to come near me, Daddy. Where am I? Where is our home? I don’t see well. Is everything all right? Everything looks bigger. Something is hanging from the walls awfully big and crooked.” He also began to look intently at his father, remarking, “Grandmother looked just like Daddy.” (We see that the man therapist not only attracted another [homosexual] transference but by his very existence brought about the manifestation of the corresponding [previously latent] conflicts at home).

In the meantime I questioned the mother again about the weeks preceding the first attack because it seemed that Fred’s guilt feeling was not entirely covered by the explanation of the crime which he felt he had committed against the grandmother. Only against severe emotional resistance did the mother reveal an incident which had occurred about one week before the grandmother’s dramatic heart attack. A toy had “inadvertently” flown from Fred’s hand, hit his mother in the face and loosened one of her front teeth. Irritable as she may have been because of the special pressure which the grandmother’s visit exerted on the home, and also worried for the precious front tooth, the mother had punished Fred corporally for the first time in his life. As she described this, Fred’s transference to both the woman psychiatrist and to me appeared in a new light—the crime complex established in connection with the grandmother’s death obviously had irradiated, in retrospect and prospect, to include guilt feelings toward both father and mother and expectations of danger for and from the side of both. (It will be remembered that against his father he never had dared to express aggression as he had so liberally done with women.)

I shall report here the way in which the transference of one of these irradiations manifested itself in his first epileptic (minor) spell in our offices.

During the first weeks of his treatment with me, we had in accordance with his wish played dominoes. The possession of the double black, so he had decided, determined who had the first move. If he were not in possession of it and whenever he lost a game, he became angry and pale. I tried (as far as he, a good player, let me) to increase the number of his defeats gradually, in the hope of being able to observe the coming and going of an attack under emotional conditions approximately known to me. One day the threshold seemed reached. Fred had lost again and at a time during the hour when he could not hope to make up for it. Suddenly he got up, took a rubber Popeye doll and hit me in the face with it; then he stiffened, got pale, his eyes stared for a fraction of a second, and he vomited. He had hardly recovered when he said in a most pathetically urgent tone of voice, “Let’s go on playing.” He hurriedly built up his domino figures in front of him in a rectangle and in such a way that the signs pointed inward; he, their possessor, would have to lie inside of his configuration (like a dead person in a coffin) in order to read them. Fully conscious, he now recognized the queer configuration and gave me the look of a cornered animal. I pointed out to him that every time he hit somebody he felt that he must die. He confirmed this by asking breathlessly, “Must I?” I explained to him the historical connection between these feelings and the death of his grandmother, whose coffin he had seen. “Yes,” he said, a little embarrassed because up to now in spite of the mourning episode he had insisted that the grandmother had gone on a trip. I furthermore pointed to the similarity between his attack on my face during a game and the attack on his mother’s face a week before the grandmother’s fatal attack. It appeared that he could not remember the attack on his mother while he seemed never to have forgotten the episodes relating to his grandmother. That the mother, too, might die as a consequence of the (earlier) aggressive acts and phantasies was obviously the deepest danger threatening him. This, too, was pointed out.

Beginning with this episode a series of interpretations used specific moments to bring his fear of death into relation with his strong impulses and his low anxiety threshold.

The effect of such interpretational steps can best be illustrated by an episode which occurred a few days after the interpretation reported above. In the afternoon Fred’s mother, fatigued, was lying on a couch. Fred stood in the doorway and looked at her. Suddenly he said slowly, “Only a very bad boy would like now to jump on you and step on you, only a very bad boy would want that, isn’t that so, mummy?” The mother, to whom I had explained some of the boy’s problems, laughed and replied, “Oh no, quite a good boy might think that, but, of course, he would know that he did not really want to do it.” This conversation established a relationship between mother and son which made it increasingly possible for him to tell her, especially when he felt as if an attack were approaching, of his aggressions, anxieties, and religious scruples, all of which she learned to handle as well as her own attitude toward death permitted. At the same time she could apply in such instances certain preventive measures recommended by pediatricians.

We see what the interpretation had done. It had used the highly affective moment (namely the repetition in transference of a scene which the memory resisted) to verbalize for him his impulses against the protecting mother—impulses derived from the same source as those which had “killed” the grandmother and thus might bring about the mother’s death. These impulses could now be admitted to consciousness, faced with the superior intelligence of his increased age, understood as more magic than real and even admitted to the mother, who, far from either wildly punishing or lightly approving, understood and offered help. Such experiences are an inducement to further transferences, confessions, and conversations, which of course included Fred’s aggressions against his father which consequently were mostly consistently transferred to the therapist not without leading to a major attack five days after this therapist, too, had gone on a trip (from which he returned, however). Thus, while historical reality had emphasized the grandmother’s death as the trigger stimulus mobilizing Fred’s epileptic reaction, analysis proved Fred’s sadistic wishes against his mother and death wishes against his father to be the psychological reality of his maturational stage which had made him susceptible for the traumatic event of the grandmother’s death. The misunderstanding of the causal connection of what had happened to the grandmother and what he had done to her was transferred and interpreted first; what he was afraid might happen to the mother because of his deeds and wishes, next; while the most-dreaded and most deeply repressed aggression against the providers, father and God (the latter now united in heaven with the revengeful grandmother), could be approached only later. During this latter stage, his persistent attempts at building configurations of a safer body and a safer world led to the construction (Figure 4). At the same time he day-dreamed of a compromise with God: “Why not eliminate death and birth?” he asked him. “Let children grow up and down, up and down, indefinitely.” The block construction says the same in spatial projection: from a firm fundament roads lead away in two directions, but both come back and close the circle of safety—an earthly infinity.

image

Figure 4

In the course of these events Fred’s attacks became fewer and better predictable, drug applications could be reduced to a minimum and to well-circumscribed critical moments, and Fred recovered from minor spells more quickly and with less after-effect. We shall not predict that he will not have a minor attack now and again; but he may be spared major ones especially if the medical suspicion of a progressive lesion of the central nervous system proves unfounded. In any event, we have reason to consider it probable that psychosomatic vigilance can help such a patient to lead a normal life in which possible rare attacks are well isolated and for the most part predictable events.

Fred’s case was chosen as our last example because it combined dramatic brevity with all the ordinary attributes of a situation in which an interpretation is warranted: The play has failed; the child is about to be overwhelmed by the guilt and the danger of the situation which he wants most to forget or to avoid. All defenses have proved inadequate, all attempts at restitution and atonement futile. The therapeutic situation has become the pathogenic situation, the therapist only one more evil. What seems needed is more cruel self-suppression, deeper regression, more radical repression. At this point the patient suddenly finds his experience put into words. The most human way (which always had seemed most completely impossible), namely, communication, now proves to be open.

However, once the first interpretation is given and its startling effects lived through, the child is conscious of the fact that the therapist understands or wants to understand more than he has been told, and the patient is expected to cooperate in the verbalization of his suffering and what lies behind it. This brings with it complications and new resistances the description of which do not belong in this monograph.

3. Medical Note

During a short period of common affiliation with the institutions named below, I had the opportunity to discuss several case histories of epileptics with Dr. Frank Fremont-Smith, then Assistant Professor of Neuropathology in the Harvard Medical School and Associate Psychiatrist in the Massachusetts General Hospital. I have asked him to study my notes on “Fred” and to interpret the medical history in the light of the psychological study. I am indebted to him for the following abstract and statement:

 

1. The patient on first admission to the hospital was three years, one and one-half months of age. His family history showed nothing of significance to the present illness. Birth was full term, normal spontaneous delivery. The boy weighed 7.5 pounds, breathed and cried spontaneously. There was no cyanosis and no convulsions. The neonatal period was normal. No breast feeding. The developmental history too seems normal, with several attacks of sore throat and fever, once followed by a mild otitis media. At one and a half years of age and at two years of age the boy fell down a flight of stairs.

The first convulsion (five a.m.), two and half months before admission, lasted 20 minutes; the second convulsion one month later, 45 minutes. The third convulsion (at eighty-thirty p.m.) was described as follows: The patient cried out and vomited—twitching of eyes and mouth on right—then clonic convulsions of right arm and both legs—frothing at mouth—eyes turned to right—urinated—convulsion continued with violent twitching entire right side intermittently until morphine and scopolamine were given at eleven p.m. Twitching continued until admission at one a.m.

On admission and on subsequent days, physical examination was entirely negative with the exception that on admission, while in coma, deep reflexes and cremasteric reflexes were temporarily absent and there was a temporary positive Babinski reflex on the right. Laboratory studies, too, including lumbar puncture and fasting blood sugar, were negative with the exception of a moderate secondary anemia.

In the two and a half years following the first admission he had two convulsions, the first after finding the body of a dead mole, and the second immediately after inadvertently killing a butterfly. His sixth convulsion took place about a year later. He has continued to have “staring” spells and also occasional periods when he seems frightened and disorientated, usually preceded by vomiting. When he is entirely well he gets excellent grades at school and appears to make a good social adjustment outside the home.

The diagnosis from the medical record is idiopathic epilepsy with psychic stimulus as the precipitating factor and organic background not unlikely.

On several occasions the convulsions were observed to begin in the right hand, in twitching about the mouth, and once in the right eyelid. Some of the attacks have involved the right side much more than the left, especially the right arm, and the eyes have been observed deviated to the right. During one attack the right pupil was greater than the left, and after two attacks there was transient positive Babinski reaction, once on the right and once bilateral.

2. The term “idiopathic epilepsy” is used to describe a syndrome, fairly clearly defined clinically but, as the term “idiopathic” indicates, etiologically obscure. Examination of the brain at autopsy in such cases, may reveal congenital abnormality, the scar of birth injury or of postnatal injury or infection, or occasionally an unsuspected tumor, while not infrequently careful study fails to demonstrate any abnormality which could be considered as an etiological factor. The capacity to react with a convulsive seizure is normal for man and for mammals in general, as well as for many of the lower vertebrates, under appropriate stimulus such as electrical or pharmacological stimulation. The threshold for the convulsive response may be lowered by various irreversible structural lesions (scars, brain tumors, etc.) or by reversible chemical alterations (hypoglycemia, anoxemia, etc.).

An “epileptic” may be described as an individual whose threshold is permanently or temporarily lowered so that stimuli which in the average individual would not result in an attack (either grand mal or petit mal) frequently precipitate a seizure. The onset of an acute infection and the accentuation of an emotional conflict are common precipitating factors, which may become effective in cases with gross pathology of the brain, such as scar or tumor, as well as in the cases in which the predisposing factors are much more obscure.

In the case of the four year old child here described no final decision can yet be reached regarding etiology. The convulsions are typical grand mal seizures and the minor attacks consistent with petit mal and psychomotor seizures. The tendency for the attacks to start on the right side and to be most prominent on the right, together with the right Babinski reflex observed once, immediately after an attack, and the inequality of the pupils observed in another attack suggest the possibility of cerebral pathology (congenital abnormality, old scar or slowly growing tumor) in the left hemisphere as a predisposing factor, while the clinical history and the special psychological studies make it clear that emotional conflict is frequently the precipitating factor.

Whether such conflict as this boy exhibited could precipitate a convulsion in a child without disturbance of the central nervous system other than that accompanying the emotional conflict itself must remain an open question. It should be pointed out, however, that whether the conflict results in convulsion or other bodily manifestations, insight into the psychodynamics of the conflict is essential to the understanding and treatment of the emotional immaturity and social maladjustment which are on the basis of the conflict itself. The seizures from this point of view, when induced by emotional stress, may be looked upon as psychosomatic crises which in other individuals, differently constituted, might become manifest through other organ systems, cardiovascular, gastrointestinal, etc., including the psychic sphere, as in “psychomotor attacks” and “epileptic fugues.”

IV. Conclusion

The psychoanalytic attributes of our material are on the whole the mechanisms first described by Freud as resistance, transference, and regression. They appear in the interplay of social, verbal, spatial, and bodily forms of expression.

To begin with the verbal, the very first words spoken by our patients on meeting us, betrayed their dominant system of defense:

John, we remember, appeared armed to the teeth. Asked whom he was going to kill, he answered, “me”—with one monosyllable betraying the “turning against himself” of all the hate which his secret and other, less conscious reasons prevented him from expressing directly. Mary, however, did not say anything to the therapist until she had regained all her stubborn superiority. She only talked to her mother, in lisping, whining baby talk. We would not be surprised to find her use deliberate regression paired with stubbornness as a defense even in riper years. Dick’s greeting “are your eyes all right?” makes the therapist the patient and the patient the therapist. It represents what Anna Freud calls “the identification with the (here potential) aggressor” and contains the projective-introjective mechanisms which prove so strong during later observations.—(Fred’s first words are not recorded.)

Robbed or about to be robbed of the protective aura of maternal presence, how do our patients act in space?

