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When, three days ago, she had first complained about her fear of asylums, I had interrupted her after her first story, that the patients were tied on to chairs. I now saw that I had gained nothing by this interruption and that I cannot evade listening to her stories in every detail to the very end. After these arrears ... |
She had probably wanted to reproach me with interrupting her story to-day just as I had previously interrupted her accounts of the horrors in the asylum; but she had not ventured to do so. Instead of this, she had produced these further stories, apparently without any transition and without revealing the connecting tho... |
That was real (not a dream): how (on an earlier occasion) she had been going to pick up a ball of wool, and it was a mouse and ran away; how she had been on a walk, and a big toad suddenly jumped out at her, and so on. I saw that my general prohibition had been ineffective and that I should have to take her frightening... |
And then after her husbands death there had been nothing but insults and agitations. His relatives, who had always been against the marriage and had then been angry because they had been so happy together, had spread a rumour that she had poisoned him, so that she had wanted to demand an enquiry. Her relatives had invo... |
my opinion about all sorts of things that seemed to her important, and became quite unreasonably agitated, for instance, when I had to look for the towels needed in massage, and so on. Her clacking and facial tic were frequent. Hypnosis. - Yesterday evening it had suddenly occurred to her why the small animals she saw ... |
She remembered, too, that I had instructed her to discover the origin of her gastric pains. She did not know it, however, and asked me to help her. I asked whether, perhaps, on some occasion after a great excitement, she had forced herself to eat. She confirmed this. After her husbands death she had for a long time los... |
She told me that she had had an attack of abdominal inflammation in 1871; when she had hardly recovered from this, she had nursed her sick brother, and it was then that the pains first came on. They had even led to a temporary paralysis of her right leg. 63 During the hypnosis I asked her whether it would now be possib... |
Lastly, she told me of how her isolated country house had been broken into at night, which had very much alarmed her. It is easy to see, however, that the essential origin of this fear of people was the persecution to which she had been subjected after her husbands death. Evening. - Though she appeared to be in high sp... |
Both in her waking state and under hypnosis, I duly told her (what amounted to the old legal tag de minimis non curat lex) that there is a whole multitude of indifferent, small things lying between what is good and what is evil - things about which no one need reproach himself. She did not take in my lesson, I fancy, a... |
frightened to death, she said once more. In reply to a question she told me that the Pension in which her children were staying was on the fourth floor of a building and reached by a lift. She had insisted yesterday that the children should make use of the lift for coming down as well as going up, and was now reproachi... |
During massage, which I resumed to-day after a few days interval, she told me a loosely connected string of anecdotes, which may have been true - about a toad which was found in a cellar, an eccentric mother who looked after her idiot child in a strange fashion, a woman who was shut up in an asylum because she had mela... |
A paramnesia then enabled her to link the anxiety she was conscious of with the idea of the lift. Her consciousness did not present her with the real cause of her anxiety; that only emerged - but now it did so without any hesitation - when I questioned her about it in hypnosis. The process was the same as that studied ... |
I shall dwell a little on this example I have given of a false connection, since in more than one respect it deserves to be described as typical. It is typical, in the first place, of the present patients behaviour; for in the further course of the treatment she afforded me many opportunities of resolving such false co... |
Next day, she took up the idea of having cool hip-baths; she tried to convince me with all the arguments which I had previously used to her, and I agreed without much enthusiasm. But on the day after she had had the hip-bath I did in fact find her in a deep depression. Why are you like this to-day? I asked. I knew befo... |
The patient who develops a symptom on a particular day - whether owing to unrest in San Domingo or else where - is always inclined to attribute it to his doctors latest advice. Of the two conditions necessary for bringing about a false connection of this kind, one, mistrust, seems always to be present; while the other,... |
As a rule, portions of the subconscious complex of ideas intrude into the subjects ordinary consciousness, and it is precisely they that provoke this kind of disturbance. What is usually perceived consciously, as in the instances I have quoted above, is the general feeling attached to the complex - a mood of anxiety, i... |
The senseless and contradictory character of the dreams could be traced back to the uncontrolled ascendancy of this latter factor. It is a quite regular thing for the mood attaching to an experience and the subject-matter of that experience to come into different relations to the primary consciousness. This was shown i... |
