Analysis of a Case of Paranoid Dementia as a Paradigm.
Anamnesis: B. St., seamstress, single, born in 1845. Patient was admitted to this hospital in 1887 and since then has remained continuously in the hospital. She is greatly tainted by heredity. Many years before admission she heard voices slandering her. For a time she intended to drown herself. She referred the voices to invisible telephones. She heard that she was a woman of doubtful character, that her child was found in the water closet, and that she stole scissors in order to pierce a child's eyes. (According to the anamnesis the patient led a thoroughly exemplary and quiet life.) The patient used here and there peculiar expressions. She generally employed a rather pretentious style. Her letters of that time will illustrate this:
July 5, 1887.
Dear Superintendent:
With these lines I request you once more to instantly discharge me. My head, as I already remarked to you in my last letter, is clearer than ever. What I have to suffer secretly on account of novelties in all domains is unfortunately known to me alone, and is too smashing for my health as well as for my mind. Unfortunately they have gone so far as to torture to death poor victims by secret cruelties, for I suffer more than you can imagine and in this manner fully expect my end, which sadly touches me more and more. I hope you will act in your place as physician and will have no need of any further reflection.
Yours respectfully, etc.
August 16, 1887.
Dear Sir:
Unfortunately I cannot make it possible for you to appreciate the sad conditions which have intruded themselves. I again call your attention to the simple fact, to discharge me without more ado, as I alone suffer under these novelties, and if you were to be convinced of it you would surely immediately discharge me, because I have suffered from the beginning since I came here, and am totally at the end of my health. I want an immediate discharge. It will be immediately better when I leave Zurich for another air where the horrors are not represented, etc.
The patient manifests active delusions. She has a fortune of millions, in the night her bed is full of needles. In 1888 her speech became more and more disconnected and her delusions less understood; she has for example the "monopoly." She makes peculiar gestures with her hands. A certain "Rubinstein" from St. Petersburg sends her money by the wagonload. In 1889 she complained that her spinal cord was torn out in the night time. "Back pains are caused by substances covered with magnetism which penetrate through the walls." The "monopoly" confirms the pains which "do not stick in the body and do not fly about in the air." "Extracts" are made by means of "inhalation of chemistry," etc. By means "of suffocation" legions are murdered. "Station for station must keep its proper governmental position so that existence-questions of the ward cannot be chosen to hide themselves behind, all things can be chosen."
In 1890–91 the delusions became more and more absurd, a great but incomprehensible rôle is played by the word "note-monopoly." In 1892 the patient became "queen of the orphans," "owner of the asylum Burghölzli," "Naples and I must provide the whole world with noodles." In 1894 patient at every visit asked for her discharge in a stereotyped and totally unemotional manner. In 1895 patient feels herself paralyzed and claims to have tuberculosis. She is the owner of a "seven-floored note factory with coal-raven-black windows, which signifies paralysis and starvation." In 1896 patient says, "I am Germania and Helvetia of exclusively sweet butter, but now I have no more any supply of butter not even as much as a fly would leave behind—hm—hm—hm—that is starvation—hm—hm." (The syllable "hm" is a characteristic stereotyped insertion which still exists.) She also says, "I am Noah's ark, the life boat and the esteem, Maria Stuart, Empress Alexander."
In 1897 patient relates that recently Dr. D. came out of her mouth "the little tiny D., the son of the Emperor Barbarossa."
In 1899 she was tormented nightly by many hundred thousands of snakes, etc.
From the extracts taken from patient's history one can easily recognize the nature of the case. At present the patient is as ever a diligent worker. She now and then gesticulates and whispers during her work. During the physicians' visits she puts her questions in a stereotyped and unemotional manner, such as "Have you heard nothing from the notes? I have so long ago established the monopoly, I am a triple world proprietress," etc. When she does not talk about her delusions her manner of expression and behavior show nothing abnormal, though there is a certain unmistakable prinking, not rarely seen in elderly unmarried women who strive to acquire an equivalent for unsatisfied sexuality by the greatest possible perfection. She naturally has no insight as to her disease, yet to a certain extent she finds it conceivable that her delusions are not understood. There is no imbecility. Her speech is changed only in the spheres of her delusions, otherwise she speaks in a normal manner. She repeats what she reads and defines ideas in a clear manner, insofar as they do not touch her complex. During the experiments and analyses the patient readily collaborated with the examiner, apparently taking the greatest pains to explain herself as well as possible. This behavior is especially due to the fact that the examination as such is also a complex-incitor, as the patient always demands interviews, hoping thereby to finally convince everybody, and thus reach the goal of her desires. The patient is always quiet and shows nothing striking in her general behavior. While at work she whispers to herself "power-words." These are stereotyped sentences or sentence-fragments of a quite strange content, such as: "Last evening I sat in the night train to Nice, I had to pass there through a triumphal arch—we have established all this as a threefold world proprietress—we are also the lilac-new-red-sea wonder," etc. Such fragments appear in great numbers, but are altogether stereotyped and can always be reproduced in the same form. Motor stereotypies but rarely occur. One stereotypy, for example, is a sudden extension of the arms, as though patient would wish to embrace some one.
Simple Word Associations.
For the last two years, at different times, I have taken from the patient simple word associations (corresponding to those discussed in the Diagnost. Assoz.-Stud.). I now present some of them:
Among these repetitions some sound quite incomprehensible. Socrates, the first reaction to "pupil," is quite a striking reaction for a tailoress; it looks very affected and gives the appearance of a complex constellation. It also shows the tendency to affected speech and behavior. The same holds true for R. 8. "Lamp—electricity" (patient would like electricity instead of gas). R. 4 "yes irretrievable" to "head" is incomprehensible if one does not know that the word "irretrievable" is one of the patient's preferred stereotyped words. The reaction "nut water " to R. 5 "ink" is explained on subsequent questioning. Nut water is dark brown, ink is black. But how does patient get to nut water? It is again a complex constellation like Socrates. Nut water is something that patient likes very much. [It is made from the green shells of unripe nuts.] Besides these oddities one is struck by the numerous repetitions of the stimulus words, the unusually long reaction times, and the frequent beginning of the reaction with "yes." As is known we take these signs also as symptoms of complex constellations, it is the intervention of an emotionally strong idea feeling. But it must be realized that we deal with a patient with dementia præcox who presents her delusions (which according to our conceptions are nothing but complex-expressions) with marked want of emotion. If we really dealt here with a true want of emotion, it would at first sight seem contradictory that just here, where we always have the impression of an emotional defect, there should be signs of a vivid feeling tone. From numerous examinations in the normal and hysterical we know that these signs in experiments always, as it were, show the appearance of a complex, we therefore retain the same view in dementia præcox. The consequence of this supposition is that most of the above reactions are so to say constellated by complexes. That this is the case in R. 1 we have already seen. R. 2 "father—yes, mother" is designated by the complex-indicator "yes."[1] As we shall see later the parents play a certain rôle in the delusions of the patient. R. 3 "table—sofa" seems objective and has therefore a short reaction time. R. 4 "head—yes, irretrievable" has on the other hand again a very long reaction time. Patient refers "head" to herself and predicates this part of the body as "irretrievable," an expression which she otherwise applies to her own person and usually in the stereotyped formula, "I am double polytechnic irretrievable." R. 5 "ink—nut water" is a very far-fetched mediate complex-constellation. The patient, among other things, desires nut water. R. 6 "needle—thread" excites her trade-complex—she is a tailoress. R. 7 "bread—butter" is objective. R. 8 "lamp—electricity, petroleum" also belongs to her desiderata. R. 9 "tree—fruit" she likewise desires, she frequently complains about getting too little fruit. Occasionally she also dreams of a large gift of fruit. R. 10 "mountain—valleys." Mountain plays a great part in her delusions. She expresses it as follows in her stereotyped manner: "I created the highest pinnacle, Finsteraarhorn " [mountain near the Jungfrau], etc. R. 11 "hair—hat" should also contain a self-reference, but it has not been confirmed. We see then that by far most of the above associations are constellated by complexes, hence the objective signs of the feeling-tone are readily understood. What is not, however, understood at first sight is the unusually large number of complex-constellations. We see such an excess among the normal and hysterical only when the complex is extraordinarily accentuated, that is, when there is present a wholly fresh affect. But this is not the case with our patient, she is perfectly calm, she simply shows the results of the affects in the associations, the one-sided prominence of the complexes without the concomitant affective excitement. From this we receive the clinical impression of "lack of emotion." We still have the shells of the affect; the content, however, is gone. Perhaps the patient has misplaced the affect and these shells are only the wornout expressions for a repressed complex, having a more sensible and comprehensible content, but it is no longer reproducible and hence the affect, too, is buried. We wish here to call attention to these possibilities concerning which we shall speak later.