John’s mother is nowhere near. While his eyes are evasive, his skin pale, he moves with unafraid strides. But he has surrounded himself with a layer of weapons. (He is the delinquent, afraid of further castration. His recent circumcision had been explained to him as a consequence of the fact that he had “played with himself,” a fact which will have to be analyzed immediately after the resistance nearest to consciousness—namely, the secret—is worked through.) Mary, on entering with her mother, throws one mischievous glance across the room toward the therapist, then closes eyes and ears and almost disappears in the maternal skirt, holding the mother near the door. (She acts with hysterical dramatization and phobic avoidance. Ambivalent flight to her mother after a play disturbance with the father and with boys in a play group will prove to be her problem.) Dick, however, with hurried determination leaves his mother and passes by the therapist as if not interested in her. (Interest in the female body will immediately begin to dominate his play.) Fred, finally after some diffused handling of the toys, goes right for the psychiatrist’s body. (Playful attack, in his case, will prove to be the defense against his fear of being attacked and of suffering an “internalized” [epileptic] attack).

It is in the metaphoric and symbolical use of toys that all these defenses are first caught off guard; in the microsphere the child does what he does not dare to do in reality:

John, in the macrosphere armed against doctors and police, in playing “delivers” his secret, although only in metaphoric allusion. Mary, the bashful one, has a moment of mischievous hilarity in pushing the toys and finally the toy train, although using a protective extension in doing so. Dick, so indifferent toward mother and psychiatrist, has many urgent questions about the toy cars, in which he plainly alludes to the female body. Fred, the killer, passionately wants to build a house—to restore a body, as we were able to translate the symbolism of his play.

Each one of these indirect admissions in the microsphere is an element in a personal transference:

John, in delivering his secret metaphorically, gives the therapist what in reality is the father’s. Mary betrays her playful interest in her father and in boys and (during the second contact) takes revenge on the therapist for a scene in which her father had reacted with irritability to her interest in him. Dick takes a little longer to express the more regressive wish to bite the mother’s body, in the words, “I want to bite your buttons.” Fred, after having “hurt” the therapist, wants her to “walk with a creepy walk” like the grandmother.

It is a question, partly only of words, which of the tricks of play language we are to call symbolic or metaphoric, which to consider analogies or allusions. A symbol, it seems, should be definitely of a higher order, very condensed and abstracted in its form, superindividual in its meaning and treated with a high degree of affectual inhibition and sublimation.

Mary, who suffered a play disruption when overturning the toy train, develops a raptured admiration for shining locomotives. Her first question on seeing me weeks later concerns the locomotive of the train which took me south. Her F in the meantime had regained her friendship by joint visits to trainyards. “Shining locomotive” has become a symbol of admired paternal power.

It will take some careful study to denote how early true symbols appear in play and what their fore-runners are. “Metaphoric” is an appealing parallel to ‘’transference” (metapherein—to transfer); “allusion” has “play” in it (alludere—to play with). At the moment I would say that the play acts reported are analogies to conflict situations. The children unconsciously allude to them by transferring their ambivalence toward their parents onto the therapist and by representing other aspects of the conflict metaphorically in play.

But a child seems to be able to solve a problem in play or other activities only inasfar as the traumatic event alluded to mainly consisted of an enforced passivity, a violation by a superior force.

Mary, whose indignation with her irritable father and fear of operation are greater than her guilt, can “solve” her problem on the second day, at least enough to meet constructively an improved home situation.

Inasfar as the trauma involves “blood guilt,” the primitive feeling of having magically violated an ambivalently loved person, only a conscious, verbally communicated “yes, yes—no, no” can bring relief. This need, becoming urgent with the successful although first unconscious allusion to the conflict, drives some patients from the treacherous play back into symptom and regression. At this point we offer interpretation as a help toward communication.

John, asked to name the uncles, answers with his symptom (defecation) and reasserts his defense—“me.” Mary becomes stiff, blind, and dumb with anxiety when the toy train overturns. Dick, after having confessed that he wanted to bite the therapist’s buttons, appears wrapped in clothes, in silence and in apathy. Fred gives me the first opportunity to observe one of his minor epileptic spells after having hit me in the face as he had done to his mother.

The play, we see, indicates the need which is both intensified (“ready to have its correlative feelings aroused”) and in a state of suppression; the form of the disruption alludes to the danger which would follow the fulfillment of the need.

John’s “me” indicates, that once his secret was revealed, something terrible would happen and that he preferred to be the victim. Mary dramatizes that, if she is too much of a tomboy and dares to envy the male his anatomical share, something similar to what already has happened to foot and genitals will, on the occasion of the threatened operation, happen to other parts of her body. Dick indicates that according to “an eye for an eye” he wil be what his oral jealousy makes him wish his sister to be, namely, an unborn nothing. Fred, in his arrangement of dominoes, confesses his expectation of death as a punishment or atonement for aggression.

All of this, of course, gives us only a first impression and allows only for tentative conclusions in regard to the degree of emotional arrest, the depth of regression, the weakness of the defenses, the rigidity of conscience, etc. On the one hand we weigh these impressions against the obstacles and weaknesses in the environment as transmitted by the parents; on the other hand, we have to reconstruct the degree of development attained when the arrest and the regression occurred, and weight this positive aspect against the chances for our getting the environment ready to help the child beyond arrest and fixation when we succeed in making him set his face again toward the future.

That goal of this description was a presentation of empirical data which (a) would allow the therapist and his study group to account for some of their diagnostic habits, and (b) could be of didactic-comparative use for non-therapeutic psychologists. However, clinical description, even where more skillfully handled, can only approximate such goals; and once such approximation is attempted, the focus shifts from the larger theoretical implications to the details of observation on which first conceptual steps can be based.

It seems advisable in conclusion to point to some of the practical and therapeutic aspects of our material.

Our “short stories” may have given the reader the impression that the psychoanalysis of a child is characterized throughout by high tension and by a rapid succession of dramatic insights. This is not the case. After our interpretations have led to relieving communication and to promising improvement, long periods follow which are quiet, peaceful, even dull. The child plays, builds, paints, writes, and discusses whatever he pleases as long as his guilt and anxiety allow him to do so. Such periods mean recovery for the child, more intimate and slowly growing insight to the therapist. But the therapist by no means accompanies the child’s acts with running interpretative commentary. Interpretations to children are rare and on the whole underlie the following guiding principles. They point out symptoms of disruption throughout the patient’s life and sum up the problem behind them as it has been reconstructed on the basis of recent observation. However, they do not translate to the child the meaning of any playfully or skillfully accomplished act. Verbal self-consciousness in conditioning connection with playful activities is not desired; for these very activities must help the child later to contact the fields of cultural value, in which alone he can really find a recovery without self-consciousness. There are also no attempts at arguing for an interpretation by transmitting to the child the details of its derivation. The interpretation will be accepted by the child if both the child and the therapist are intellectually and emotionally ready for it; which means for the therapist if he is in the right mood and frame of mind to put his insight into coherent, constructive, and understandable words.

This point deserves emphasis in conclusion. Throughout a tedious piece of writing I have paid compulsive attention to details of clinical reasoning. An analytical instrument was to be demonstrated. But to learn to know the properties and the range of an instrument is one thing—to learn to use it unself-consciously and firmly, another. It is good to be explicit for the sake of training; for the sake of therapy, it is necessary to act with intuitive regard for implied probabilities and possibilities. The scientific world wants to know why we are so sure to be on the right track; the patients only that we are sure. Few patients (and they are apt to argue and doubt) want to know whether or not our interpretations are scientifically true; most patients are satisfied that they feel true and that they give meaning to suffering. Except where the parent already has learned to expect this meaning from elaborate analysis and synthesis, increased scientific conscientiousness on the part of the therapist by no means necessarily conveys a feeling of security to him. Some groups of parents and adult patients, it is true, share the specialist’s delight in new terminological, experimental, statistical rituals. The majority are bewildered by them. The conceptual frames of therapeutic habits, it must often seem to them, are like the microsphere in play, into which we project complex reality in order to have our wishes for omnipotence come true according to the less refractory microcosmic law and language. By reprojecting our interpretation into the macrosphere of social reality, we are able to observe whether or not it provided constructive meaning within the patient’s culture. By correlating it with those of other conceptual microspheres which have been longer and more consistently corrected by systematic experimental reprojection into physical reality we may see how scientific we are. But only if and where science will prove dominant over other sources of psychological strength will the scientific attitude in therapy also necessarily be the efficient one.

It is an intriguing idea that even where nobody sees it or does anything about it children proceed to express their vital problems in the metaphoric language of play—more consistently and less self-consciously than they are able or willing to in words.

To be observed when playing is natural for children; it does not have to wait for the family’s clinical surrender. If we can establish the language of play with its various cultural and age dialects16 we may be able to approach the problem why it is that certain children live undamaged through what seem to be neurotic episodes and how early neurotic children may indicate that they have reached a deadlock.

This objective becomes important at a time when there is increasing awareness of both the extent of mental suffering and the impracticability and social deficiency of the alleviating techniques. Their results point to childhood as the possibly more economic time of correction.

The neurotic adult has usually made his choice of vocation and marriage companion on the basis of his neurosis. Both are endangered when that basis is reconsidered. The child’s choices (except for that of his parents) are still preliminary; the changes we effect only replace changes which would occur with less planning. Furthermore, the adult patient usually develops a therapeutic dependency on his therapist, a dependency which every observing person will agree, often persists in the cured, and especially the much more frequent halfcured neurotic, in a form which differs from a neurosis only in the degree of terminological rationalization. One reason for this embarrassing fact undoubtedly is the impossibility, after one’s analysis, of settling one’s grievances with the childhood parents and of beginning life again, where the old road to isolation branched off. One has only one childhood. That which was merely repressed from consciousness, after having been reasonably developed and experienced, one may hope to liberate through analysis; but emotional impoverishment in childhood is incurable in later life, and to face the fact that one is crippled to the extent of having had the wrong childhood and to gain spiritually and intellectually from this fact is, after all, open to few.

The child’s dependence, however, is his natural state. Transference in childhood has a different connotation; it is of shorter duration and less consistent, and what is transferred can usually be retransferred to the parents. The parents, in turn, are more accessible to correction and advice as long as they and the child are young, and small changes in the parents are often gratefully responded to by the child with obvious and far-reaching improvements. Thus, what is delegated to the therapist can be returned to the home before the child’s personality development is completed and before all chances have been exhausted of identifying thoroughly with parents who are enlightened and live up to their capacity to love.

References

1. Psychoanalytic Quarterly, 4, 1 (1935). Child analysis number.

2. E. Homburger Erikson, “Configurations in Play: Clinical Notes.” Psychoanalytic Quarterly, 6 (1937), 138–214.

3. ——, “Problems of Infancy and Early Childhood.” In Cyclopedia of Medicine, Surgery, and Specialties (Philadelphia: Davis, 1940).

4. L. K. Frank, “Projective Methods for the Study of Personality.” Journal of Psychology, 8 (1939), 389–413.

5. Anna Freud, Introduction to the Technique of Child Analysis, auth. trans. by L. Pierce Clark. Nervous and Mental Disease Monograph Series No. 48 (New York: 1928), 59.

6. ——, The Ego and the Mechanisms of Defense (London, Hogarth, 1937), 196.

7. S. Freud, “Analysis, Terminable and Interminable.” International Journal of Psychoanalysis, 18 (1937), 373–405.

8. ——, Beyond the Pleasure Principle, auth. trans. from 2d German ed. by C. J. M. Hubback (New York: Ballou, 1924), 90.

9. ——, “Neue Folge der Vorlesungen zur Einführung in die Psychoanalyse In Gesammelte Schriften, vol. 12 (1934), 151–345.

10. M. Gitelson et al., “Clinical Experience with Play Therapy.” American Journal of Orthopsychiatry, 8 (1938), 466–78.

11. Melanie Klein, The Psychoanalysis of Children (New York: W. W. Norton, 1932), 393.

12. J. W. Macfarlane, “Studies in Child Guidance.” Society for Research in Child Development Monographs, 3, 6 (1938).

13. H. A. Murray et al., Explorations in Personality (New York: Oxford University Press, 1938), 775.

14. H. Spencer, Principles of Psychology, 3d ed. (New York: Appleton-Century, 1892). 2 vols.

15. E. C. Tolman, Purposive Behavior in Animals and Men (New York: Appleton-Century, 1932), 463.

16. R. Wälder, “The Problem of the Genesis of Psychical Conflict in Earliest Infancy: Remarks on a Paper by Joan Riviere.” International Journal of Psychoanalysis, 18 (1937), 406–73.

Notes

1 The members of the Study Group were Felice Begg-Emery, M.D.; E. H. Erikson; Edith B. Jackson, M.D.; Marion C. Putnam, M.D., in the Department of Psychiatry and Mental Hygiene: and Ruth W. Washburn, Ph.D., in the Department of Child Development, Institute of Human Relations and School of Medicine, Yale University.

These studies and their publication were aided by a grant to the Institute of Human Relations, Yale University, from the Josiah Macy, Jr. Foundation.