For nearly three years after this she once again lived through all the traumas of her life - long-forgotten, as they seemed to her, and some, indeed, never remembered at all - accompanied by the acutest suffering and by the return of all the symptoms she had ever had. The old debts which were thus paid covered a period... |
When I was prevented from doing so, so that she was obliged to say these things to a person in whose presence she felt embarrassed, it sometimes happened that she would tell him her story quite calmly and would subsequently, in hypnosis, produce for me all the tears, all the expressions of despair, with which she would... |
After a short discussion, she clearly recognized this; but her next hypnosis brought to light a recollection of an occasion, twelve years earlier, which had aroused severe selfreproaches in her - though, incidentally, she no longer subscribed to them in the least. I then got her to tell me the history of her pains in t... |
She said she did not know where these attacks came from. On subsequent reflection, I cannot help thinking that these neck cramps may have been determined organically and have been analogous to migraine. In medical practice we come across a number of conditions of this kind which have not been described. These show such... |
She had pains of this kind while she was in an agitated state nursing her sick brother; and, owing to her exhaustion, she felt them more acutely than usual. These pains, which were originally associated only accidentally with those experiences, were later repeated in her memory as the somatic symbol of the whole comple... |
Such pains provide the material of countless neuralgias and so-called sciaticas, etc. I will only refer briefly here to the relation of these pains to the gouty diathesis. My patients mother and two of her sisters suffered very severely from gout (or chronic rheumatism). Some part of the pains which she complained of a... |
In hypnosis she informed me that she still occasionally has frightening ideas, such as that something might happen to her children, that they might fall ill or lose their lives, or that her brother, who is now on his honeymoon, might have an accident, or his wife might die (because the marriages of all her brothers and... |
At the same time she gave every indication of terror, together with stammering and fic. I first got her to tell me in her waking state what had happened. Crooking her fingers and stretching out her hands before her, she gave a vivid picture of her terror as she said :An enormous mouse suddenly whisked across my hand in... |
I told her the story of Bishop Hatto. She knew it too, and listened to it with extreme horror. - How did you come to think of the circus? I went on to ask. She said that she had clearly heard the horses stamping in their stables near-by and getting tied up in their halters, which might injure them. When this happened J... |
She had written a great many letters; it had taken her three hours and had given her a bad head. - I could assume, accordingly, that her attack of delirtum was brought on by fatigue and that its content was determined by associations from such things as the shadeless place in the garden, etc. I repeated all the lessons... |
She told me she had dreamt last night that she was walking on a lot of leeches. The night before she had had horrible dreams. She had had to lay out a number of dead people and put them in coffins, but would not put the lids on. (Obviously, a recollection of her husband.) She told me further that in the course of her l... |
I tried to free her from her fear of animals by going through them one by one and asking her if she was afraid of them. In the case of some of them she answered no; in the case of others, I mustnt be afraid of them. I asked her why she had stammered and jerked about so much yesterday. She replied that she always did th... |
His wife had been sitting beside him, and she (the patient) could not help thinking that this might be the poor mans last evening. After this last piece of information her depression seemed to be cleared up.? Evening. - She was very cheerful and contented. The hypnosis produced nothing whatever. I devoted myself to d... |
Her stammering and clacking were not completely relieved after they had been traced back to the two initial traumas, though from then on the two symptoms were strikingly improved. The patient herself explained the incompleteness of the success as follows. She had got into the habit of stammering and clacking whenever s... |
Her astonishment the evening before at its being so long since she had had a neckcramp was thus a premonition of an approaching condition which was already in preparation at the time and was perceived in the unconscious. This curious kind of premonition occurred regularly in the case already mentioned of Frau Cacilie M... |
idea, which emerged as a sudden notion, was worked over by the unsuspecting official consciousness (to use Charcots term) into a feeling of satisfaction, which swiftly and invariably turned out to be unjustified. Frau Cacilie, who was a highly intelligent woman, to whom I am indebted for much help in gaining an underst... |