R. 12 "wood—cushion" refers to her complaint that there are only wooden benches in the asylum; for her own use she desires padded furniture ("I establish upholstered furniture"). R. 13 "dream—reality": Most of her delusions she takes from dreams, and when they are refuted she always emphasizes energetically the reality of all objects of her desire. R. 15 "paper—stamped paper" is connected with her delusions that there exists a state document about her enormous activities. R. 16 "book—books" refers to her stereotypy, "I saw the book awfully high above the grounds of the city hall," etc. This stereotypy likewise refers to her unusual activity, as we shall see below. The many reactions in R. 19 "ring—band, union or engagement" show an especially strong feeling-tone. The erotic complex is here quite plain—it plays a great part, as we shall see later. R. 20 "tooth—set of teeth, teeth" also belongs to her wishes; she would like a new set of teeth.
S. 21 "window" has a multiform significance in her delusions, one of the most important is what she designates as "ventilation." She is nightly disturbed by fecal odors which she hopes to remove by better ventilation. The very odd reaction to S. 22 "frog" is explained by patient as follows: "A person is like that when he watches how a frog leaps, I always have such paralysis in my legs." "I have a paralysis," or "that is a paralysis" are stereotypies meant to indicate a feeling of paralysis in her legs. It can be seen how very far the patient leads the assimilations to her complexes. In S. 23 "flower" the reaction camelia again sounds as though affected. The camelia belongs to the ornaments of which she dreams. S. 24 "cherry" belongs to the fruit-complex. The remarkable R. 25 "asylum—causing" is explained by patient as follows. "Private people cause such asylums. I as world proprietress established this asylum but did not cause it, in spite of the fact that someone cried out that I did on my entrance." When patient was entering this asylum the voices told her that it was her fault that this asylum existed; she, however, denied this, but since then she has delusions of owning this asylum, for as "world proprietress all great buildings, so to say, are established as her property." R. 26 "nurse—locked in" is as shown by the reaction a perseverance of the preceding complex. R. 28 "oven—draughts of interest" is explained by patient as follows: "We are the ovens for the State, I am the lessor of interest-draughts." The last sentence is stereotyped—what it signifies we will see later. Reactions like "asylum—causing," "oven—draughts of interest," are certainly typical of dementia præcox, and are not found in any other psychic abnormality.
Here again a delusion is set free. Patient states that "Mr. Prim is the first dancing teacher in Zurich." This name and person are totally unknown to me; we probably deal here with a delusional formation.
This far-fetched complex-constellation is explained by patient as follows: "I was once slandered by somebody because I always carried cats in my arms." It is not clear whether the slandering came from voices or from persons. The carrying about of cats is not rare as a symptomatic action in erotic complexes (child!).
The complex constellated here is a delusion which is expressed stereotypically as "I am Forel and Forel's star." [Forel—former Superintendent of Burghölzli.]
A word which can not be so well written: to caress.
Here, too, an erotic complex is constellated, as probably also in the above association. Both reactions came hesitatingly, with introductions, showing a feeling of uncertainty, a "sentimentd'incomplétude." This is probably due to a co-excitement of a strong unconscious complex, on account of which the conscious idea loses in clearness and completeness.
Again a far-fetched complex-constellation. Patient says one speaks though about unpleasant things, "that is really splendid." She finds it especially annoying that her fortune which she has long ago "established" is kept away from her "so imposingly."
Here patient again reacts egocentrically, that is, her complexes employ every available occasion to manifest themselves. R. 53 "to ride" also refers to a stereotypically expressed delusion. "I should have been horseback riding since 1866." This idea belongs to the grandiose delusions.
Patient explains this as follows: "The villa S. in T. is my crown. I affirm it as my property." The villa S. is one of the finest villas in the suburbs of Zurich.
The first association is a distinct complex-constellation, the last is a fragment of her fancies which always occupy themselves with great festal occasions.
This also belongs to the complex of her extraordinary intelligence.
I do not wish to heap up examples, for we can find all the essentials from those mentioned. We are struck before all, by enormous number of quite clear complex-constellations. With few exceptions all associations are scantily veiled complex-expressions. Because the complexes stand everywhere prominently in the foreground we have the corresponding disturbances of the experiments. The extraordinary long reaction times throughout could be partially explained by the constantly encroaching complexes, a thing more rarely seen in the normal and even in the hysteric. From this it can also be concluded that the patient's psychical activtiy is fully occupied by the complex. She is under the yoke of the complex, she speaks, acts and dreams of nothing else but what the complex inspires. There seems to exist some intellectual weakness which expresses itself in a tendency towards definitions, which, however, in contradistinction to the reactions of imbecility does not tend towards generalization,[3] but the content of the stimulus is defined or designated in the sense of the complex. What is characteristic here is the unusual affectedness and embellishment of the expressions which often merge into incomprehensibility. The awkward and peculiarly sounding definitions of imbeciles are found at situations which are intellectually somewhat difficult, where they are of course to be expected; but here the affected definitions appear in unexpected locations which accidentally stimulate the complex. In the normal and hysteric we always see striking and disturbed reactions, such as unusual or foreign words, in the critical situations. Corresponding to this we have here the neologisms which represent nothing else than especially forceful and rich expressions for the complex-thought. Hence we also understand why the patient designates her neologisms as "power-words." Wherever they appear they always refer to the whole system hidden behind them, similarly to technical terms in normal language.
We see then that the complex is connected with the most far-fetched words; it assimilates, as it were, everything.