2 For example, the anthropological observer with psychoanalytic training learns to understand, one is tempted to say, the culturality of a cultural entity from the way a given complex of ideas is represented on the dynamic scale of a culture’s collective consciousness: in one variation as historical memory and in another as mythological history; in one disguise re-enacted in heavy rituals, in another in light games; in a third entirely represented by avoidance. The complex may be recognizable in culture pattern dreams or in individual dreams; in humorous or in hateful projections on the neighbor, on the prehuman race, or on the animal world; it may be represented in deviating behavior designating either the select or the damned or both.

3 A future psychoanalysis of play will be based on material allowing the weighing of an individual’s play against that of his age and culture group.

4 For the most comprehensive criticism of the “English School of Child Analysis” see Robert Wälder (16).

5 The author wishes to recommend especially the papers by Bertha Bornstein and Steff Bornstein (1).

6 I must acknowledge here the influence of Kurt Lewin’s terminology, although my grasp of it does not seem to go beyond the recognition of a most valuable reformulation which gives certain modern modes of thinking terminological recognition.

7 In regard to the influence of the presence of these toys on the total situation, an animal psychologist’s remark comes to my mind: “Whenever a rat is placed within sight or smell of food, it appears quite obvious and therefore it tends to remain unremarked that his selectiveness as to the surrounding means-objects are thereby affected.” (10)

8 Worries of this type are, of course, common among hospitalized children. The increased specialization which makes it necessary that before and after an operation the child is contacted by a great number of experts, each of whom has his own little method of “talking the child’s language,’ brings with it a disturbing variety of assurances, reassurances, promises, back-slaps, playful threats, etc., which may often make the psychological safety a reverse function of the physiological one said to be achieved by the specialistic perfection. As our patient was being prepared for his operation one attending individual had referred to his “beautiful eyelashes” and jokingly threatened that upon waking up he would find them removed from his eyes and attached to hers.

9 That he had the spool and that I made a mistake have to be considered as (regularly present) supporting factors in the particular development of what, in view of its coherent manifestation must be considered the “contemplated” play configuration.

10 The patient’s brother.

11 The reader is urged to read this description and its discussion (8). Freud, Beyond the Pleasure Principle, loc. cit.

12 A schizophrenic patient at the Worcester State Hospital was asked to build a house. He looked into space, grasped one block firmly and “tasted it” with his fingers; then he took a block in the other hand and did the same thing. With an expression of recognition, he bent his head forward, then brought first one then the other block to his mouth, snapping at them, making sounds of “tasting” and exclaiming “Good!,” “Good!” He did not touch them with his lips; nor was he able to put more blocks on top of one another than the two which he could hold in his two hands. Similarly, when given toy cars, he could (with much delight) push them so that they flew over the edge of the table, but he could or would not “direct” them in any way. He manifested a stage of play organization between the autocosmic extension use of toys and their use in the microsphere.

13 Ps = psychoanalyst or psychiatrist, Pt = patient.

14 In Mary’s case we saw how the image “man who plays with me” overcame the doctor association and favored the transfer of her conflict with the temporarily less playful father; while John, armed against all doctors, could not help delivering the secret to me which belonged to his father. But the material, especially in regard to the confession compulsion expressed in “A,” is influenced by the initial “doctor”-expectations of the child. In the psychoanalysis of adults, too, there is a situational connection between the patient’s very first associations and memories with the enforced infantile position into which he is asked to revert: the position of lying down, the sacrifice of upright and aggressive motility, the suggestion to lay himself open psychologically before a person who in his turn guards his integrity, the suggested lowering of the critical threshold and of cultural standards in expressing uncritically the flow of association. If not a verbal suggestion, all this certainly represents a situational emphasis which should be kept in mind when evaluating the first selection of childhood material emanating from the patient’s associations and resistances.

15 The first 20 hours of Dick’s psychoanalytic treatment were signified by the fact that he had every toy bite every other toy, with two exceptions: a baby doll and a toy cow never bit one another.

16 In connection with Jean Walker MacFarlane’s guidance study (12) I am having the opportunity to collect in regular intervals microcosmic constructions of two hundred unselected children of the pre-adolescent age and to enter into a developmental and statistical appraisal of some of the play metaphors first encountered in clinical work. What sort of test can be based on such material is still a debatable question. At any rate my contribution to H. A. Murray’s Explorations in Personality (13) is not as it has been titled a “Dramatic Production Test” but a clinical exploration.

 

The Dream Specimen of Psychoanalysis (1954)

I. Orientation

Before we embark on advanced exercises in the clinical use of dream interpretation, it seems an attractive task to return, once more, to the “first dream ever subjected to an exhaustive interpretation.” This, of course, is Freud’s dream of his patient Irma (6). While Freud has by no means published a full account of his exhaustive analysis, he, nevertheless, has offered this dream to his students as the original dream “specimen.” For this reason (and for others, only dimly felt up to the time when Freud’s letters to Fliess [9] were published) the “Irma Dream” had imprinted itself on the minds of many as a truly historical document; and it seems instructive to discuss this dream once more with the specific purpose of enlarging upon some aspects of dream interpretation which we today, half a century later, would consider essential to an exhaustive analysis.

As we review in our minds the incidents of dream analysis in our daily practice and in our seminars and courses, it must be strikingly clear that the art and ritual of “exhaustive” dream analysis have all but vanished. Our advanced technique of psychoanalysis, with its therapeutic zeal and goal-directed awareness of ever-changing transference and resistances, rarely, maybe too rarely, permits that intellectual partnership, that common curiosity between analyst and patient which would take a good-sized dream seriously enough to make it the object of a few hours’ concerted analysis. We know too well that patients learn to exploit our interest in dreams by telling us in profuse nocturnal productions what they should struggle and learn to tell us in straight words. And we have learned (or so we think) to find in other sources what in Freud’s early days could be garnered only from dreams. Therefore, we feel that even a periodic emphasis on dreams today is wasteful and may even be deleterious to therapy. But let us admit that such restraint, more often than not, is a policy of scarcity rather than abundance; and that the daily choice of dream data, made necessary by such restraint, is more arbitrary and often whimsical than systematic. The truth is that the privilege of using choice and restraint in the interpretation of dreams must be earned; only sufficient regard, at least during the years of training, for the art of total dream analysis, brought up to date at each stage of the development of psychoanalysis, can help a candidate in psychoanalytic training to graduate to that much more advanced practice (now freely granted to beginners) of picking from a patient’s daily dream productions whatever dream fragments, symbols, manifest images, and latent dream thoughts support the prevalent trend of interpretations. It stands to reason that a psychoanalyst can know which dream details he may single out for the purposes of the day only if, at least preconsciously, he has somehow grasped the meaning of the whole dream in relation to the course of the analysis and in relation to the course of the patient’s life.

Such grasp can become a firm possession of the analyst’s preconscious mental activity only if he has acquired by repeated exercise the potential mastery of the whole inventory of manifest leads, association trends, and relevant life data which make up a whole dream. If he can learn this in his own analysis, so much the better. Some must learn it later, when dream analysis becomes the main vehicle of self-analysis. In the course of formal training, however, “exhaustive” dream analysis can best be studied in connection with those seminars, usually called “continuous,” in which the study of the history of a whole treatment permits a thorough assessment of the inventory of forces, trends, and images in a patient’s life—including his dream life. I propose that we prepare ourselves for the task of this total analysis by taking up once more Freud’s dream of his patient Irma.

To reinterpret a dream means to reinterpret the dreamer. Let me, therefore, discuss first the spirit in which we undertake such a reinterpretation.

No man has ever consciously and knowingly revealed more of himself, for the sake of human advance, than did Freud. At the same time, he drew firm lines where he felt that self-revelation should come to an end, because the possible scientific gain was not in proportion to the pain of self-exhibition and to the inconvenience of calumny. If we, in passing, must spell out more fully than Freud did certain latent dream thoughts suggested by him, we are guided by the consideration that the most legitimate didactic use of the personal data of Freud’s life concerns a circumscribed area of investigation, namely, the dynamics of creative thought in general and, specifically, in psychoanalytic work. It seems to us that the publication of Freud’s letters to Fliess points in this direction (2).

In reviewing the dream of Irma, we shall focus our attention, beyond the fragmentary indices of familiar infantile and neurotic conflicts, primarily on the relation of this very dream to the moment in Freud’s life when it was dreamed—to the moment when creative thought gave birth to the interpretation of dreams. For the dream of Irma owes its significance not only to the fact that it was the first dream reported in The Interpretation of Dreams. In a letter sent to his friend Fliess, Freud indulges in a fancy of a possible tablet which (he wonders) may sometimes adorn his summer home. Its inscription would tell the world that “In this house, on July 24, 1895, the Mystery of the Dream unveiled [enthüllte] itself to Dr. Sigm. Freud” (9). The date is that of the Irma Dream. Such autobiographic emphasis, then, supports our contention that this dream may reveal more than the basic fact of a disguised wish fulfillment derived from infantile sources; that this dream may, in fact, carry the historical burden of being dreamed in order to be analyzed, and analyzed in order to fulfill a very special fate.

This, then, is our specific curiosity regarding the dream of Irma. We can advance this approach only in the general course of demonstrating the dimensions of our kind of “exhaustiveness” in the interpretation of dreams.

But first, the background of the dream, the dream itself, and Freud’s interpretation.

II. The Irma Dream, Manifest and Latent

The dreamer of the Irma Dream was a thirty-nine-year-old doctor, a specialist in neurology in the city of Vienna. He was a Jewish citizen of a Catholic monarchy, once the Holy Roman Empire of German Nationality, and now swayed both by liberalism and increasing anti-Semitism. His family had grown rapidly; in fact, his wife at the time was again pregnant. The dreamer just then wished to fortify his position and, in fact, his income by gaining academic status. This wish had become problematic, not only because he was a Jew but also because in a recent joint publication with an older colleague, Dr. Breuer, he had committed himself to theories so unpopular and, in fact, so universally disturbing that the senior co-author himself had disengaged himself from the junior one. The book in question (Studies in Hysteria) had emphasized the role of sexuality in the etiology of the “defense neuropsychoses,” i.e., nervous disorders caused by the necessity of defending consciousness against repugnant and repressed ideas, primarily of a sexual nature. The junior worker felt increasingly committed to these ideas; he had begun to feel, with a pride often overshadowed by despair, that he was destined to make a revolutionary discovery by (I shall let this stand) undreamed-of means.

It had occurred to Freud by then that the dream was, in fact, a normal equivalent of a hysterical attack, “a little defense neuropsychosis.” In the history of psychiatry, the comparison of normal phenomena with abnormal ones was not new: the Greeks had called orgasm “a little epilepsy.” But if hysterical symptoms, if even dreams, were based on inner conflict, on an involuntary defense against unconscious thoughts, what justification was there for blaming patients for the fact that they could not easily accept, nor long remember, and not consistently utilize the interpretations which the psychiatrist offered them? What use was there in scolding the patient, as Bernheim had done: “vous vous contre-suggestionez, madame?” “Defense,” “transference,” and “resistance” were the mechanisms, the concepts, and the tools to be elucidated in the years to come. It was soon to dawn on Freud that in order to give shape to these tools, a basic shift from physiologic concepts (to which he was as yet committed) to purely psychological ones, and from exact and sober medical and psychotherapeutic techniques to intuitive observation, even to selfobservation, was necessary.

This, then, is the situation: within an academic milieu which seemed to restrict his opportunities because he was a Jew; at an age when he seemed to notice with alarm the first signs of aging, and, in fact, of disease; burdened with the responsibility for a fast-growing family—a medical scientist is faced with the decision of whether to employ his brilliance, as he had shown he could, in the service of conventional practice and research, or to accept the task of substantiating in himself and of communicating to the world a new insight, namely, that man is unconscious of the best and of the worst in himself. Soon after the Irma Dream, Freud was to write to his friend Fliess with undisguised horror that in trying to explain defense he had found himself explaining something “out of the core of nature.” At the time of this dream, then, he knew that he would have to bear a great discovery.

The evening before the dream was dreamed, Freud had an experience which had painfully spotlighted his predicament. He had met a colleague, “Otto,” who had just returned from a summer resort. There he has seen a mutual friend, a young woman, who was Freud’s patient: “Irma.” This patient, by Freud’s effort, had been cured of hysterical anxiety, but not of certain somatic symptoms, such as intense retching. Before going on vacation, Freud had offered her an interpretation as the solution of her problems; but she had been unable to accept it. Freud had shown impatience. Patient and doctor had thus found themselves in a deadlock which made a righteous disciplinarian out of the doctor and a stubborn child out of the patient: not a healthy condition for the communication of insight. It was, of course, this very kind of deadlock which Freud learned later on to formulate and utilize for a working through of resistance. At the time, Freud apparently had heard some reproach in Otto’s voice regarding the condition of the patient who appeared “better, but not well”; and behind the reproach he thought to detect the stern authority of “Dr. M.,” a man who was “the leading personality in our circle.” On his return home, and under the impression of the encounter, Freud had written a lengthy case report for “Dr. M.,” explaining his views on Irma’s illness.