Since I did not take the initiative in looking for the symptoms and their basis, but waited for something to come up in the patient or for her to tell me some thought that was causing her anxiety, her hypnoses soon ceased to produce material. I therefore made use of them principally for the purpose of giving her maxims... |
Her trouble recurred, however, while they were at home, and her mother called in a gynaecologist from the neighbouring University town. He prescribed a combined local and general treatment for the girl, which, however, brought on a severe nervous illness (she was seventeen at the time). It is probable that this was alr... |
A distinguished physician in her neighbourhood, to whom she went for advice, and Dr. Breuer, who was in correspondence with her, succeeded in convincing her of the innocence of the two targets of her accusations; but even after this was cleared up, the aversion to me which she formed at the time was left over as a hyst... |
She felt sad at one particular time of day (five oclock). This was the regular hour at which, during the winter, she had been able to visit her daughter in the nursing home. She stammered and clacked a great deal and kept rubbing her hands together as though she was in a rage, and when I asked her if she saw a great ma... |
at the hotel in which she was staying had concealed himself in her bedroom. In the darkness, she said, she had taken the object for an overcoat and put out her hand to take hold of it; and the man had suddenly shot up into the air. I took this memory-picture away, and in fact from that time on she ceased to stammer not... |
It was evidently the erotic factor in this little adventure which had caused her to give an untrue account of it. This taught me that an incomplete story under hypnosis produces no therapeutic effect. I accustomed myself to regarding as incomplete any story that brought about no improvement, and I gradually came to be ... |
This duly happened and presently the only remaining sign of her speech-inhibition was her uncertainty over this name. Eventually, following a remark by Dr. Breuer, I relieved her of this compulsive paramnesia. I had a longer struggle with what she described as the storms in her head than with the residues of these expe... |
to discover some means of correcting its bad effects, no way out presented itself. When, at such a time, she felt her thoughts becoming confused, she made it a practice to call out her daughters name, so that it might help her back to clear-headedness. For, during the period when her daughters illness was imposing fres... |
When I asked her why she ate so little she answered that she was not in the habit of eating more and that it would be bad for her if she did; she had the same constitution as her late father, who had also been a small eater. When I enquired what she drank she told me she could only tolerate thick fluids, such as milk, ... |
But I found Frau Emmy herself lying in a profoundly depressed state and in a very ungracious mood. She complained of having very violent gastric pains. I told you what would happen, she said. We have sacrificed all the successful results that we have been struggling for so long. Ive ruined my digestion, as always happe... |
I found her twenty-four hours later, docile and submissive. When I asked her what she thought about the origin of her gastric pains, she answered, for she was incapable of prevarication: I think they come from my anxiety, but only because you say so. I then put her under hypnosis and asked her once again: Why cant you ... |
I knew it was contagious and was terribly afraid of making a mistake and picking up his knife and fork (she shuddered) . . . and in spite of that I ate my meals with him so that no one should know that he was ill. And how, soon after that, I nursed my other brother when he had consumption so badly. We sat by the side o... |
The therapeutic effect of these discoveries under hypnosis was immediate and lasting. She did not starve herself for a week but the very next day she ate and drank without making any difficulty. Two months later she wrote in a letter: I am eating excellently and have put on a great deal of weight. I have already drunk ... |
I communicated to Frau von N. without any reservation the opinion for which she had asked and she received it calmly and with understanding. She had grown stout, and looked in flourishing health. She had felt relatively very well during the nine months that had passed since the end of her last treatment. She had only b... |
She seemed reluctant, however, to be communicative under hypnosis, and even then I began to suspect that she was on the point of withdrawing once more from my influence and that the secret purpose of her railway inhibition was to prevent her making a fresh journey to Vienna. It was during these days, too, that she made... |
At lunch to-day you will pour me out a glass of red wine, just as you did yesterday. As I raise the glass to my lips you will say: "Oh, please pour me out a glass, too", and when I reach for the bottle, you will say: "No thank you, I dont think I will after all". You will then put your hand in your bag, draw out the pi... |
At first I did not understand why my permission was necessary, till I remembered that in 1890 I had, at her own request, protected her against being hypnotized by anyone else, so that there should be no danger of her being distressed by coming under the control of a doctor who was antipathetic to her, as had happened a... |