In the normal and hysterical we see similar relations in complexes with very strong feeling-tones where the affect is still fresh. In regard to the experiment the patient behaves like a person with a fresh affect. In reality this is naturally not the case, but the effects on the associations are such as can only occur in strong affects; that is, by far most of the reactions are constellated in the clearest manner by subjective complexes. This fact is explained by the hypothesis constructed in the preceding chapters, namely, that in the content of dementia præcox there is an abnormally strong affect which becomes fixed at the onset of the disease. If this hypothesis be correct and holds true for all forms of dementia præcox we have to expect the associations in dementia præcox to be characterized by the presence of an abnormally strong complex. As far as my experience goes, this is really everywhere the case. In this point, too, we can see the great resemblance to hysteria. The complexes which have principally impressed themselves on this experiment are the following:
The complex of personal grandeur constellates most of the associations. It especially manifests itself in the embellishment which serves no other purpose than to raise the dignity of the personality. So far it is a normal and very familiar concomitant of self-sufficiency, but here it reaches an exaggerated height corresponding to the morbid degree of self-consciousness. Because the propelling affect lying at its foundation never apparently becomes extinguished, it remains for decades, becoming a mannerism and glaringly contrasting with reality. The same may also be seen among the normal who are unreasonably vain, and who retain their imposing attitudes even when the real situation in no way warrants it. Hand in hand with this exaggerated embellishment we find the exaggerated grandiose delusions which in view of their contrast with reality and also in consequence of their pretentious and indistinct expressions, show something of the grotesque. The principle of this manifestation we also find among normal persons whose self-consciousness contrasts with their intelligence and station. In the patient we again deal with an exaggeration which points to the conclusion that there is a corresponding deep affect. What goes beyond the normal mechanism is the difficulty of comprehension, and the inadequacy of expression which indicates injury to the fundamental conception. The complex of personal grandeur expresses itself also in inappropriate demands and wishes.[4]
The persecutory complex contrasts with the grandiose complex, and also manifests itself with great distinctness. In this disease it is the usual compensation for the greatness. Here, too, the expression is exaggerated and often difficult to understand and hence grotesque.
We also find some indications of an erotic complex which is, however, considerably concealed by the two former complexes. Yet it is possible that the erotic complex is the principal one; indeed in women one must expect it. Perhaps it is only characteristically in the background, while the other complexes are nothing but its transferences. We shall speak of this later.
A very sensitive person possessing an exaggerated self-consciousness will generally meet with many obstacles in life. This fact alone may be the reason for the complexes of grandeur and of being wronged. But in this mechanism we do not find the specific cause. We have to look for it among those symptoms which farthest deviate from the normal, that is, in the unintelligible. Among the latter the neologisms stand first. It is for this reason that I subjected the new speech formations of the patient to a special study, hoping thereby to find the clue to the essential.
Continuous Associations.
At first I attempted to have the patient explain to me what she meant by her neologisms. This attempt was a total failure, for she immediately produced a series of fresh neologisms which resembled "word-salad." She spoke in a self-confident tone, as if she were perfectly clear about the meaning of her words, and seemed to think that what she said was an explanation. I then realized that direct questioning would lead to nought, just as in hysteria, when one interrogates directly as to the origin of symptoms. I therefore made use of a means which is also applied in hysteria. I asked patient to tell me all her thoughts evoked by the stimulus word. In this manner it was possible to exhaust in every way the content of the idea and to learn its different relations. As stimuli I employed the neologisms which are repeatedly used by the patient. As the patient spoke very slowly in reference to her delusions, and was constantly disturbed by "thought deprivations" (complex-inhibitions) it could readily be literally transcribed. I reproduce the tests verbatim, omitting, however, the repetitions.
A. Wish-Fullfilment.
1. Socrates—scholar—books—wisdom—modesty—no words in order to express this wisdom—it is the highest groundpostament—his teachings—had to die on account of bad people—falsely accused—sublimest sublimity—self-satisfied—that is all Socrates—the fine learned world—no thread cut—I was the best tailoress, never had a piece of cloth on the floor—fine artist world—fine professorship—is doubloon—twenty-five francs—that is the highest—prison—slandered by bad people—unreason—cruelty—excess—rudeness.
The thoughts did not follow smoothly, but were constantly inhibited by "thought-deprivation" which patient designated as an invisible force which always takes away just what she wishes to say. Thought-deprivation especially appears whenever she wishes to explain something conclusive. The conclusive is the complex. Thus we see in the above analysis that the essential appears only after having been preceded by a number of obscure analogies.[5] The object of the test is, as the patient knows, to explain the neologisms. If it takes her so long to reproduce the important phrase ("no thread cut") her imaginative faculty must suffer from a peculiar disturbance which can be best designated as deficiency in the faculty of discrimination between the important and the unimportant material. The explanation of her stereotype "I am Socrates" or "I am Socratic" lies in the fact that she was the "best tailoress" "who never cut a thread" and "never had a piece of cloth on the floor." She is an "artist," a "professor" in her line. She is tortured, she is not recognized as world proprietress, etc., she is considered sick which is a "slander." She is "wise" and "modest." She has performed the "highest." All these are analogies to the life and end of Socrates. She therefore wishes to say "I am and suffer like Socrates." With a certain poetic license, characteristic in a moment of strong affect, she says directly "I am Socrates." The pathological part in this is the fact that the degree of her identification with Socrates is such that she cannot free herself from it. She takes her identification in a way as self-evident and presupposes so much reality for the metonymy that she expects everybody to understand it. Here we distinctly see the inability of discriminating between two ideas. Every normal person can differentiate between an assumed part or a metaphoric designation and his real personality, even if a vivid phantasy, i. e., an intense feeling-tone will for a time firmly adhere to such a dream or wish-formation. The correction finally comes with a reversal of feeling and with a readaptation to reality. The process is somewhat different in the unconscious. We saw, for example, how the dream changed a metaphoric expression to a reality which it inserted into the personality of the dreamer, or, e. g., an unconscious complex immediately condensed a distant analogy with the personality and thus attained the necessary intensity to disturb the conscious process, as in "A fir tree stood alone, etc." If in a brief dreamy state the unconscious complex could have reached the speech innervation he would have said "I am the fir tree." As was pointed out in the preceding chapters, the necessary presupposition for this condensation is the indistinctness of ideas as they normally exist in the unconsciousness. From the above source we explain the condensation in our case. As soon as the patient thinks in the complex she no more thinks with the normal energy, i. e., distinctness, but her thought is indistinct and dreamy, as is normally the case in the unconscious or in the dream. As soon as the patient's associations reach the realms of the complex, the hierarchy of the chief ideas ceases and the stream of thought moves in dreamlike analogies, which, in the self-evidence of dreams, is put on an equal value with reality. The complex works here automatically following its laws of analogy. It is equally freed from the dominations of the ego-complex, and for that reason it is impossible for the ego-complex to properly direct the complex associations. On the contrary it is subjected to the complex and is constantly disturbed by defective reproductions ("thought-deprivation") and by obsessive associations (pathological fancies). The same process of obscuration, which takes place in the ideas, is also found in the speech of the complex. It gradually becomes indistinct, similar expressions readily substitute one another and there are also sound displacements and mediate (speech) associations. Thus it makes no difference to the patient whether she says "artist" or "fine artist world," "professorship" instead of "professor," "fine learned world" instead of "learned tailoress." These conceptions substitute each other with the same facility as the patient's personality with Socrates. The accent is characteristically not on the simple but on the unusual, because that corresponds to the tendency towards external distinction.