He had apparently gone to bed with a feeling that this report would settle matters so far as his own peace of mind was concerned. Yet that very night the personages concerned in this incident, namely, Irma, Dr. M., Dr. Otto, and another doctor, Dr. Leopold, constituted themselves the population of the following dream (6, pp. 196–197).

A great hall—a number of guests, whom we are receiving—among them Irma, whom I immediately take aside, as though to answer her letter, and to reproach her for not yet accepting the “solution.” I say to her: “If you [du]1 still have pains, it is really only your own fault.”—She answers: “If you [du] only knew what pains I have now in the throat, stomach, and abdomen—I am choked by them.” I am startled, and look at her. She looks pale and puffy. I think that after all I must be overlooking some organic affection. I take her to the window and look into her throat. She offers some resistance to this, like a woman who has a set of false teeth. I think, surely she doesn’t need them [sie hat es doch nicht nötig].—The mouth then opens wide, and I find a large white spot on the right, and elsewhere I see extensive grayish-white scabs adhering to curiously curled formations which are evidently shaped like the turbinal bones of the nose.—I quickly call Dr. M., who repeats the examination and confirms it. Dr. M. looks quite unlike his usual self; he is very pale, he limps, and his chin is clean-shaven [bartlos]. . . . Now my friend, Otto, too, is standing beside her, and my friend Leopold percusses her covered chest and says: “She has a dullness below, on the left,” and also calls attention to an infiltrated portion of skin on the left shoulder (which I can feel in spite of the dress). M. says, “There’s no doubt that it’s an infection, but it doesn’t matter; dysentery will follow and the poison will be eliminated.” . . . We know, too, precisely [unmittelbar] how the infection originated. My friend, Otto, not long ago, gave her, when she was feeling unwell, an injection of a preparation of propyl . . . propyls . . . propionic acid . . . trimethylamin (the formula of which I see before me, printed in heavy type) One doesn’t give such injections so rashly Probably, too, the syringe [Spritze] was not clean.

I must assume here that Freud’s associations to this dream are known to all readers, in all the literary freshness which they have in The Interpretation of Dreams, and in all the convincing planlessness of true associations, which, unforeseen and often unwelcome, make their determined entrance like a host of unsorted strangers, until they gradually become a chorus echoing a few central themes. Here I must select and classify.

Irma proves, first of all, to be the representative of a series of women patients. Freud remembers a number of young women in connection with the question whether or not they were willing to accept their therapist’s “solution.” Besides Irma, who we now hear is a rosy young widow, a governess comes to memory, also of youthful beauty, who had resisted an examination because she wanted to hide her false teeth. The dreamer remembers that it had been this governess about whom he had had the angry thought (which in the dream he expresses in regard to Irma), namely, “Sie hat es doch nicht nötig” (incorrectly translated as, “She does not need them”). This trend of association establishes an analogy between women patients who will not accept solutions, who will not yield to examination, and who will not submit to advances, although their status promises an easy yielding: young widows, young governesses. Fifty years ago as well as today, suspicions concerning young women patients and especially “merry widows” found their way into medical wit, humor, and scandal. They were accentuated at the time by the common but not officially admitted knowledge that the large contingent of hysterical women was starved for sexual adventure. On the sly it was suggested that the doctor might as well remove their inhibitions by deeds as well as words. It was Freud who established the fact that the hysterical patient transfers to the doctor by no means a simply sexual wish, but rather an unconscious conflict between an infantile wish and an infantile inhibition. Medical ethics aside, neither satisfaction nor cure could ensue from a sexual consummation of the transference.

But then other kinds of patients—men, women, and children—impose themselves on the dreamer’s memory: “good ones” who fared badly, and “bad ones” who, maybe, were better off. Two hysterical ladies had accepted his “solutions” and had become worse; one had died. As to obstreperous patients, the dreamer must admit that he thinks of a very occasional patient, his own wife, and he must confess that even she is not at ease with him as the ideal patient would be. But are there any easy, any ideal patients? Yes, children. They do not “put on airs.” In those Victorian days, little girls were the only female patients who undressed for examination matter-of-factly. And, we may add, children oblige the dream interpreter by dreaming simple wish fulfillments where adults build up such complicated defenses against their own wishes—and against the interpretation of dreams.

In speaking of his men patients, the dreamer is ruthless with himself and his memories. Years ago he had played a leading role in research which demonstrated the usefulness of cocaine for local anesthesia, especially in the eye. But it took some time to learn the proper dosage and the probable dangers: a dear friend died of misuse of cocaine. Other men patients come to mind, also badly off. And then there are memories concerning the dreamer himself in his double role as patient and as doctor. He had given himself injections for swelling in the nose. Had he harmed himself?

Finally the dreamer, apparently looking for a friend in his dilemma, thinks of his oldest and staunchest admirer, a doctor in another city, who knows all his “germinating ideas,” and who has fascinating ideas regarding the relationship of nose and sexuality and regarding the phasic aspect of conception; but, alas, he too has a nasal affliction. This far-away doctor is no other than Dr. Fliess, whom Freud at the time was consulting, confiding his emotions and his ideas, and in whom he was soon to confide his very self-analysis.

To state the case which Freud at the time wished to make we shall quote from his lengthy summary (6, pp. 204–207).

The dream fulfills several wishes which were awakened within me by the events of the previous evening (Otto’s news, and the writing of the clinical history). For the result of the dream is that it is not I who am to blame for the pain which Irma is still suffering, but that Otto is to blame for it. Now Otto has annoyed me by his remark about Irma’s imperfect cure; the dream avenges me upon him, in that it turns the reproach upon himself. The dream acquits me of responsibility for Irma’s condition, as it refers this condition to other causes (which do, indeed, furnish quite a number of explanations). The dream represents a certain state of affairs, such as I might wish to exist; the content of the dream is thus the fulfillment of a wish; its motive is a wish.

This much is apparent at first sight. But many other details of the dream become intelligible when regarded from the standpoint of wish fulfillment. I take my revenge on Otto. . . . Nor do I pass over Dr. M.’s contradiction; for I express in an obvious allusion my opinion of him: namely, that his attitude in this case is that of an ignoramus (“Dysentery will develop, etc.”). Indeed, it seems as though I were appealing from him to someone better informed (my friend, who told me about trimethylamin), just as I have turned from Irma to her friend, and from Otto to Leopold. It is as though I were to say: Rid me of these three persons, replace them by three others of my own choice, and I shall be rid of the reproaches which I am not willing to admit that I deserve! In my dream the unreasonableness of these reproaches is demonstrated for me in the most elaborate manner. Irma’s pains are not attributable to me, since she herself is to blame for them in that she refuses to accept my solution. They do not concern me, for being as they are of an organic nature, they cannot possibly be cured by psychic treatment. —Irma’s sufferings are satisfactorily explained by her widowhood (trimethylamin!); a state which I cannot alter. —Irma’s illness has been caused by an incautious injection administered by Otto, an injection of an unsuitable drug, such as I should never have administered. —Irma’s complaint is the result of an injection made with an unclean syringe, like the phlebitis of my old lady patient, whereas my injections have never caused any ill effects. I am aware that these explanations of Irma’s illness, which unite in acquitting me, do not agree with one another; that they even exclude one another. The whole plea—for this dream is nothing else—recalls vividly the defense offered by a man who was accused by his neighbor of having returned a kettle in a damaged condition. In the first place, he said, he had returned the kettle undamaged; in the second place, it already had holes in it when he borrowed it; and in the third place, he had never borrowed it at all. A complicated defense, but so much the better; if only one of these three lines of defense is recognized as valid, the man must be acquitted.

Still other themes play a part in the dream, and their relation to my non-responsibility for Irma’s illness is not so apparent. . . . But if I keep all these things in view they combine into a single train of thought which might be labeled: concern for the health of myself and others; professional conscientiousness. I recall a vaguely disagreeable feeling when Otto gave me the news of Irma’s condition. Lastly, I am inclined, after the event, to find an expression of this fleeting sensation in the train of thoughts which forms part of the dream. It is as though Otto had said to me: “You do not take your medical duties seriously enough; you are not conscientious; you do not perform what you promise.” Thereupon this train of thought placed itself at my service, in order that I might give proof of my extreme conscientiousness, of my intimate concern about the health of my relatives, friends and patients. Curiously enough, there are also some painful memories in this material, which confirm the blame attached to Otto rather than my own exculpation. The material is apparently impartial, but the connection between this broader material, on which the dream is based, and the more limited theme from which emerges the wish to be innocent of Irma’s illness, is, nevertheless, unmistakable. I do not wish to assert that I have entirely revealed the meaning of the dream, or that my interpretation is flawless. . . .

For the present I am content with the one fresh discovery which has just been made: If the method of dream-interpretation here indicated is followed, it will be found that dreams do really possess a meaning, and are by no means the expression of a disintegrated cerebral activity, as the writers on the subject would have us believe. When the work of interpretation has been completed the dream can be recognized as a wish-fulfillment.

We note that the wish demonstrated here is not more than pre-conscious. Furthermore, this demonstration is not carried through as yet to the infantile sources postulated later in The Interpretation of Dreams. Nor is the theme of sexuality carried through beyond a point which is clearly intended to be understood by the trained reader and to remain vague to the untrained one. The Irma Dream, then, serves Freud as a very first step toward the tasks of the interpretation of dreams, namely, the establishment of the fact that dreams have their own “rationale,” which can be detected by the study of the “work” which dreams accomplish, in transforming the latent dream thoughts into manifest dream images. Dream work uses certain methods (condensation, displacement, symbolization) in order to derive a set of manifest dream images which, on analysis, prove to be significantly connected with a practically limitless number of latent thoughts and memories, reaching from the trigger event of the preceding day, through a chain of relevant memories, back into the remotest past and down into the reservoir of unconscious, forgotten, or unclearly evaluated, but lastingly significant, impressions.

Our further efforts, then, must go in two directions. First, we must spell out, for the Irma Dream, certain latent connections, which in The Interpretation of Dreams, for didactic reasons, are dealt with only in later chapters: here we think primarily of the dream’s sexual themata, and their apparent relation to certain childhood memories, which in Freud’s book follow the Irma Dream by only a number of pages. And we must focus on areas of significance which are only implicit in The Interpretation of Dreams but have become more explicit in our lifetime. Here I have in mind, first of all, the relationship of the latent dream thought to the dream’s manifest surface as it may appear to us today after extensive studies of other forms of imaginative representation, such as children’s play; and then, the relationship of the dream’s “inner population” to the dreamer’s social and cultural surroundings.

I propose to approach this multidimensional task, not by an immediate attempt at “going deeper” than Freud did, but, on the contrary, by taking a fresh look at the whole of the manifest dream. This approach, however, will necessitate a brief discussion of a general nature.

III. Dimensions of the Manifest Dream

The psychoanalyst, in looking at the surface of a mental phenomenon, often has to overcome a certain shyness. So many in his field mistake attention to surface for superficiality, and a concern with form for lack of depth. But the fact that we have followed Freud into depths which our eyes had to become accustomed to does not permit us, today, to blink when we look at things in broad daylight. Like good surveyors, we must be at home on the geological surface as well as in the descending shafts. In recent years, so-called projective techniques, such as the Rorschach Test, the Thematic Apperception Test, and the observation of children’s play, have clearly shown that any segment of overt behavior reflects, as it were, the whole store: one might say that psychoanalysis has given new depth to the surface, thus building the basis for a more inclusive general psychology of man. It takes the clinical psychoanalytic method proper to determine which items of a man’s total behavior and experience are amenable to consciousness, are preconscious, or unconscious, and why and how they became and remained unconscious; and it takes this method to establish a scale of pathogenic significance in his conscious and unconscious motivations. But in our daily work, in our clinical discussions and nonclinical applications, and even in our handling of dreams, it has become a matter of course that any item of human behavior shows a continuum of dynamic meaning, reaching from the surface through many layers of crust to the “core.” Unofficially, we often interpret dreams entirely or in parts on the basis of their manifest appearance. Officially, we hurry at every confrontation with a dream to crack its manifest appearance at if it were a useless shell and to hasten to discard this shell in favor of what seems to be the more worthwhile core. When such a method corresponded to a new orientation, it was essential for research as well as for therapy; but as a compulsive habituation, it has since hindered a full meeting of ego psychology and the problems of dream life.2

Let us, then, systematically begin with the most “superficial”: our first impression of the manifest dream. After years of practice one seems to remember, to compare, and to discuss the dreams of others (and even the reports given to us of dreams reported to others) in such a matter-of-fact manner that one reminds himself only with some effort of the fact that one has never seen anybody else’s dream nor has the slightest proof that it ever “happened” the way one visualizes it. A dream is a verbal report of a series of remembered images, mostly visual, which are usually endowed with affect. The dreamer may be limited or especially gifted, inhibited or overeager in the range of his vocabulary and in its availability for dream reports; in his ability to revisualize and in his motivation to verbalize all the shades of what is visualized; in his ability to report stray fragments or in the compulsion to spin a meaningful yarn; or in his capacity or willingness to describe the range of his affects. The report of a dream, in turn, arouses in each listener and interpreter a different set of images, which are as incommunicable as is the dream itself. Every dream seminar gives proof that different people are struck by different variables of the manifest dream (or, as I would like to call them, by dream configurations) in different ways, and this by no means only because of a different theoretical approach, as is often hastily concluded, but because of variations in sensory and emotional responsiveness. Here early overtraining can do much harm, in that, for example, the immediate recognition of standardized symbols, or the immediate recognition of verbal double meanings may induce the analyst to reach a premature closure in his conviction of having listened to and “understood” a dream and of understanding dreams in general. It takes practice to realize that the manifest dream contains a wealth of indicators not restricted to what the listener happens to be receptive for. The most important of these indicators are, it is true, verbal ones; but the mere experiment of having a patient retell toward the end of an analytic hour a dream reported at the beginning will make it quite clear to what extent a verbal report is, after all, a process of trying to communicate something which is never completely and successfully rendered in any one verbal formulation. Each completed formulation is, of course, a complete item for analysis; and one it is told, the memory of the first verbal rendering of a dream more or less replaces the visual memory of it, just as a childhood experience often retold by oneself or described by others becomes inextricably interwoven with the memory itself.