The mildness of her deliria and hallucinations (while her other mental activities remained intact), the change in her personality and store of memories when she was in a State of artificial somnambulism, the anaesthesia in her painful leg, certain data revealed in her anamnesis, her ovarian neuralgia, etc., admit of no... |
It is impossible any longer at this point to avoid introducing the idea of quantities (even though not measurable ones). We must regard the process as though a sum of excitation impinging on the nervous system is transformed into chronic symptoms in so far as it has not been employed for external action in proportion t... |
An incomplete transformation is however more usual, so that some part at least of the affect that accompanies the trauma persists in consciousness as a component of the subjects state of feeling. The psychical symptoms in our present case of hysteria with very little conversion can be divided into alterations of mood (... |
Nevertheless, in this group the primary - or, one might say, the instinctive - fear (regarded as a psychical stigma) plays the preponderant part. The other, more specific phobias were also accounted for by particular events. Her dread of unexpected and sudden shocks was the consequence of the terrible impression made o... |
Her fear of asylums and their inmates went back to a whole series of unhappy events in her family and to stories poured into her listening ears by a stupid servant-girl. Apart from this, this phobia was supported on the one hand by the primary and instinctive horror of insanity felt by healthy people, and on the other ... |
Our patients abulias (inhibitions of will, inability to act) admit even less than the phobias of being regarded as psychical stigmata due to a general limitation of capacity. On the contrary, the hypnotic analysis of the case made it clear that her abulias were determined by a twofold psychical mechanism which was at b... |
from the earliest times been connected with memories of disgust whose sum of affect had never been to any degree diminished; and it is impossible to eat with disgust and pleasure at the same time. Her old-established disgust at meal times had persisted undiminished because she was obliged constantly to suppress it, ins... |
I have not hitherto succeeded in confirming, by means of hypnotic analysis, this theory about motor paralyses, but I can adduce Frau von N.s anorexia as proving that this mechanism is the operative one in certain abulias, and abulias are no thing other than a highly specialized - or, to use a French expression, systema... |
My therapeutic procedure was based on the course of this activity of her memory and endeavoured day by day to resolve and get rid of whatever that particular day had brought to the surface, till the accessible stock of her pathological memories seemed to be exhausted. These two psychical characteristics, which I regard... |
include pains among somatic symptoms. So far as I can see, one set of Frau von N.s pains were certainly determined organically by the slight mortifications (of a rheumatic kind) in the muscles, tendons or fascia which cause so much more pain to neurotics than to normal people. Another set of pains were in all probabili... |
She played restlessly with her fingers (1888) or rubbed her hands against one another (1889) so as to prevent herself from screaming. This reason reminds one forcibly of one of the principles laid down by Darwin to explain the expression of the emotions - the principle of the overflow of excitation, which accounts, for... |
Our hysterical patient, exhausted by worry and long hours of watching by the bedside of her sick child which had at last fallen asleep, said to herself: Now you must be perfectly still so as not to awaken the child. This intention probably gave rise to an antithetic idea in the form of a fear that she might make a nois... |
It may further be assumed that it was her horror at the noise produced against her will that made the moment a traumatic one, and fixed the noise itself as a somatic mnemic symptom of the whole scene. I believe, indeed, that the character of the fic itself, consisting as it did of a succession of sounds which were conv... |
Having originated at a moment of violent fright, they were thenceforward joined to any fright (in accordance with the mechanism of monosymptomatic hysteria which will be described in Case 5), even when the fright could not lead to an antithetic idea being put into effect. The two symptoms were eventually linked up with... |
T may here be giving an impression of laying too much emphasis on the details of the symptoms and of becoming lost in an unnecessary maze of sign-reading. But I have come to learn that the determination of hysterical symptoms does in fact extend to their subtlest manifestations and that it is difficult to attribute too... |
Symmetrical cortical areas in the immediate vicinity of the median fissure might be held responsible for the movement of the toes. But the explanation turned out to be a different one. When I had come to know the girl better I put a straight question to her as to what kind of thoughts came to her during these attacks. ... |
She got the idea of correcting the defect by practising for a quarter of an hour at a time pulling down her upper lip over the projecting teeth. The failure of these childish efforts once led to a fit of despair; and thenceforward the drawing and pricking sensations from the cheek downwards were established as the cont... |