2. Double polytechnic (stereotype: "I am double polytechnic irretrievable"); that is, the highest of the highest, the highest of tailoring, the highest accomplishment—the highest intelligence—the highest accomplishment of the art of cooking—the highest accomplishment in all spheres—the double polytechnic is irretrievable—the universal with 20,000 francs—to cut no thread—fine artist world—not to apply lace trimming where nothing is seen—plum cake on an indian meal layer—it is of great importance—finest professorship—is a doubloon—twenty-five francs—snail museum clothing is the highest—parlor and bedroom—I should live there as double polytechnic.
The content of "double polytechnic" is very similar to "Socrates," only here the "arts" are more elevated. Next to the tailoring we have the cooking art with its specialities "plum cake on an indian meal layer." The art of tailoring reappears, as before, in the same stereotyped associations. It is quite evident that "polytechnic" is only another metonymy for the acme of art and wisdom. This is further determined by the "I should live there" meaning in the "polytechnic," as patient subsequently stated. At the same time it is no contradiction for either her consciousness or for the dream that she lives in the polytechnic as "double polytechnic." It is quite impossible to make her realize this incongruity, she simply answers with one of the above stereotypies. "The polytechnic is a government building" and hence "belongs to her." "Double" is an obscure epithet which perhaps resounds in "doubloon." Perhaps by this is meant the expected reward for this "highest" activity. "Double" may also have the sense of augmentation, or it may have another sense of which we shall speak later.
If the "double polytechnic" is the "highest," the epithet "irretrievable" then becomes clear.
3. Professorship (stereotype: "I am the finest professorship"). This is again the highest activity—double—twenty-five francs—I am double polytechnic irretrievable—professorship includes in itself the fine learned world—the finest world of art—I am also these titles—snail museum clothing, am I, that emanates from me—to cut no thread, to choose the best samples, those representing much—the finest learned world includes that in itself—to choose the best samples, those representing much, and consuming little cloth—I created that—that concerns me—the fine art world is, to apply the trimming where it can best be seen—plum cake on indian meal layer—the finest professorship is double—twenty-five francs—it doesn't go any further, no one can earn more than twenty-five francs—snail museum clothing is the highest clothing—the others wish to bring together the learned world always with astronomy and everything possible.
The content of this idea "professorship" coincides with the two above analyzed ideas. "Professorship" is nothing but a further symbolic designation for the grandiose idea that the patient is the best tailoress. Through sound similarity "doubloon" is here replaced by "double," both expressions apparently have the same value for the patient. A doubloon corresponds to the value of twenty-five francs, and here it is clear that it means the highest day's wages that can be earned by labor. The expression "snail museum clothing" is a symbolic designation for the product of her art which she takes as the highest order of dress. It is explained as follows: The museum is a place of rendezvous for the intellectual gatherings of Zurich; the house "To the Snail," a prominent guild hall, stands near the museum. These two presentations fuse together, forming the singular idea "snail museum clothing," which, as the patient says, designates also the highest type of clothing. Her manner of speech, too, is interesting; patient does not say "I make," but "I am the snail museum clothing, it emanates from me." She "condenses" or identifies herself also with this object, in so far as she treats with the same value the "I am" and "it emanates from me." The "I am" seems to be nothing but a reinforcement of the "I have" or "I make."
The three ideas thus far analyzed are technical terms which in brief designate (as it seems to the patient) in a pregnant manner an abundance of ideas and relations. Whenever she whispers to herself she simply repeats these terms and nods affirmatively, without adding any further explanations. The origin of these technical terms is unknown; some according to the patient come from dreams. Probably these expressions originated on some occasion spontaneously and on account of their strangeness were quite obvious to the patient, just as philosophers occupying themselves with obscure ideas readily play with obscure words.
4. Summit: sublimest sublimation—I am self satisfied club-house "To the Plate"—the fine learned world—world of art—snail museum clothing—my right side—Nathan the Wise am I—father, mother, brother, sisters, I have none in this world—an orphan child—am Socrates—Loreley—Schiller's Bell and the monopoly—God, Mary, mother of God—main key, the key in heaven—I always legalize our hymnbook with the gilt edge and the Bible—am proprietress of southerly zones—royally lovely, so lovely and so pure—in my single personality I am a von Stuart, von Muralt, von Planta, von Kugler—highest reasoning belongs to me—no one else should be dressed here—I legalize a second six floored note factory for the Socrates representation—the insane asylum should accept the Socrates representation, no more the former representation, which the parents had, but Socrates—this can be explained to you by a doctor—I am Germania and Helvetia from sweet butter—this is a life symbol—the highest summit I created—I saw the book awfully high over the city hall gardens, covered with white sugar—high in heaven, is the highest summit created—higher than the highest height—you can bring no one who can prove a mightier title.
In the conception of "summit" we find an enormous number of senseless ideas, some of which sound extraordinarily comical. From this material we see that the patient designates by "summit" the sum total of all her "titles" and activities. The subtitles such as Schiller's bell, Loreley, etc., probably designate special analogies which will have to be looked for in the special words.
5. Loreley: is world proprietress—it expresses the deepest mourning because the world is so depraved—a title which for the others is the greatest happiness—I might say that usually those personalities are extraordinarily tormented, who have the misfortune to be world proprietors—Loreley is also the highest living portrait—no higher memory can the world prove—no higher reverence—it is like a statue—for example the song runs "I know not what ere it presages"—it often happens that the title of world proprietor is not at all understood—that the people say, that they know not what it means, this is really a great misfortune—Yet I affirm the greatest silver island—that is a very old song, so old that the title didn't become known—that is mourning.
When the patient says "I am the Loreley" it is simply, as can be seen from the above analysis, a condensation of the connection of an awkward analogy, namely, the people do not know what world proprietress means; that is sad; the song reads "I know not," etc., hence patient is the Loreley. It can be seen that it follows the type of the example of the "pine tree."
6. Crown (stereotype: "I am the crown"): greatest goodness of life, which one can gain by conquest—those who accomplish the highest come to the crown—highest fortune of life and goodness of earth—the greatest wealth of earth—it is all acquired—there are also lazy people who always remain poor—highest picture of heaven—the highest godliness—Mary, mother of God—the main key and a key in heaven with which one severs relations—I myself saw how a door was bolted—the key is necessary for irrefutable justice—title—Empress—world proprietress—highest merited nobility.
"Crown" is another analogy with "summit," but it expresses the nuances of the merits and rewards. The reward is not, however, consummated on this earth in the form of the gifts of the greatest earthly possessions such as wealth, crowning as empress, and merited nobility, but reaches into the religious heaven, into which patient is allowed to enter by means of a key and where she even becomes Empress of heaven. In consideration of her merits this development seems to her "irrefutable justice." A simple-minded dreamlike fragment which recalls to an extent the "Ascension of Hannele " (Hauptman).
7. Main key (stereotype: "I am the main key")—the main key is the house key, I am not the house key but the house—the house belongs to me—yes, I am the main key, I affirm the main key as my property—it is a house key to fold—a key which can again unlock all doors—therefore it includes also the house in itself—it is a keystone—monopoly—Schiller's bell.
By this patient has reference to the pass key carried by the physicians. With the stereotypy "I am the main key" she solves the complex of her confinement. Here it can very well be seen how obscure her ideas as well as her expressions are; now she is the main key, now she only affirms it; likewise she is now the house, and now it belongs to her. This key, which opens everything and frees her, gives her also the occasion for the analogy with the key to heaven, which opens for her the entrance to bliss.