I pause here for an illustration, the shortest illustration, from my practice. A young woman patient of German descent once reported a dream which consisted of nothing but the image of the word S [E] INE (with the “E” in brackets), seen light against a dark background. The patient was well-traveled and educated and it therefore seemed plausible to follow the first impression, namely, that this image of a word contained, in fact, a play of words in a variety of languages. The whole word is the French river SEINE, and indeed it was in Paris (France) that the patient had been overcome with agoraphobia. The same French word, if heard and spelled as a German word, is SEHN, i.e., “to see,” and indeed it was after a visit to the Louvre that the patient had been immobilized: there now existed a complete amnesia for what she had seen there. The whole word, again, can also be perceived as the German word SEINE, meaning “his.” The letter “E” is the first letter of my name and probably served as an anchorage for the transference in the dream. If the letter “E” is put aside, the word becomes the Latin SINE, which means “without.” All of this combined makes for the riddle “To see (E) without his . . . in Paris.” This riddle was solved through a series of free associations which, by way of appropriate childhood memories of a voyeuristic character and through the analysis of a first transference formation, led to the visual recovery of one of the forgotten pictures: It was a “Circumcision of Christ.” There she had seen the boy Savior without that mysterious loincloth which adorns Christ on the Crucifix—the loincloth which her sacrilegious eyes had often tucked at during prayers. (The dream word SEINE also contains the word SIN.) This sacrilegious and aggressive curiosity had been shocked into sudden prominence by the picture in the Louvre, only to be abruptly repressed again because of the special inner conditions brought about by the state of adolescence and by the visit to the capital of sensuality. It had now been transferred to the analyst, by way of the hysterical overevaluation of his person as a therapeutic savior.

The presence of meaningful verbal configurations in this dream is very clear. Less clear is the fact that the very absence of other configurations is equally meaningful. That something was only seen, and in fact focused upon with the exclusion of all other sensory experiences (such as spatial extension, motion, shading, color, sound, and, last but not least, the awareness of a dream population), is, of course, related to the various aspects of the visual trauma: to the symptom of visual amnesia, to an attempt to restore the repressed image in order to gain cure by mastery, and to a transference of the original voyeuristic drive onto the person of the analyst. We take it for granted that the wish to revive and to relive the repressed impulse immediately “muscles” its way into the wish to be cured. That the dream space was dark and completely motionless around a clear image was an inverted representation of the patient’s memory of the trauma: an area with a dark spot in the center (the repressed picture) and surrounded by lively and colorful halls, milling crowds, and noisy and dangerous traffic, in bright sunlight. The lack of motion in the dream corresponds to the patient’s symptoms: agoraphobia and immobilization (based on early determined defense mechanisms) were to end the turmoil of those adolescent days and bring to a standstill the struggle between sexual curiosity and a sense of sin. There was no time dimension in the dream, and there was none in the patient’s by now morbid psychic life. As is often the case with hysterics, a relative inability to perceive the passage of time had joined the symptom of spatial avoidance, just as blind anxiety had absorbed all conflicting affects. Thus, all the omitted dimensions of the manifest dream, with the help of associations, could be made to converge on the same issues on which the one overclear dimension (the visual one) was focused. But the choice of the manifest dream representation, i.e., the intelligent use of multilingual word play in a visual riddle, itself proved highly overdetermined and related to the patient’s gifts and opportunities: for it was in superior esthetic aspirations that the patient had found a possible sphere of conflict-free activity and companionship. In the cultivation of her sensitive senses, she could see and hear sensually, without being consciously engaged in sexual fantasies; and in being clever and witty she had, on occasion, come closest to replacing a son to her father. This whole area of functioning, then, had remained more or less free of conflict, until, at the time of accelerated sexual maturation and under the special conditions of a trip, sacrilegious thoughts in connection with an esthetic-intellectual endeavor had brought about a short-circuit in her whole system of defenses and reasonably conflict-free intellectual functions: the wish to see and feel esthetically, again, converged on sexual and sinful objects. While it is obvious, then, that the desublimated drive fragment of sacrilegious voyeurism is the force behind this dream (and, in this kind of case, necessarily became the focus of therapeutic interpretation) the total dream, in all of its variables, has much more to say about the relationship of this drive fragment to the patient’s ego development.

I have temporarily abandoned the Irma Dream for the briefest dream of my clinical experience in order to emphasize the fact that a dream has certain formal aspects which combine to an inventory of configurations, even though some of these configurations may shine only by their absence. In addition to a dream’s striving for representability, then, we would postulate a style of representation which is by no means a mere shell to the kernel, the latent dream; in fact, it is a reflection of the individual ego’s peculiar time-space (2), the frame of reference for all its defenses, compromises, and achievements (3). Our “Outline of Dream Analysis” (Chart I), consequently, begins with an inventory of Manifest Configurations, which is meant to help us, in any given dream or series of dreams, to recognize the interplay of commissions and omissions, of overemphases and underemphases. As mentioned before, such an inventory, once having been thoroughly practiced, must again become a preconscious set of general expectations, against which the individual style of each dream stands out in sharp contour. It will then become clear that the dream life of some (always, or during certain periods, or in individual dream events) is characterized by a greater clarity of the experience of spatial extension and of motion (or the arrest of motion) in space; that of others by the flow or the stoppage of time; other dreams are dominated by clear somatic sensations or their marked absence; by a rich interpersonal dream life with an (often stereotyped) dream population or by a pronounced aloneness; by an overpowering experience of marked affects or their relative absence or lack of specificity. Only an equal attention to all of these variables and their configurations can help the analyst to train himself for an awareness of the varieties of manifest dream life, which in turn permits the exact characterization of a given patient’s manifest dream life at different times of his treatment.

CHART I: OUTLINE OF DREAM ANALYSIS

I. Manifest Configurations

VERBAL

general linguistic quality
spoken words and word play

SENSORY

general sensory quality, range and intensity
specific sensory focus

SPATIAL

general quality of extension
dominant vectors

TEMPORAL

general quality of succession
time-perspective

SOMATIC

general quality of body feeling
body zones
organ modes

INTERPERSONAL

general social grouping
changing social vectors
“object relations”
points of identification

AFFECTIVE

quality of affective atmosphere
inventory and range of affects
points of change of affect

SUMMARY

correlation of configurational trends

II. Links between Manifest and Latent Dream Material

ASSOCIATIONS

SYMBOLS

III. Analysis of Latent Dream Material

ACUTE SLEEP-DISTURBING STIMULUS

DELAYED STIMULUS (DAY RESIDUE)

ACUTE LIFE CONFLICTS

DOMINANT TRANSFERENCE CONFLICT

REPETITIVE CONFLICTS

ASSOCIATED BASIC CHILDHOOD CONFLICTS

COMMON DENOMINATORS

“wishes,” drives, needs

methods of defense, denial, and distortion

IV. Reconstruction

LIFE CYCLE

present phase

corresponding infantile phase

defect, accident, or affliction

psychosexual fixation

psychosexual arrest

SOCIAL PROCESS: COLLECTIVE IDENTITY

ideal prototypes

evil prototypes

opportunities and barriers

EGO IDENTITY AND LIFEPLAN

mechanisms of defense

mechanisms of integration

As for Part II of our “Outline” (Links between Manifest and Latent Material), the peculiar task of this paper has brought it about that the dreamer’s associations have already been discussed, while some of the principal symbols still await recognition and employment.

IV. Verbal Configurations

In the attempt now to demonstrate in what way a systematic use of the configurational analysis of the manifest dream (in constant interplay with the analysis of the latent content) may serve to enrich our understanding of the dream work, I find myself immediately limited by the fact that the very first item on our list, namely, “verbal configurations,” cannot be profitably pursued here, because the Irma Dream was dreamed and reported in a German of both intellectual and colloquial sophistication which, I am afraid, transcends the German of the reader’s high school and college days. But it so happens that the English translation of the Irma Dream which lies before us (6) contains a number of conspicuous simplifications in translation, or, rather, translations so literal that an important double meaning gets lost. This, in a mental product to be analyzed, can be seriously misleading, while it is questionable that any translation could avoid such mistakes; in the meantime we may profit from insight into the importance of colloquial and linguistic configurations. Actually, what is happening in this translation from one language into another offers analogies with “translations” from any dreamer’s childhood idiom to that of his adult years, or from the idiom of the dreamer’s milieu to that of the analyst’s. It seems especially significant that any such transfer to another verbal system of representation is not only accidentally to mistranslate single items, but to become the vehicle for a systematic misrepresentation of the whole mental product.

There is, to begin with, the little word du, with which the dreamer and Irma address one another and which is lost in the English “you.” It seems innocent enough on the surface, yet may contain quite a therapeutic burden, a burden of countertransference in reality and of special meaning in the dream. For with du one addressed, in those days and in those circles, only near relatives or very intimate friends. Did Freud in real life address the patient in this way—and (a much more weighty question) did she address the Herr Professor with this intimate little word? Or does the dreamer use this way of addressing the patient only in the dream? In either case, this little word carries the burden of the dreamer’s sense of personal and social obligation to the patient, and thus of a new significance in his guilt over some negligence and in his wish that she should get well—an urgency of a kind which (as Freud has taught us since then) is disadvantageous to the therapeutic relation.

To enumerate other verbal ambiguities: there is a very arresting mistranslation in the phrase “I think, surely she doesn’t need them” which makes it appear that the dreamer questions the necessity for Irma’s false teeth. The German original, “sie hat es doch nicht nötig,” means literally, “she does not need it,” meaning her resistive behavior. In the colloquial Viennese of those days a richer version of the same phrase was “das hat sie doch gar nicht nötig, sich so zu zieren,” the closest English counterpart to which would be: “Who is she to put on such airs?” This expression includes a value judgment to the effect that a certain lady pretends that she is of a higher social, esthetic, or moral status than she really is. A related expression would be the protestation brought forth by a lady on the defense: “Ich hab das doch gar nicht nötig, mir das gefallen zu lassen”; in English, “I don’t need to take this from you,” again referring to a misjudgment, this time on the part of a forward gentleman, as to what expectations he may cultivate in regard to a lady’s willingness to accept propositions. These phrases, then, are a link between the associations concerning patients who resist “solutions” and women (patients or not) who resist sexual advances.

Further mistranslations continue this trend. For example, the fact the Dr. M.’s chin, in the dream, is bartlos, is translated with “clean-shaven.” Now a clean-shaven appearance, in the America of today, would be a “must” for a professional man. It is, therefore, well to remember that the German word in the dream means “beardless.” But this indicates that Dr. M. is minus something which in the Europe of those days was one of the very insignia of an important man, to wit, a distinctive beard or mustache. This one little word then denudes the leading critic’s face, where the English translation would give it the luster of professional propriety; it is obvious that the original has closer relations to a vengeful castrative impulse on the part of the dreamer than the translation conveys.

Then, there is that little word “precisely” which will become rather relevant later in another context. In German one would expect the word genau, while one finds the nearly untranslatable unmittelbar (“with a sense of immediacy”). In relation to something that is suddenly felt to be known (like the cause of Irma’s trouble in the dream) this word refers rather to the degree of immediate and absolute conviction than to the precise quality of the knowledge; in fact, as Freud points out in his associations, the immediacy of this conviction really stood in remarkable contrast to the nonsensical quality of the diagnosis and the prognosis so proudly announced by Dr. M.

There remains the brief discussion of a play of words and of a most relevant simplification. It will have occurred to you that all the mistranslations mentioned so far (except “precisely”) allude to sexual meanings, as if the Irma Dream permitted a complete sexual interpretation alongside the professional one—an inescapable expectation in any case.