the habit of wriggling her toes about in her shoes, as people do when they want to discover whether a shoe is much too large, how much smaller a size they could take, etc. During the excursion on the Schafberg (which she was far from finding an exertion) there was once again, of course, an opportunity for her attention... |
- (Added 1924:) Some years later her neurosis turned into a dementia praecox. In accordance with the rules governing hysterical attacks, the exclamation of Emmy during her attacks of confusion reproduced, it will be remembered, her frequent states of helplessness during her daughters treatment. This exclamation was lin... |
They can be shown to have an original or long-standing connection with traumas, and stand as symbols for them in the activities of the memory. 87 Others of the patients somatic symptoms were not of a hysterical nature at all. This is true, for example, of the neck-cramps, which I regard as a modified form of migraine a... |
Like her neckcramps, distressing present-day events (cf. her last delirtum in the garden) or anything which powerfully recalled any of her traumas brought her into a state of delirium. In such states - and the few observations I made led me to no other conclusion - there was a limitation of consciousness and a compulsi... |
At the beginning of the treatment the delirium lasted all day long; so that it was difficult to decide with certainty whether any given symptoms - like her gestures - formed part of her psychical state merely as symptoms of an attack, or whether - like the clacking and stammering - they had become genuine chronic sympt... |
somnambulism, she had access during somnambulism to the memories of all three states. In point of fact, therefore, she was at her most normal in the state of somnambulism. Indeed, if I leave on one side the fact that in somnambulism she was far less reserved with me than she was at her best moments in ordinary life - t... |
A few minutes later I asked her under hypnosis if she now knew the name of the plant in the hall. Without any hesitation she replied; The German name is "7iirkenlilie" (Turks-cap lily); I really have forgotten the Latin one. Another time, when she was feeling in good health, she told me of a visit she had paid to the R... |
Thus we see that even in somnambulism she did not have access to the whole extent of her knowledge. Even in that state there was an actual and a potential consciousness. It used often to happen that when I asked her during her somnambulism, where this or that phenomenon was derived from, she would wrinkle her forehead,... |
ever lie to me under hypnosis. Occasionally, however, she would give me incomplete answers and keep back part of her story until I insisted a second time on her completing it. It was usually - as in the instance quoted on conOwSyf7con0wSyf7 - the distaste inspired by the topic which closed her mouth in somnambulism no ... |
If, as with her animal phobia, I failed to give her convincing reasons, or did not go into the psychical history of the origin of a symptom but tried to operate by the agency of authoritative suggestion, I invariably observed a strained and dissatisfied expression on her face; and when, at the end of the hypnosis, I as... |
If we go into the mechanism of idées fixes, we find that they are based upon and supported by so many experiences operating with such intensity that we cannot be surprised to find that these ideas are able to put up a successful resistance against the opposing idea brought forward by suggestion, which is clothed with o... |
treatment for more than five months without my being able to help her. She was analgesic and had painful areas in both legs and a rapid tremor in her hands. She walked bent forward, dragging her legs and with short steps; she staggered as though she was a cerebellar case and, indeed, often fell down. Her temperament wa... |
Afterwards I felt ashamed of myself, and did not suspect that my clever patient would save my reputation in the eyes of her father, who was a physician and was present during her hypnoses. Next day her father said to me : What do you think she did yesterday? We were walking along the Ringstrasse when she suddenly got i... |
At this she gave way to the extent of letting fall a single significant phrase; but she had hardly said a word before she stopped, and her old father, who was sitting behind her, began to sob bitterly. Naturally I pressed my investigation no further; but I never saw the patient again. It was while I was studying Frau v... |
state in which her memory had access to all her psychical experiences. I may have called up the state by my suggestion but I did not create it, since its features - which are, incidentally, found universally - came as such a surprise to me. The case history makes sufficiently plain the way in which therapeutic work was... |
The patients tendency to fall ill in a similar way under the impact of fresh traumas was not got rid of. Anyone who wanted to undertake the definitive cure of a case of hysteria such as this would have to enter more thoroughly into the complex of phenomena than I attempted to do. Frau von N. was undoubtedly a personali... |