8. World proprietress (stereotype: "I am threefold world proprietress"): grand hotel—hotel establishment— omnibus—theatrical performance—comedy—public parks—equipage—cab—tramway—street mobile—houses—railway station—steamship—railroad—post—telegraph—national holiday—musics—stores—library—state—letters—monograms—postal cards—gondolas—delegate—great occasions—payments—lordship—coach—negro on the box—flags—one-horse carriage—open carriage—pavilion—public instruction—banknote factory—mightiest silver island of the world—gold—precious stones—pearls—rings—diamonds—bank—central court—credit establishment—villa—male and female servants—carpets—curtains—mirrors, etc.
The picture which appears to patient at "world proprietress" concerns the requisites of a princely existence, some of which are situations carefully and most diligently pictured, such as "negro on the box." These references give us an idea of the incessant inner complex-activity of dementia præcox which objectively makes itself known through a few unintelligible fragments. The psychic activity reaches no more to the "fonction du réel," but turns internally to an infinite thought elaboration which exhausts itself in the building up of the complex.
9. Interest draughts (stereotype: "My interest draughts will have to be accepted "): cocoa, chocolate, noodles, macaroni, coffee, petroleum, black tea, green tea, sugar candy, white sugar, nut water, red wine, honey cake, winecake—cloths, velvet, merino, double merino, saxonian merino, alpaca, twilled goods, fustian, white percale, shirt cloth, linen, wool, shoes, boots, socks, undershirts, underwear, coats, umbrellas, hats, jackets, mantles, gloves—these are interest draughts which in reality belong to me.
The above is only a sample of the content of the "interest draughts." We deal here with the concrete wishes of everyday life, which have nothing to do with the "world proprietress" complex. The imagination runs into the finest details and gives the impression of careful assortment.
10. To affirm: to corroborate, to verify, to recommend—mostly quite conclusion—to express an opinion—to take into consideration—what one affirms—to take in hand—the heathens chatter so, the same thing is daily explained to them, yet they do nothing in the matter—I affirm that I am paralyzed—nine years ago I needed eighty thousand francs—payments through superintendent Forel—they are rough to me—I affirmed the insane asylum six-fold as world proprietress.
The content of affirm is the same as mentioned above. The clearest meaning is in the sentence "I affirm that I am paralyzed." Here "affirm" has its exact and original sense. Mostly, however, patient uses "affirm" in a figurative sense as "I affirm the insane asylum" meaning "I affirm it as my property" or "I affirm a payment," meaning "I affirm that I have a claim on a payment." As was shown in the analysis of "main key" patient's speech is abnormally flexible and tends toward arbitrary and odd expressions. Normally changes in speech occur very slowly, here the changes take place rapidly and within the limits of the individual's life. The reason for these rapid changes seems to lie in the vagueness of her conceptions. She scarcely differentiates, and her conceptions are used and expressed now this way, now that way (compare "main key"). Judging by its content the sense of affirm is here very equivocal. Affirm contains corroborate, and verify, which at all events may be understood, although both terms go somewhat beyond the sense of affirm, but to recommend, to give one's opinion, and to take notice of, can no longer be logically connected with affirm unless it be as superficial associations. Both expressions do not in any way explain the sense of "affirmation," on the contrary they only cause it to become blurred. This is due to the fact that the presentations of the words are but indistinctly perceived and hence she does not recognize their dissimilarity.
11. Universal (stereotype: "I am the universal"): I came as the universal seventeen years ago—universal firmly includes the reposal—regulated conditions—it is also by inheritance—it includes also wealth conditions—the title of world proprietress includes in itself one thousand millions—that is really the villa, equipage—since 1886 I was riding horseback and driving—I am universal since the death of my father—in the winter month I affirm the universal—even if I had not affirmed it in the dream I would have known it—on account of being a bequeathor—at least twenty-five thousand—with what an energy!—the Swiss life annuity is one hundred and fifty thousand—according to the telephone, Mr. O. drew my life annuity—universal is something definite—you can be that through deceased—through inheritance—universal is property—the property belongs to me.
According to these associations "universal" means universal heiress; at least this expression seems to be thus derived. The idea, however, is used quite promiscuously, now for persons and now for property. Again we have the same uncertainty. Instead of "affirm" patient prefers to use here "include" and on one occasion she condenses the two words into "festschliessen" (firmly include). The characteristic uncertainty exists also in her use of moods and tenses. Patient says, for example, "since 1886 I was riding horseback, etc."; she knows, however, quite well that this is not the case. On another occasion she says, "since 1886 I should have been riding horseback, but I adhered to driving." It makes no difference to her whether she expresses a subjunctive instead of a present or imperfect. She speaks as if in a dream. As is known, Freud[6] has pointed out this peculiarity in dreams. This clearly coincides with her other dream-like, partially condensed and disconnected manner of speech.
"Universal" is another symbol of her wealth which she not only acquired herself, but also inherited. In this we also get a glimpse of her family whom, as we shall see later, she includes in her wish-dream.
12. Hero: I am a hero of the pen—pride—patience—heroic act—a hero of the pen, by the content of which, what one writes—the highest intelligence—the highest gifts of character—the highest perseverance—highest noblesse—the highest that the world shows—includes in itself—letters business letters and letters of credit.
"Hero of the pen" is really a ludicrous expression which, however, the patient takes in earnest. Perhaps due to her deficient education, probably, however, because the comical has lost all its feeling, as is generally the case in dementia præcox. Furthermore this deficiency is also characteristic in the dream. "Hero" is another symbolic expression for "highest intelligence," etc. Her concluding remarks explain how much "hero of the pen" she is. The patient does not write anything except a letter on rare occasions. Her fancies, however, seem to be in favor of writing more letters, and especially "business letters and letters of credit," another requisite of her acquisition complex. Here it is also interesting to see how she expresses this distant thought symbolically by "hero."
13. Conclusion: alliance, counter-bill, closures, signatures, title-right, procuration—it mostly includes in itself the "key," the highest closures—dedication of the highest—adoration—I have dreamt that the adoration, reverence and admiration, of which I am worthy, cannot be brought to me—so wanders the noblest of women, with roses she would like to surround the people—Queen Louise of Prussia—I affirmed this long ago—I am that too—those are the highest conclusions in life—keystone.
The limits of the conception of "conclusions" is again very indistinct. It seems to me that "counter bill, signature, procuration, title-right," etc., accentuate more the "validity" (Gültigkeit), while "closure, alliance and keystone" put forward more the "conclusiveness" or finality (Endgültige). In reality these two relations merge into each other. From "procuration" the association goes to "key" which, as we know, plays a great rôle as "main key," and regularly also evokes its symbolic counterpart, the "heavenly key." Here, too, it goes from "key" to similar religious associations, such as "motto," which in her sense represents something "highest" and hence she can assimilate it. From "motto" it goes via "dedication" to "adoration." In a former analysis the patient identified or "condensed " herself in a similar passage with "Mary, mother of God"; here it is only the "noblest" of women, the "Queen Louise," which is another symbol for her greatness. She designates by this another acme of human virtue which, in addition to her other numerous attributes, she adds to the conception of "conclusion." This citation is a preferred complex-expression.