The word play “propyl . . . propyls . . . propionic acid,” which leads to the formula of trimethylamin, is so suggestive that I shall permit myself to go beyond the data at our disposal in order to provide our discussion of word play in dreams and in wit with an enlightening example. Freud associated “propyl” to the Greek word propylon (in Latin vestibulum, in German Vorhof), a term architectonic as well as anatomic, and symbolic of the entrance to the vagina; while “propionic” suggests priapic—phallic. This word play, then, would bring male and female symbols into linguistic vicinity to allude to a genital theme. The dream here seems to indulge in a mechanism common in punning. A witty word play has it, for example, that a mistress is “something between a mister and a mattress”—thus using a linguistic analogy to the principal spatial arrangement to which a mistress owes her status.

Finally, a word on the instrument which dispenses the “solution.” The translation equips Dr. Otto with a “syringe” which gives the dream more professional dignity than the German original aspires to. The German word is Spritze, which is, indeed, used for syringes, but has also the colloquial meaning of “squirter.” It will be immediately obvious that a squirter is an instrument of many connotations; of these, the phallic-urinary one is most relevant, for the use of a dirty syringe makes Otto a “dirty squirter,” or “a little squirt,” not just a careless physician. As we shall see later, the recognition of this double meaning is absolutely necessary for a pursuit of the infantile meaning of the Irma Dream.

The only verbal trend, then, which can be accounted for in this English discussion of a dream reported and dreamed in German induces us to put beside the interpretation of the Irma Dream as a defense against the accusation of medical carelessness (the dispensation of a “solution”) and of a possible intellectual error (the solution offered to Irma) the suggestion of a related sexual theme, namely, a protest against the implication of some kind of sexual (self-) reproach.

In due time, we shall find the roots for this sexual theme in the dream’s allusion to a childhood problem and then return to the dreamer’s professional predicament.

We will then appreciate another double meaning in the dream, which seems to speak for the assumption that one link between the medical, the intellectual, and the sexual themes of the dream is that of “conception.” The dream, so we hear, pictures a birthday reception in a great hall. “We receive” stands for the German empfangen, a word which can refer to conception (Empfängnis) as well to reception (Empfang). The dreamer’s worries concerning the growth of his family at this critical time of his professional life are clearly expressed in the letters to Fliers. At the same time, the typical association between biological conception and intellectual concept formation can be seen in the repeated reference to “germinating ideas.”

V. Interpersonal Configurations in the Dream Population

For a variety of reasons, it will be impossible to offer in this paper a separate discussion of each of the configurational variables listed in our “Outline.” The medical implications of the sequence of somatic configurations must be ignored altogether, for I am not sufficiently familiar with the history of medicine to comprehend the anatomical, chemical, and procedural connotations which the body parts and the disease entities mentioned in the dream had in Freud’s early days. The sensory configurations happen in this dream to fuse completely with the dreamer’s interpersonal activities. Only once—at a decisive point in the middle of the dream—there occurs a kinesthetic sensation. Otherwise, at the beginning as well as at the end of his dream the dreamer is “all eyes.”

SELECTED MANIFEST CONFIGURATIONS

image

Most outstanding in his visual field, so it seems, is, at one time, Irma’s oral cavity, and, at another, the formula trimethylamin, printed in heavy type. The infinite connotations of these two items of fascination become clearer as we see them in a variety of dimensions.

image

The Irma Dream, to me, suggests concentration on the dreamer’s interaction with the people who populate his dream, and relate this interaction to changes in his mood and to changes in his experience of space and time. The chart above lists contemporaneous changes in the dream’s interpersonal, affective, spatial, and temporal configurations.

Given a diagrammatic outline, we have the choice between a horizontal and a vertical analysis. If we try the vertical approach to the first column, we find the dreamer, immediately after having abandoned the receiving line, preoccupied with an intrusive and coercive kind of examination and investigation. He takes the patient aside, reproaches her, and then looks and thinks; finally he finds what he is looking for. Then his activities of examining fuse with those of the other doctors, until at the end he again sees, and this time in heavy type, a formula. It is obvious, then, that investigation, in isolation or co-operation, is the main theme of his manifest activities. The particular mode of his approach impresses one as being intrusive, and thus somehow related to phallic.3 If I call it a singularly male approach, I must refer to research in another field and to unfinished research in the field of dreams. Observations on sex differences in the play construction of adolescents (4) indicate that male and female play scenes are most significantly different in the treatment of the space provided, i.e., in the structuring of the play space by means of building blocks and in the spatial vectors of the play activities. I shall not review the criteria here, because without detailed discussion a comparison between the task, suggested by an experimenter, of constructing a scene with a selection of building material and toys, is too different from the inner task, commanded by one’s wish to sleep, to represent a set of images on the dream screen. Nevertheless, it may be mentioned that Dr. Kenneth Colby, in following up the possibility of preparing an analogous kind of psychosexual index for the formal characteristics of dreams, has found temporal suddenness, spatial entering, the sensory activity of looking, concern with authority, and a sense of ineffectuality, to be among the numerous items which are significantly more frequent in male dreams.4 Dr. Colby has been able to isolate some such regularities in spite of the fact that the dream literature at the moment indulges in every possible license in the selection, description, and connotation of dream items. It seems to me that such studies might prove fruitful for research and technique, especially if undertaken in the frame of a standardized inquiry into the variables of dream experience, as suggested in our inventory of configurations. It is possible that the dream has hardly begun to yield its potentialities for research in personality diagnosis.

But now back to the “interpersonal” configurations, from which we have isolated, so far, only the dreamer’s activities. If we now turn to the behavior of the dream population, it is, of course, a strangely intrapersonal social life which we are referring to: one never knows whether to view the cast of puppets on the dreamer’s stage as a microcosmic reflection of his present or past social reality or as a “projection” of different identity fragments of the dreamer himself, of different roles played by him at different times or in different situations. The dreamer, in experimenting with traumatic reality, takes the outer world into the inner one, as the child takes it into his toy world. More deeply regressed and, of course, immobilized, the dreamer makes an autoplastic experiment of an alloplastic problem: his inner world and all the past contained in it becomes a laboratory for “wishful” rearrangements. Freud has shown us how the Irma Dream repeats a failure and turns to an illusory solution: the dreamer takes childish revenge on Otto (“he did it”) and on Dr. M. (“he is a castrate and a fool”), thus appeases his anxiety, and goes on sleeping for a better day. However, I would suggest that we take another look at the matter, this time using the horizontal approach to the diagrammatic outline, and correlating the dream’s changing interpersonal patterns with the dreamer’s changing mood and perspective.

The dreamer, at first is a part of a twosome, his wife and himself, or maybe a family group, vis-à-vis a number of guests. “We receive,” under festive circumstances in an opulent spatial setting. Immediately upon Irma’s appearance, however, this twosomeness, this acting in concert, abruptly vanishes. The wife, or the family, is not mentioned again. The dreamer is suddenly alone with his worries, vis-à-vis a complaining patient. The visual field shrinks rapidly from the large hall to the vicinity of a window and finally to Irma’s oral aperture; the festive present is replaced by a concern over past mistakes. The dreamer becomes active in a breathless way: he looks at the patient and thinks, he looks into her throat and thinks, and he finds what he sees ominous. He is startled, worried, and impatient, but behaves in a punitive fashion. Irma, in all this, remains a complaining and resistive vis-à-vis, and finally seems to become a mere part of herself: “the mouth opens.” From then on, even when discussed and percussed, she does neither act nor speak—a good patient (for, unlike the proverbial Indian, a good patient is a half-dead patient, just alive enough to make his organs and complexes accessible to isolation and probing inspection). Seeing that something is wrong, the dreamer calls Dr. M. urgently. He thus establishes a new twosome: he and the “authority” who graciously (if foolishly) confirms him. This twosome is immediately expanded to include a professional group of younger colleagues, Dr. Otto and Dr. Leopold. Altogether they now form a small community: “We know. . . .”

At this point something happens which is lost in the double meaning of the manifest words, in the German original as well as in translation. When the dreamer says that he can “feel” the infiltrated portion of skin on the (patient’s) left shoulder, he means to convey (as Freud states in his associations) that he can feel this on his own body: one of those fusions of a dreamer with a member of his dream population which is always of central importance, if not the very center and nodal point of a dream. The dreamer, while becoming again a doctor in the consenting community of doctors, thus at the same time turns into his and their patient. Dr. M. then says some foolish, nonsensical phrases, in the course of which it becomes clear that it had not been the dreamer who had harmed Irma, not at all. It is clear with the immediacy of a conviction that it was Dr. Otto who had infiltrated her. The dream ends, then, with Otto’s professional and moral isolation. The dreamer (first a lonely investigator, then a patient, now a joiner) seems quite righteous in his indignation. The syringe was not clean: who would do such a thing? “Immediate” conviction, in harmony with authority, has clarified the past and unburdened the present.

The study of dreams and of culture patterns and ritualizations reveals parallels between interpersonal dream configurations and religious rites of conversion or confirmation. Let me repeat and underscore the points which suggest such an analogy. As the isolated and “guilty” dreamer quickly calls Dr. M., he obviously appeals for help from higher authority. This call for help is answered not only by Dr. M., but also by Dr. Leopold and Dr. Otto, who now, together with the dreamer, form a group with a common conviction (“we know”). As this happens, and the examination proceeds, the dreamer suddenly feels as if he were the sufferer and the examined, i.e., he, the doctor and man, fuses with the image of the patient and woman. This, of course, amounts to a surrender analogous to a spiritual conversion and a concomitant sacrifice of the male role. By implication, it is now his mouth that is open for inspection (passivity, inspiration, communion). But there is a reward for this. Dr. M. (symbolically castrated like a priest) recites with great assurance something that makes no logical sense (Latin, Hebrew?) but seems to be magically effective in that it awakes in the dreamer the immediate conviction (faith) that the causality in the case is now understood (magic, divine will). This common conviction restores in the dream a “We-ness” (congregation) which had been lost (in its worldly, heterosexual form) at the very beginning when the dreamer’s wife and the festive guests had disappeared. At the same time it restores to the dreamer a belongingness (brotherhood) to a hierarchic group dominated by an authority in whom he believes implicitly. He immediately benefits from his newly won state of grace: he now has sanction for driving the devil into Dr. O. With the righteous indignation which is the believer’s reward and weapon, he can now make “an unclean one” (a disbeliever) out of his erstwhile accuser.

Does this interpretation of the Irma Dream as a dream of conversion or confirmation contradict that given by Freud, who believed he had revenged himself on the professional world which did not trust him? Freud, we remember, felt that the dream disparaged Dr. M., robbing him of authority, vigor, and wholeness, by making him say silly things, look pale, limp, and be beardless. All of this, then, would belie as utterly hypocritical the dreamer’s urgent call for help, his worry over the older man’s health,5 and his “immediate” knowledge in concert with his colleagues. This wish (to take revenge on his accusers and to vindicate his own strivings) stands, of course, as the dream’s stimulus. Without such an id wish and all of its infantile energy, a dream would not exist; without a corresponding appeasement of the superego, it would have no form; but, we must add, without appropriate ego measures, the dream would not work. On closer inspection, then, the radical differentiation between a manifest and a latent dream, while necessary as a means of localizing what is “most latent,” diffuses in a complicated continuum of more manifest and more latent items which are sometimes to be found by a radical disposal of the manifest configuration, sometimes by a careful scrutiny of it.

Such double approach seems to make it appear that the ego’s overall attitude in dream life is that of a withdrawal of its outposts in physical and social reality. The sleeping ego not only sacrifices sense perception and motility, i.e., its reactivity to physical reality but also renounces those claims on individuation, independent action, and responsibility which may keep the tired sleeper senselessly awake. The healthy ego, in dreams, quietly retraces its steps; it does not really sacrifice its assets, it merely pretends that, for the moment, they are not needed.6

I shall attempt to indicate this systematic retracing of ego steps in a dream by pointing to the psychosocial criteria which I have postulated elsewhere (2) (3) for the ego’s successive graduations from the main crises of the human life cycle. To proceed, I must list these criteria without being able to enlarge upon them here. I may remind the reader, however, that psychoanalytic theory is heavily weighted in favor of insights which make dysfunction plausible and explain why human beings, at certain critical stages, should fail, and fail in specific ways. It is expected that this theory will eventually make adequate or superior human functioning dynamically plausible as well (12, 13). In the meantime, I have found it necessary to postulate tentative criteria for the ego’s relative success in synthesizing, at critical stages, the timetable of the organism, and the representative demands and opportunities which societies universally, if in different ways, provide for these stages. At the completion of infancy, then, the criterium for the budding ego’s initial and fundamental success can be said to be a Sense of Basic Trust which, from then on, promises to outbalance the lastingly latent Sense of Basic Mistrust. Such trust permits, during early childhood, the critical development of a Sense of Autonomy which henceforth must hold its own against the Senses of Shame and Doubt, while at the end of the oedipal phase, an unbroken Sense of Initiative (invigorated by play) must begin to outdo a more specific Sense of Guilt. During the “school age,” a rudimentary Sense of Workmanship and Work-and-Play companionship develops which, from then on, must help to outbalance the Sense of Inferiority. Puberty and Adolescence help the young person sooner or later to consummate the selective gains of childhood in an accruing sense of Ego Identity which prevents the lasting dominance of a then threatening Sense of Role Diffusion. Young adulthood is specific for a structuring of the Sense of Intimacy or else expose the individual to a dominant Sense of Isolation. Real intimacy, in turn, leads to wishes and concerns to be taken care of by an adult Sense of Generativity (genes, generate, generation) without which there remains the threat of a lasting Sense of Stagnation. Finally, a Sense of Integrity gathers and defends whatever gains, accomplishments, and vistas were accessible in the individual’s life time; it alone resists the alternate outcome of a Sense of vague but over-all Disgust.