The circle of her duties was very wide, and she performed the whole of the mental work which they imposed on her by herself, without a friend or confidant, almost isolated from her family and handicapped by her conscientiousness, her tendency to tormenting herself and often, too, by the natural helplessness of a woman.... |
It has also struck me that amongst all the intimate information given me by the patient there was a complete absence of the sexual element, which is, after all, more liable than any other to provide occasion for traumas. It is impossible that her excitations in this field can have left no traces whatever; what I was al... |
Dr. Breuer and I knew her pretty well and for a fairly long time, and we used to smile when we compared her character with the picture of the hysterical psyche which can be traced from early times through the writings and the opinions of medical men. We had learnt from our observations on Frau Cacilie M. that hysteria ... |
94 I must confess, too, that I can see no sign in Frau von N.s history of the psychical inefficiency to which Janet attributes the genesis of hysteria. According to him the hysterical disposition consists in an abnormal restriction of the field of consciousness (due to hereditary degeneracy) which results in a disregar... |
I am inclined to believe, then, that all this involved a considerable excess of efficiency, which could perhaps not be kept up in the long run and was bound to lead to exhaustion - to a secondary misére psychologique (psychological impoverishment ). It seems likely that disturbances of this kind in her efficiency were ... |
When I took this in connection with some other remarks which she had made, but to which I had not paid sufficient attention, I was led to conclude that she was longing at that time to be married again but found an obstacle to the realization of her purpose in the existence of her two daughters, who were the heiresses o... |
Her elder daughter - the one of whom I had earlier made such an unfavourable prognosis - approached me with a request for a report on her mothers mental condition on the strength of my former treatment of her. She was intending to take legal proceedings against her mother, whom she represented as a cruel and ruthless t... |
She had a delicate constitution, with a poor pigmentation, but was in good health apart from her nasal affection. Her first statements confirmed what the physician had told me. She was suffering from depression and fatigue and was tormented by subjective sensations of smell. As regards hysterical symptoms, she showed a... |
hysterical symptoms. Her depression might perhaps be the affect attaching to the trauma, and is should be possible to find an experience in which these smells, which had now become subjective, had been objective. This experience must have been the trauma which the recurring sensations of smell symbolized in memory. It ... |
What I knew of the circumstances of the patients life was limited to the fact that the two children whom she was looking after had no mother; she had died some years earlier of an acute illness. I therefore decided to make the smell of burnt pudding the starting-point of the analysis. I will describe the course of this... |
In Bernheims clinic it almost seemed as though such an art really existed and as though it might be possible to learn it from Bernheim. But as soon as I tried to practise this art on my own patients, I discovered that my powers at least were subject to severe limits, and that if somnambulism were not brought about in a... |
It seemed to me a matter of indifference what degree of hypnosis - according to one or other of the scales that have been proposed for measuring it - was reached by this non somnambulistic state; for, as we know, each of the various forms taken by suggestibility is in any case independent of the others, and the bringin... |
If so, they may adopt some procedure other than mine. It seems to me, however, that if one can reckon with such frequency on finding oneself in an embarrassing situation through the use of a particular word, one will be wise to avoid both the word and the embarrassment. When, therefore, my first attempt did not lead ei... |
the pathogenic memories which, as we have already said in our Preliminary Communication are absent from the patients memory, when they are in a normal psychical state, or are only present in a highly summary form. I was saved from this new embarrassment by remembering that I had myself seen Bernheim producing evidence ... |
Thus when I reached a point at which, after asking a patient some question such as: How long have you had this symptom? or: What was its origin?, I was met with the answer: I really dont know, I proceeded as follows. I placed my hand on the patients forehead or took her head between my hands and said: You will think of... |
I told them I was ready to repeat the procedure as often as they liked and they would see the same thing every time. I turned out to be invariably right. The patients had not yet learned to relax their critical faculty. They had rejected the memory that had come up or the idea that had occurred to them, on the ground t... |
The fact that in looking for numbers and dates our choice is so limited enables us to call to our help a proposition familiar to us from the theory of aphasia, namely that recognizing something is a lighter task for memory than thinking of it spontaneously. Thus, if a patient is unable to remember the year or month or ... |
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