14. Mountain peak (stereotype: "I created the highest mountain peak"): I effected the highest of all mountain peaks by mending—apparently this makes a sugar cone—it comes out quite white—one has to descend the mountain for meals—it was kingly—little houses are built on the slope—during clear weather one will go up there with tourists—it must be very remunerative—I, too, was there once—but the weather was bad—sea of fog—I wondered that such eminent inhabitants still remained up there—they had to descend for their meals—during pleasant weather it is very remunerative—it may also be thought that bad people are up there—the sense is royal because it is the best sense—if one has a royal sense it is excluded, that one should be killed and robbed in such a place—yes, this is the mountain peak—the Finsteraarhorn.
The patient has long occupied herself with mending linen, she has mended enough linen to make a "whole mountain," "the highest mountain peak." Linen is white, hence "sugar cone."[7] The snowy mountains can be compared to sugar cones which are white on top and blue below, hence "Finsteraarhorn." Among these dreamlike but transparent associations the patient also inserts a dreamlike intermezzo about a mountain upon which prominent people live. Involuntarily one thinks of the Rigi peak, whose large hotels doubtless excited the covetous fancies of the patient. When subsequently asked about this intermezzo she states that she does not refer to any particular mountain, that she only dreamed of it. Nothing further could be elicited. She, however, talks about it as something real or as though it were a vision. Manifestly we again deal with an extraordinarily strong realization of a fanciful formation which occurs otherwise only in dreams.
15. Turkey (stereotype: "I am the finest Turkey"): I belong to the finest Turkey of the world—no other woman in the world can be drawn by lot—to choose—I am the owner of Champagne, and the strongest black wine—especially of the finest products—we are the mightiest preservers of the world—Switzerland as the most magnificent and mightiest state comes to my side—Biel, Liestal, Baden, Seefeld, Neumunster—no discord—Switzerland expresses itself in Turkey—the fine Turkey introduces the finest victuals—fine wine—cigars—much coffee, etc.
This recalls certain advertising pictures of Greek wine and Egyptian cigarettes, ornamented with the picture of a beautiful oriental girl (the patient also says, "I am an Egyptian"). Similar advertising pictures are also used for champagne. This is probably the source of these symbols. We again deal with some of her desiderata, such as "wine, coffee," etc. It also seems as if she imagines that she distributes all these things to humanity ("I am the bequeathor," etc.), perhaps only commercially, for such importation appears to her especially lucrative. She also "affirms businesses," as we shall see below. Be it as it may, what is essential for us is how figuratively the patient expresses herself and how she assumes a geographical collective idea (Turkey) as her title. This technical term expresses for her the whole material mentioned.
16. Silver (stereotype: "I affirm the mightiest silver island in the world"): speech is silver, silence is gold—silvery star—moneys are suspended by silver—creation of moneys—the greatest silver island in the world—silver medals—one must adhere to that out of which it is created—watches—silver snuff boxes—curios—spoons—highest eloquence—speech is silver, silence is gold—the mightiest silver island in the world belongs to me as world proprietress—I afterwards gave the order to produce money only, no external things—the already existing dishes will have to be melted into money.
The silver island belongs to the requisites of the world proprietress, it is from there that her numerous millions come. Silver is, however, also speech; hence she also possesses the highest eloquence. This example again shows quite clearly how indistinct her ideas are. One cannot really speak here of directed associations, as these are only association principles of speech combinations or of picture similarity.
17. Zähringer[8] (stereotype: "I am a Zähringer since 1886"): Means paymaster—extraordinary health—often in life they say you are tough!—I am a Zähringer since 1886—long life extraordinary accomplishments—incredible with many people—it is in the realm—one is so misunderstood—there are so many people who always wish to be ill—they do not agree with the Zähringer—quite extraordinary—highest age—do you know where the Zähringer quarter is?—it is near the Franciscan church—a nice quarter—extraordinary—ordinary people are not reminded by this title—one often says they are so tough—this concerns the state of health—it is such a great thing, this difference in age—I am a Zähringer on account of health—that is extraordinary—they often say what she accomplishes is to be admired—how tough she is—in 1886 I affirmed this quarter, I have to live there.
The symbolic significance of Zähringer is clear. Patient is a Zähringer because she is Zäh (tough). This sounds like a pun, but to her this sound metonymy becomes reality. At the same time Zähringer also means to her a nice residence in the "Zähringer quarter." Again we have a dreamlike condensation of the most multiform ideas.
18. Recently patient repeatedly uttered the following neologism: "I am a Switzerland." Analysis: Long since I affirmed Switzerland as double—I do not belong here confined—I came here free—he who is free from death and error retains a child's pure soul—I am also a crane—one cannot confine Switzerland.
It is not difficult to see how patient is Switzerland: Switzerland is free—patient "came here free," hence she should not be confined. The tertium comparationis "free" leads to a "contamination" with Switzerland. Similar but more grotesque is the neologism "I am a crane." "He who is free from debt," etc., is the familiar quotation from the "Cranes of Ibykus." Patient therefore identifies or "condenses" herself very rapidly with "crane." The analysis thus far given concerns only symbols, of the unusualness, power, health, and virtue of patient. They are purely thoughts of self-admiration and self-glorification, which express themselves in enormous and hence grotesque exaggerations. The fundamental thought: I am an excellent tailoress, I have lived respectably and therefore claim respect and financial reward, can be readily understood. We can also understand that these thoughts are the cause of many wishes, such as recognition, praise, and financial provision for old age. Before her disease patient was very poor and belonged to a family of low station, her sister being a puella publica. Her thoughts and desires express a striving to come out of this milieu and to attain a better social standing; it is therefore no wonder that her wish for money, etc., is especially accentuated. All strong wishes are themes for dreams, in which they are represented as fulfilled, not in the conception of reality, but in dreamlike obscure metaphors. In this patient the wish-fulfilling dreams go side by side with the associations of the waking state. The inhibiting ability of the ego-complex being destroyed by the disease, the complex appears in the waking state and automatically spins its dreams on the surface, in the same manner as it used to do under normal conditions, only in the dim depths of the inhibited unconscious. Dementia præcox has here pierced the investment of consciousness, that is, destroyed the function of the clearest purposive associations, so that it is now possible to see from all sides the automatic workings of the unconscious complexes. What the patient and we see are only the complicated, distorted and displaced products of complex-ideations which are analogous to our dreams, wherein we only see the dream-picture but not the complex-thought hidden beneath it. Thus the patient takes her dream productions also as substantial and claims that they are realities. She acts just as we do in dreams, when we are no longer able to distinguish the connection between the logical and analogical. It is therefore the same to her whether she says "I am the double polytechnic" or "I am the best tailoress." When we speak about our dreams we speak as it were of something apart, we speak from the point of view of the waking state; when the patient talks about her dreams she speaks as if still in the dream. She is involved in the automatic machinery in which naturally all logically adjusted reproduction ceases. She is then thrown entirely upon her sudden fancies and is wholly dependent on the complex for any new reproductions. Accordingly, her stream of thought is burdened, constantly reiterating (perseverations), and is frequently interrupted by thought-deprivation which the patient considers very trying. If an explanation is asked the patient is able to reproduce only new dream fragments, so that no one is the wiser for it. She is unable to dominate the complex material and to reproduce it as if it were indifferent material.