This, of course, is a mere list of terms which point to an area still in want of theoretical formulation. This area encompasses the kind and sequence of certain universal psychosocial crises which are defined, on the one hand, by the potentialities and limitations of developmental stages (physical, psychosexual, ego) and, on the other, by the universal punctuation of human life by successive and systematic “life tasks” within social and cultural institutions.

The Irma Dream places its dreamer squarely into the crisis of middle age. It deals most of all with matters of Generativity, although it extends into the neighboring problems of Intimacy and of Integrity. To the adult implications of this crisis we shall return later. Here we are concerned with the dream’s peculiar “regression.” The doctor’s growing sense of harboring a discovery apt to generate new thought (at a time when his wife harbored an addition to the younger generation) had been challenged the night before by the impact of a doubting word on his tired mind: a doubting word which was immediately echoed by self-doubts and self-reproaches from many close and distant corners of his life. At a birthday party, then, the dreamer suddenly finds himself isolated. At first, he vigorously and angrily asserts his most experienced use of one of the ego’s functions: he examines, localizes, diagnoses. Such investigation in isolation is, as we shall see later on, one of the cornerstones of this dreamer’s sense of Inner Identity. What he succeeds in focusing on, however, is a terrifying discovery which stares at him like the head of the Medusa. At this point, one feels, a dreamer with less flexible defenses might have awakened in terror over what he saw in the gaping cavity. Our dreamer’s ego, however, makes the compromise of abandoning its positions and yet maintaining them. Abandoning independent observation the dreamer gives in to a diffusion of roles: Is he doctor or patient, leader or follower, benefactor or culprit, seer or fumbler? He admits to the possibility of his inferiority in workmanship and urgently appeals to “teacher” and to “teacher’s pets.” He thus forfeits his right to vigorous male initiative and guiltily surrenders to the inverted solution of the oedipal conflict, for a fleeting moment even becoming the feminine object for the superior males’ inspection and percussion; and he denies his sense of stubborn autonomy, letting doubt lead him back to the earliest infantile security: childlike trust.

In his interpretation of the Irma Dream, Freud found this trust most suspect. He reveals it as a hypocritical attempt to hide the dream’s true meaning, namely, revenge on those who doubted the dreamer as a worker. Our review suggests that this trust may be overdetermined. The ego, by letting itself return to sources of security once available to the dreamer as a child, may help him to dream well and to sustain sleep, while promising revengeful comeback in a new day, when “divine mistrust” will lead to further discoveries.

VI. Acute, Repetitive, and Infantile Conflicts

I have now used the bulk of this paper for the demonstration of a few items of analysis which usually do not get a fair share in our routine interpretations: the systematic configurational analysis of the manifest dream and the manifest social patterns of the dream population. The designation of other, more familiar, matters will occupy less space.

Our “Outline of Dream Analysis” suggests next a survey of the various segments of the life cycle which appear in the dream material in latent form, either as acutely relevant or as reactivated by associative stimulation. This survey leads us, then, back along the path of time.

OUTLINE OF DREAM ANALYSIS

III. Analysis of Latent Dream Material

Acute sleep-disturbing stimulus

Delayed stimulus (day residue)

Acute life conflicts

Dominant transference conflict

Repetitive conflicts

Associated basic childhood conflicts

Common denominators

“wishes,” drives, needs

methods of defense, denial, and distortion

The most immediately present, the acute dream stimulus of the Irma Dream may well have been triggered by discomfort caused by swellings in nose and throat which, at the time, seem to have bothered the usually sound sleeper; the prominence in the dream of Irma’s oral cavity could be conceived as being codetermined by such a stimulus, which may also have provided one of the determinants for the latent but all-pervading presence in the dream of Dr. Fliess, the otolaryngologist. Acute stimulus and day residue (obviously the meeting with Dr. Otto) are associated in the idea as to whether the dreamer’s dispensation of solutions may have harmed him or others. The acute life conflicts of a professional and personal nature have been indicated in some measure; as we have seen, they meet with the acute stimulus and the day residue in the further idea that the dreamer may be reproachable as a sexual being as well.

Let us now turn to matters of childhood. Before quoting from The Interpretation of Dreams, a few childhood memories, the relevance of which for the Irma Dream are beyond reasonable doubt, I should like to establish a more speculative link between the dream’s interpersonal pattern and a particular aspect of Freud’s childhood, which has been revealed only recently.

I must admit that on first acquaintance with regressive “joining” in the Irma Dream, the suggestion of a religious interpretation persisted. Freud, of course, had grown up as a member of a Jewish community in a predominantly Catholic culture; could the over-all milieu of the Catholic environment have impressed itself on this child of a minority? Or was the described configuration representative of a basic human proclivity which had found collective expression in religious rituals, Jewish, Catholic, or otherwise?

It may be well to point out here that the therapeutic interpretation of such patterns is, incidentally, as violently resisted as is any id content (5). Unless we are deliberate and conscious believers in a dogma or declared adherents to other collective patterns, we dislike being shown to be at the mercy of unconscious religious, political, ethnic patterns as much as we abhor sudden insight into our dependence on unconscious impulses. One might even say that today when, thanks to Freud, the origins in instinctual life of our impulses have been documented and classified so much more inescapably and coherently than impulses rooted in group allegiances, a certain clannish and individualist pride has attached itself to the free admission of instinctual patterns, while the simple fact of the dependence on social structures of our physical and emotional existence and well-being seems to be experienced as a reflection on some kind of intellectual autonomy. Toward the end of the analysis of a young professional man who stood before an important change in status, a kind of graduation, a dream occurred in which he experienced himself lying on the analytic couch, while I was sawing a round hole in the top of his head. The patient, at first, was willing to accept almost any other interpretation, such as castration, homosexual attack (from behind), continued analysis (opening a skull flap), and insanity (lobotomy), all of which were indeed relevant, rather than to recognize this dream as an over-all graduation dream with a reference to the tonsure administered by bishops to young Catholic priests at the time of their admission to clerical standing. A probable contact with Catholicism in impressionable childhood was typically denied with a vehemence which is matched only by the bitter determination with which patients sometimes disclaim that they, say, could possibly have observed the anatomic difference between the sexes at any time in their childhood, or could possibly have been told even by a single person on a single occasion that castration would be the result of masturbation. Thus, infantile wishes to belong to and to believe in organizations providing for collective reassurance against individual anxiety, in our intellectuals, easily join other repressed childhood temptations—and force their way into dreams. But, of course, we must be prepared to look for them in order to see them; in which case the analysis of defenses gains a new dimension, and the study of social institutions a new approach.

The publication of Freud’s letters to Fliess makes it unnecessary to doubt any further the possible origin of such a religious pattern in Freud’s early life. Freud (9) informs Fliess that during a most critical period in his childhood, namely, when he, the “first-born son of a young mother,” had to accept the arrival of a little brother who died in infancy and then the advent of a sister, an old and superstitiously religious Czech woman used to take him around to various churches in his home town. He obviously was so impressed with such events that when he came home, he (in the words of his mother) preached to his family and showed them how God carries on (“wie Gott macht”): this apparently referred to the priest, whom he took to be God. That his mother, after the death of the little brother, gave birth to six girls in succession, and that the Irma Dream was dreamed during his wife’s sixth pregnancy, may well be a significant analogy. At any rate, what the old woman and her churches meant to him is clearly revealed in his letters to Fliess, to whom he confessed that, if he could only find a solution of his “hysteria,” he would be eternally grateful to the memory of the old woman who early in his life “gave me the means to live and to go on living.” This old woman, then, restored to the little Freud, in a difficult period, a measure of a sense of trust, a fact which makes it reasonably probable that some of the impressive rituals which she took him to see, and that some of their implications as explained by her, appear in the Irma Dream, at a time when his wife was again expecting and when he himself stood before a major emancipation as well as the “germination” of a major idea. If this is so, then we may conclude that rituals impress children in intangible ways and must be sought among the covert childhood material, along with the data which have become more familiar to us because we have learned to look for them.

For a basic childhood conflict more certainly reflected in the Irma Dream, we turn to one of the first childhood memories reported by Freud in The Interpretation of Dreams (6, p. 274):

Then, when I was seven or eight years of age another domestic incident occurred which I remember very well. One evening before going to bed I had disregarded the dictates of discretion, and had satisfied my needs in my parents’ bedroom, and in their presence. Reprimanding me for this delinquency, my father remarked: “That boy will never amount to anything.” This must have been a terrible affront to my ambition, but allusions to this scene recur again and again in my dreams, and are constantly coupled with enumerations of my accomplishments and successes, as though I wanted to say: “You see, I have amounted to something after all.”

This memory calls first of all for an ethnographic clarification, which I hope will not make me appear to be an excessive culturalist. That a seven-year-old by “satisfies his needs in his parents’ bedroom” has sinister implications, unless one hastens to remember the technological item of the chamber pot. The boy’s delinquence, then, probably consisted of the use of one of his parents’ chamber pots instead of his own. Maybe he wanted to show that he was a “big squirt,” and instead was called a small one. This crime, as well as the punishment by derisive shaming, and, most of all, the imperishable memory of the event, all point to a milieu in which such character weakness as the act of untimely and immodest urination becomes most forcefully associated with the question of the boy’s chances not only of ever becoming a man, but also of amounting to something, of becoming a “somebody,” of keeping what he promises. In thus hitting the little exhibitionist in his weakest spot, the father not only followed the dictates of a certain culture area which tended to make youngsters defiantly ambitious by challenging them at significant times with the statement that they do not amount to much and with the prediction that they never will. We know the importance of urinary experience for the development of rivalry and ambition, and therefore recognize the memory as doubly significant. It thus becomes clearer than ever why Dr. Otto had to take over the severe designation of a dirty little squirt. After all, he was the one who had implied that Freud had promised too much when he said he would cure Irma and unveil the riddle of hysteria. A youngster who shows that he will amount to something is “promising”; the Germans say he is vielversprechend, i.e., he promises much. If his father told little Freud, under the embarrassing circumstance of the mother’s presence in the parental bedroom, that he would never amount to anything—i.e., that the intelligent boy did not hold what he promised—is it not suggestive to assume that the tired doctor of the night before the dream had gone to bed with a bitter joke in his preconscious mind: yes, maybe I did promise too much when I said I could cure hysteria; maybe my father was right after all, I do not hold what I promised; look at all the other situations when I put dangerous or dirty “solutions” in the wrong places. The infantile material thus adds to the inventory of the doctor’s and the man’s carelessness in the use of “solutions” its infantile model, namely, exhibitionistic urination in the parents’ bedroom: an incestuous model of all these associated dispensations of fluid.

But it seems to me that this memory could be the starting point for another consideration. It suggests not only an individual trauma, but also a pattern of child training according to which fathers, at significant moments, play on the sexual inferiority feelings and the smoldering oedipal hate of their little boys by challenging them in a severe if not viciously earnest manner, humiliating them before others, and especially before the mother. It would, of course, be difficult to ascertain that such an event is of a typical character in a given area or typical for a given father; but I do believe that such a “method” of arousing and testing a son’s ambition (in some cases regularly, in some on special occasions) was well developed in the German cultural orbit which included German Austria and its German-speaking Jews. This matter, however, could be properly accounted for only in a context in which the relation of such child-training patterns could be demonstrated in their relation to the whole conscious and unconscious system of child training and in their full reciprocity with historical and economic forces. And, incidentally, only in such a context and in connection with a discussion of Freud’s place in the evolution of civilized conscience could Freud’s inclination to discard teachers as well as students (as he discards Dr. O. in his dream after having felt discarded himself) be evaluated. Here we are primarily concerned with certain consequences which such a cultural milieu may have had for the sons’ basic attitudes: the inner humiliation, forever associated with the internalized father image, offered a choice between complete submission, a readiness to do one’s duty unquestioningly in the face of changing leaders and principles (without ever overcoming a deep self-contempt and a lasting doubt in the leader); and, on the other hand, sustained rebellion and an attempt to replace the personal father with an ideological principle, a cause, or, as Freud puts it, an “inner tyrant.”7

Another childhood memory, however, may illuminate the personal side of this problem which we know already from Freud’s interpretation of the Irma Dream as one of a vengeful comeback.

I have already said that my warm friendships as well as my enmities with persons of my own age go back to my childish relations to my nephew, who was a year older than I. In these he had the upper hand, and I early learned how to defend myself; we lived together, were inseparable, and loved one another, but at times, as the statements of older persons testify, we used to squabble and accuse one another. In a certain sense, all my friends are incarnations of this first figure; they are revenants. My nephew himself returned when a young man, and then we were like Caesar and Brutus. An intimate friend and a hated enemy have always been indispensable to my emotional life; I have always been able to create them anew, and not infrequently my childish idea has been so closely approached that friend and enemy have coincided in the same person; but not simultaneously, of course, nor in constant alternation, as was the case in my early childhood [6, p. 451].

This memory serves especially well as an illustration of what, in our “Outline,” we call repetitive conflicts, i.e., typical conflicts which punctuate the dreamer’s life all the way from the infantile to the acute and to the outstanding transference conflicts. The fact that we were once small we never overcome. In going to sleep we learn deliberately to return to the most trustful beginning, not without being startled, on the way, by those memories which seem to substantiate most tellingly whatever negative basic attitude (a sense of mistrust, shame, doubt, guilt, etc.) was aroused by the tiring and discouraging events of the previous day. Yet this does not prevent some, in the restored day, from pursuing, on the basis of their very infantile challenges, their own unique kind of accomplishment.

VII. Transference in the Irma Dream

Among the life situations in our inventory, there remains one which, at first, would seem singularly irrelevant for the Irma Dream: I refer to the “current transference conflict.” If anything, this dream, dreamed by a doctor about a patient, would promise to contain references to countertransference, i.e., the therapist’s unconscious difficulties arising out of the fact that the patient may occupy a strategic position on the chessboard of his fate. Freud tells us something of how Irma came to usurp such a role, and the intimate du in the dream betrays the fact that the patient was close to (or associated with somebody close to) the doctor’s family either by blood relationship or intimate friendship. Whatever her personal identity, Irma obviously had become some kind of key figure in the dreamer’s professional life. The doctor was in the process of learning the fact that this made her, by definition, a poor therapeutic risk for him.

But one may well think of another kind of “countertransference” in the Irma Dream. The dreamer’s activities (and those of his colleagues) are all professional and directed toward a woman. But they are a researcher’s approaches: the dreamer takes aside, throws light on the matter, looks, localizes, thinks, finds. May it not be that it was the Mystery of the Dream which itself was the anxious prize of his persistence?

Freud reports later on in The Interpretation of Dreams (6) that one night, having exhausted himself in the effort of finding an explanation for dreams of “nakedness” and of “being glued to the spot,” he dreamed that he was jumping light-footedly up a stairway in a disarray of clothes. No doubt, then, Freud’s dreams during those years of intensive dream study carry the special weight of having to reveal something while being dreamed. That this involvement does not necessarily interfere with the genuineness of his dreams can be seen from the very fact, demonstrated here, that Freud’s dreams and associations (even if fragmentary and, at times, altered) do not cease to be fresh and almost infinitely enlightening in regard to points which he, at the time, did not deliberately focus upon.

In our unconscious and mythological imagery, tasks and ideals are women, often big and forbidding ones, to judge by the statues we erect for Wisdom, Industry, Truth, Justice, and other great ladies. A hint that the Dream as a mystery had become to our dreamer one of those forbidding maternal figures which smile only on the most favored among young heroes (and yield, of course, only to sublimated, to “clean” approach) can, maybe, be spotted in a footnote where Freud writes, “If I were to continue the comparison of the three women I should go far afield. Every dream has at least one point at which it is unfathomable; a central point, as it were, connecting it with the unknown.” The English translation’s “central point,” however, is in the original German text a Nabel—“a navel.” This statement, in such intimate proximity to allusions concerning the resistance of Victorian ladies (including the dreamer’s wife, now pregnant) to being undressed and examined, suggests an element of transference to the Dream Problem as such: the Dream, then, is just another haughty woman, wrapped in too many mystifying covers and “putting on airs” like a Victorian lady. Freud’s letter to Fliess spoke of an “unveiling” of the mystery of the dream, which was accomplished when he subjected the Irma Dream to an “exhaustive analysis.” In the last analysis, then, the dream itself may be a mother image; she is the one, as the Bible would say, to be “known.”

Special transferences to one’s dream life are, incidentally, not exclusively reserved for the author of The Interpretation of Dreams. In this context I can give only a few hints on this subject. Once a dreamer knows that dreams “mean” something (and that, incidentally, they mean a lot to his analyst), an ulterior wish to dream forces its way into the wish to sleep by way of dreaming. That this is a strong motivation in dream life can be seen from the fact that different schools of dynamic psychology and, in fact, different analysts manage to provoke systematically different manifest dreams, obviously dreamed to please and to impress the respective analysts: and that members of primitive societies apparently manage to produce “culture pattern dreams,” which genuinely impress the dreamer and convince the official dream interpreters. Our discussion of the style of the Irma Dream has, I think, indicated how we would deal with this phenomenon of a variety of dream styles: we would relate them to the respective cultural, interpersonal, and personality patterns, and correlate all of these with the latent dream. But as to the dreamer’s transference to his dream life, one may go further: in spurts of especially generous dream production, a patient often appeals to an inner transference figure, a permissive and generous mother, who understands the patient better than the analyst does and fulfills wishes instead of interpreting them. Dreams, then, can become a patient’s secret love life and may elude the grasp of the analyst by becoming too rich, too deep, too unfathomable. Where this is not understood, the analyst is left with the choice of ignoring his rival, the patient’s dream life, or of endorsing its wish fulfillment by giving exclusive attention to it, or of trying to overtake it with clever interpretations. The technical discussion of this dilemma we must postpone. In the meantime, it is clear that the first dream analyst stands in a unique relationship to the Dream as a “Promised Land.”

This, however, is not the end of the transference possibilities in the Irma Dream. In the letters to Fliess, the impression is amply substantiated that Freud, pregnant with inner experiences which would soon force upon him the unspeakable isolation of the first self-analysis in history—and this at a time when his father’s death seemed not far off—had undertaken to find in Fliess, at all cost, a superior friend, an object for idealization, and later an (if ever so unaware and reluctant) sounding board for his self-analysis. What this deliberate “transference” consisted of will undoubtedly, in due time, be fully recorded and analyzed. Because of the interrelation of creative and neurotic patterns and of personal and historical trends in this relationship, it can be said that few jobs in the history of human thought call for more information, competence, and wisdom. But it furthers an understanding of the Irma Dream to note that only once in all the published correspondence does Freud address Fliess with the lone word Liebster (“Dearest”): in the first letter following the Irma Dream (August 8, 1895). This singular appeal to an intellectual friend (and a German one at that) correlates well with the prominence which the formula for trimethylamin (a formula related to Fliess’ researches in bisexuality) has in the dream, both by dint of its heavy type and by its prominent place in the play of configurations, for it signifies the dreamer’s return to the act of independent observation—“I see” again.

The Irma Dream, then, in addition to being a dream of a medical examination and treatment and of a sexual investigation, anticipates Freud’s self-inspection and with it inspection by a vastly aggrandized Fliess. We must try to visualize the historical fact that here a man divines an entirely new instrument with unknown qualities for an entirely new focus of investigation, a focus of which only one thing was clear: all men before him, great and small, had tried with every means of cunning and cruelty to avoid it. To overcome mankind’s resistance, the dreamer had to learn to become his own patient and subject of investigation; to deliver free associations to himself; to unveil horrible insights to himself; to identify himself with himself in the double roles of observer and observed. That this, in view of the strong maleness of scientific approach cultivated by the bearded savants of his day and age (and represented in the dreamer’s vigorous attempts at isolating and localizing Irma’s embarrassing affliction), constituted an unfathomable division within the observer’s self, a division of vague “feminine yielding” and persistent masculine precision: this, I feel, is one of the central meanings of the Irma Dream. Nietzsche’s statement that a friend is a lifesaver who keeps us afloat when the struggling parts of our divided self threaten to pull one another to the bottom was never more applicable; and where, in such a situation, no friend of sufficient superiority is available, he must be invented. Fliess, to a degree, was such an invention. He was the recipient of a creative as well as a therapeutic transference.

The “mouth which opens wide,” then, is but the oral cavity of a patient and not only a symbol of a woman’s procreative inside, which arouses horror and envy because it can produce new “formations” but also the investigator’s oral cavity, opened to medical inspection; and it may well represent, at the same time, the dreamer’s unconscious, soon to offer insights never faced before to an idealized friend with the hope that (here we must read the whole dream backwards) wir empfangen: we receive, we conceive, we celebrate a birthday. That a man may incorporate another man’s spirit, that a man may conceive from another man, and that a man may be reborn from another, these ideas are the content of many fantasies and rituals which mark significant moments of male initiation, conversion, and inspiration (11); and every act of creation, at one stage, implies the unconscious fantasy of inspiration by a fertilizing agent of a more or less deified, more or less personified mind or spirit. This “feminine” aspect of creation causes tumultuous confusion not only because of man’s intrinsic abhorrence of femininity but also because of the conflict (in really gifted individuals) of this feminine fantasy with an equally strong “masculine” endowment which is to give a new and original form to that which has been conceived and carried to fruition. All in all, the creative individual’s typical cycle of moods and attitudes which overlaps with neurotic mood swings (without ever coinciding with them completely) probably permits him, at the height of consummation, to identify with father, mother, and newborn child all in one; to represent, in equal measure, his father’s potency, his mother’s fertility, and his own reborn ideal identity. It is obvious, then, why mankind participates, with pity and terror, with ambivalent admiration and ill-concealed abhorrence, in the hybris of creative men, and why such hybris, in these men themselves, can call forth all the sinister forces of infantile conflict.

VIII. Conclusion

If the dreamer of the Irma Dream were the patient of a continuous seminar, several evenings of research work would now be cut out for us. We would analyze the continuation of the patient’s dream life to see how his inventory of dream variations and how his developing transference would gradually permit a dynamic reconstruction of the kind which, in its most ambitious version, forms point

VI of our “Outline”:

IV. Reconstruction

LIFE CYCLE

present phase

corresponding infantile phase

defect, accident, or affliction

psychosexual fixation

psychosexual arrest

SOCIAL PROCESS: COLLECTIVE IDENTITY

ideal prototypes

evil prototypes

opportunities and barriers

EGO IDENTITY AND LIFEPLAN

mechanisms of defense

mechanisms of integration

In the case of the Irma Dream, both the material and the motivation which would permit us to aspire to relative completeness of analysis are missing. I shall, therefore, in conclusion, select a few items which will at least indicate our intentions of viewing a dream as an event reflecting a critical stage of the dreamer’s life cycle.

As pointed out, the Irma Dream and its associations clearly reflect a crisis in the life of a creative man of middle age. As the psychosocial criterion of a successful ego synthesis at that age I have named a Sense of Generativity. This unpretty term, incidentally, is intended to convey a more basic and more biological meaning than such terms as creativity and productivity do. For the inventory of significant object relations must, at this stage, give account of the presence or absence of a drive to create and secure personal children—a matter much too frequently considered merely an extension, if not an impediment, of genitality. Yet any term as specific as “parental sense” would not sufficiently indicate the plasticity of this drive, which may genuinely include works, plans, and ideas generated either in direct connection with the tasks of securing the life of the next generation or in wider anticipation of generations to come. The Irma Dream, then, reflects the intrinsic conflict between the partners and objects of the dreamer’s intimate and generative drives, namely, wife, children, friends, patients, ideas; they all vie for the maturing man’s energy and commitment, and yet none of them could be spared without some sense of stagnation. It may be significant that Freud’s correspondence with Fliess, which initiates an intellectual intimacy of surprising passion, had begun a few months after Freud’s marriage: there are rich references to the advent and the development of the younger generation in both families, and, with it, much complaint over the conflicting demands of family, work, and friendship. Finally, there is, in the material of the Irma Dream, an indication of the problem which follows that of the generative conflict, namely, that of a gradually forming Sense of Integrity which represents man’s obligation to the most mature meaning available to him, even if this should presage discomfort to himself, deprivation to his mate and offspring, and the loss of friends, all of which must be envisaged and endured in order not to be exposed to a final Sense of Disgust and of Despair. The fact that we are dealing here with a man of genius during the loneliest crisis of his work productivity should not blind us to the fact that analogous crises face all men, if only in their attachments and allegiances to trends and ideas represented to them by strong leaders and by coercive institutions. Yet again, such a crisis is raised to special significance in the lives of those who are especially well endowed or especially favored with opportunities, for the “most mature meaning available to them” allows for deeper conflict, greater accomplishment, and more desperate failure.