From this analysis we see that the pathological dream has fulfilled the wishes and hopes of the patient in a most splendid manner. Where there is so much light there must also be shadow. Large estates of happiness must psychologically be bought dearly. We therefore come to another group of neologisms or delusions, which have to do with the contrasts, with the injuries or derogations.
B. The Ideas of Injury.
1. Paralysis (stereotype: "That is paralysis"): bad victuals—overwork—sleep deprivation—telephone—these are the natural causes—consumption—backbone—from there comes the paralysis—rolling chairs, only these do they mention as paralysis—tortured—expresses itself in certain pains—that is the way it is with me—woe is not far away—I belong to the monopoly, to the payment—bank notes—in this the distress is affirmed—this is a right system—crutches—dust development—need immediate help.
Here we have the reverse of the medal. Just as on the one side the fancies lead automatically to every splendor, so on the other side we meet with all possible malicious persecution and suffering. It is for this reason that patient requests an indemnity which she expresses by "I belong to payment," which is synonymous with "the payment belongs to me." In consequence of her distress (Not) she claims bank notes (we shall refer to this pun later). Her complaints are of the physical injuries which are common to paranoid states. What the psychological root of the sufferings described may be I am unable to say.
2. Hieroglyphical (stereotype: "I suffer hieroglyphical"): Just now I suffer hieroglyphical. Mary (nurse) said that I should remain today in the other ward, Ida (nurse) said that she could not even do the patching, it was only due to my kindness that I did the patching—I am in my house and the others live with me—I affirm the asylum sixfold, not that I am capricious to remain here, I was forced to remain here—in the church yard I also affirmed the house—fourteen years I was confined so that my breath could nowhere come out—that is suffered hieroglyphically—this is the highest suffering—that not even the breath could come out—yet I affirm everything—and I don't even belong to a little chamber—that is suffering hieroglyphically—through speaking trumpets which are directed outward.
From this analysis, which was interrupted by an intermezzo with nurses, we are unable to see what she means by "hieroglyphical," though she illustrates by examples. During another analysis of this neologism she says "I suffer in an unknown manner that is hieroglyphical." This explanation is quite sensible. Hieroglyphics for the uneducated is the proverbial example for the incomprehensible. Patient does not understand why and to what end she suffers. It is a hieroglyphical suffering. To be confined for fourteen years so that "not even the breath could come out" seems nothing but a very exaggerated apostrophizing of her being forced to remain in the asylum. The suffering through "speaking trumpets which are directed outwards" seems to refer to the voices from the "telephone." Another interpretation may also be possible.
3. Discord (stereotype: "It is such a great discord"): Discords—it is even criminal—I have to be cared for—I saw in a dream how two persons twisted two cords in the loft—these are two such big discords—I have to be cared for—discords can by no means go any more on this floor—it is too great discord that they don't wish to care for me—they made laces in the loft and worked on without thinking or caring for me—discords come from negligence—discords do not belong to this floor, but to Siberia—it is the highest time that I should be cared for, I have consumption—instead of providing for me now the bank title—they always continue to work—both have accidentally made laces in the loft.
"Discord" seems to express something like "precarious states." Patient especially feels precarious because the doctor never wishes to hear anything regarding the payment which she demands at each visit. She then mostly complains about the selfishness of humanity who only think of themselves and "always continue to work on" without thinking of the payment. The dreamlike intermezzo of the two men who were twisting two cords in the loft and "always continued to work" without thinking of caring for patient can be conceived as a symbol for the indifference with which patient is here treated. "Siberia" also points to the bad treatment. In spite of the splendid health which she on another occasion claims to enjoy she considers herself "consumptive." But just like all other self-evident absurdities these too do not conflict. Dementia præcox has also this in common with normal dreams. Moreover it can also be observed in hysterics and in somewhat emotional normal individuals; as soon as they mention their complex they talk in a contradictory manner. The reproduction of complex-ideas is always disturbed in this or that direction or it is falsified. Judgment concerning the complexes is almost always somewhat clouded or uncertain. Everyone who occupies himself with psychoanalysis knows this.
4. Monopoly (stereotype: "I am Schiller's Bell and the monopoly or bank monopoly"): With me it expresses itself in the bank note factory—very black windows—I saw that in my dream—that is paralysis—seven floored note factory—it is a double house, a front one, and the back is the residence—the note factory is real American—the factory is drawn into the monopoly just as, for example, also Schiller's bell and the monopoly—the monopoly includes in itself all that can happen—all diseases which are due to chemical products, poisonings without seeing anyone, then attacks of suffocation—from above it is credible—again the awful extension—they always spread me out—with these victuals one cannot get such a figure—the awful system of burdening as if there were tons of iron plate on the back—then the poisoning, it is invisible—it is shot through the window—then as if one were in ice—the pains in the back, this too belongs to the monopoly—as Schiller's bell and monopoly Forel should have paid me eighty thousand nine years ago, because I had to pass through such pain—I am in need of immediate help—monopoly is a conclusion of all innovations since 1886, chemistry productions, ventilations and sleep deprivations—a government would be forced without this to give immediate help—I affirm a note factory—even if I were not "world proprietress" the state would be compelled to bring help—as "world proprietress" I should have already fifteen years ago paid out with gentlemen through the note factory, forever, as long as I live—therefore it is such a great loss if one has to die only a year earlier—since 1886 the oleum belongs to me—all those who pass through such suffering, should be advanced, have to be advanced to the note factory, to the payment—such innovations are all comprehended in the word monopoly just as there are people who have the powder monopoly."
The sense of monopoly is again a very indistinct one. It is associated with a series of tortures. To this distress (Not) also belongs the "note factory." The patient emphasizes repeatedly that she needs immediate help. The often-mentioned "payments" are connected with "she has to be advanced to payment on account of her great suffering." The probable trend of thought should be as follows: her unheard of and unique suffering, as well as her advanced age, demand that she should once for all be given her rights, which she probably designates by the idea "monopoly." The special content of monopoly is that patient as "world proprietress" is alone entitled to manufacture bank notes. The psychological connection is probably through the sound associations Not (distress)—notes.
5. Note factory: this is the creation of circumstances on account of too great distress (Not)—the notes are of the same value as the moneys—all that is necessary to order—banknotes to alleviate the greatest (Not) distress—payments of wealth circumstances—I should with the town through life—the note factory should at all events be on our soil—I with four gentlemen should forever pay out with it—it would be a great loss to die one year earlier than is necessary, etc.
We can be satisfied with this fragment of the much longer analysis originally made. I believe it is clear whence the conception of "bank note factory" originates. Bank notes mitigate the (Not) distress. In this way another sound-symbolic connection was created, as so frequently happens in dreams. Thus one complex assimilates the other, and the two complexes are condensed in the words Not (distress) and bank notes, so that one conception always contains the other. It is quite characteristic of dreamlike ideation, that the most banal resemblances give cause for condensation. Two simultaneously existing complexes always blend also in normal conditions, especially in dreams, where the tertium comparationis may be any superficial resemblance. The money complex and the distress complex are both related as to contents; for this reason alone they must blend; distress (Not) and bank notes on account of their sound-association gain as to contents even greater significance. This type of thinking, as all psychiatrists know, is met with not only in dementia præcox, but in many other obscure manifestations. I call attention, for example, to the mystical interpretation of the name "Napoleon."
6. Oleum: belongs to the title "eternal"—it is for an old age—if I die, the title is gone, everything is gone—it is a somewhat longer duration of office of life—oleum serves toward prolonging—it belongs to me, but I don't know of what it is composed—one affirms the age—already since 1886.
Oleum seems to be an elixir of life which is to prolong the precious life of the patient. The expression "duration of office of life" is quite a characteristic pleonasm of patient. We see in this mainly the hazy thinking which joins together two totally different ideas. It also shows the pronounced tendency of patient to express herself as learnedly as possible (court language), a thing also common to many normal persons who strive to assume an air of special importance, as for instance in minor official reports. The pompous style of the courthouse or of half-educated journalists may under circumstances offer similar productions. Such individuals and the patient both exhibit a striving towards importance. The origin of the word "oleum" I do not know. The patient claims to have heard it from the voices just as she heard "monopoly." The creation of such productions is frequently due to fortuitous coincidences. (Compare "Japansünder.")
7. Hufeland (stereotype: "I affirm a million Hufeland left," etc.): Whoever belongs to Hufeland is universal, a millionaire—on a Monday between eleven and twelve o'clock I slept and affirmed a million Hufeland to the left on the last fragment of earth up on the hill—to this belong the highest qualities—wisdom—many people make themselves sick, this is really a great loss—as is known, one of the most prominent doctors, who affirms, what is true in life—seven eighths make themselves sick through unwise things—the million belongs in the realm of the million for distinction—a million on the last fragment of earth—you have also two sides doctor, that now concerns left—they would have had to pay me a million—this is extraordinary—the empty lazy people do not belong here—the money always goes into false hands—these are the deadly enemies of Hufeland, the empty, lazy, unwise—Hufeland is extraordinarily famous—to be a Hufeland is so mighty, to feel one's self quite healthy or quite sick, yes the will power does a lot—the highest essence of man is necessary in order to be Hufeland—perhaps doctor, you do not belong to Hufeland—Hufeland has no relations to cruelty, not at the present time—they also conditioned away my underskirt—and but only two bed sheets, that is unhufeland, that is murdered, if they make one violently ill—I once had an abstract from him, it is beautiful to read, how he agrees with every fiber of life—I am Hufeland—to Hufeland belong no cruelties.
Patient is "Hufeland"; we know her usage of speech and know, therefore, that that means that there is something in her relations which may be symbolically expressed by "Hufeland." She once read about Hufeland and therefore knows that he was a celebrated doctor. Perhaps she knows something of his "Makrobiotik," as is suggested by "will power does so much." It is unhufeland to take away her skirt and to receive only two bed sheets. In this manner she gets a cold, and this happens by the doctor's orders. Only a bad doctor who is no Hufeland can order such things. I was the physician and therefore she says: "You have also two sides doctor—perhaps you do not belong to Hufeland, doctor." The adjective "unhufeland" is most noteworthy, it has the meaning of "not in accordance with Hufeland." She employs the word "Hufeland" like a technical term, just as the surgeons say "We will do a Bier here" (sc. Bier's stasis) or a "Bassini" (sc. Bassini's operation), or, as the psychiatrists would say, "this is a Ganser" or "this symptom gives the impression of a Ganser" (sc. Ganser's symptom-complex). In the word "unhufeland," therefore, only the prefixed "un" is the pathological formation. The many complaints of the patient about unjust cruel treatment will justify the supposition that she wishes a "Hufeland" for her doctor. This thought may also be expressed quite well by the fact that she designates herself as "Hufeland": such a metonymy as we have seen is not at all unexpected. The idea of bad, unhygienic and dangerous treatment always associates with it "payment" which patient apparently conceives as a sort of indemnity. She does not make herself sick as seven eighths of the others do, but she is made "violently" sick. Probably for this reason a million should be paid to her. With this we approach the sense of her stereotype, "I affirm a million Hufeland to the left on the last fragment of earth," etc. The meaning of "left" in this stereotype is not quite clear to me. As in "oleum" we meet again the complex of death-expectation. The "Makrobiotik" is therefore a further nuance in the idea of Hufeland. The stereotype "I affirm a million Hufeland to the left on the last fragment of earth on the hill above" must therefore be a peculiar metaphoric paralogic condensation ("ellipse") for the sentence: For the bad treatment of the physicians which I have to endure here and with which I am tortured to death, I claim a high indemnity.
8. Gessler (stereotype: "I suffer under Gessler"): Gessler's head is set up here below, I saw it in the dream—Gessler is the greatest tyrant—I suffer under Gessler, William Tell is therefore the greatest tragedy in the world, on account of such personalities as Gessler—I shall tell you what he exacted of the people—he demanded that they should have always the same linen and clothing and never the smallest coin he was always for war, for battle—all cruelties, which these battles legalize—to cause, I suffer under Gessler, he is a tyrant, there are people who are quite inadmissible, of unnatural lack of reason and bloody cruelty. For three fourths of a year I should have had trimmings on my coat—it was only not given to me, that is Gessler, yes, Gessler—bloody cruelty.
Patient uses the word "Gessler" just as she used "Hufeland" as a technical term, with which she distinguishes the petty disturbances of everyday asylum life, under which she imagines she suffers. The tertium comparationis, which this metaphor has taken from "William Tell" is the humility which Gessler exacted from the people. It is interesting to see how this thought immediately blends with the personal vexations of the patient. Gessler does not demand of the people to greet the set up hat, but "to have always the same linen and the same dresses." Patient then assimilated completely the scene from William Tell to her own complex.
9. Schiller's bell (stereotype: "I am Schiller's bell and the monopoly"): That is then—as Schiller's bell I am also the monopoly—Schiller's bell is in need of immediate help—he who achieved this is in need of immediate help—belong to the highest title of the world—includes the greatest conclusion in itself—is in need of immediate help. All who affirm this are at the end of life and have worked themselves to death—immediate help is necessary. Schiller is the most celebrated poet—for example William Tell is the greatest tragedy—I suffer under Gessler—that is really famous—the poem, the bell—this really affirms the whole creation—creation of the world—this is the greatest conclusion. Schiller's bell is the creation—the highest conclusion—that is a state's groundpostament—the world should now be in the best of conditions—we have examined everything so practically and so thoroughly. Schiller's bell is the creation—the work of powerful masters—the world was helped out of misery—it should be in the best conditions.
As can be readily seen the tertium comparationis is the greatness of the accomplishment. Schiller's masterpiece is the Bell; the patient too has created something exceedingly great, hence resembling Schiller's Bell. Following her familiar practice of thought and speech the condensation takes place without any further considerations, and the patient is then Schiller's Bell. Because the patient now created her greatest and utmost work ("the world was helped out of misery"), therefore nothing greater can follow, besides she is of advanced age. It is therefore no wonder that the complex of death-expectation becomes manifested (even among normal persons at such an age it plays no small part), and she then urges "immediate help," whereby she naturally means the payment. By way of instructive intermezzo I may mention here that the patient took it very much amiss of the former superintendent Forel because he did not give her the "payments." Once during an analysis she said: "I saw also in my dream how Mr. Forel was struck by a bullet by means of which he caused his own death—that is really awfully stupid—one has not always continued to do thus, if one really affirmed the note factory." Patient rids herself of her enemies by shooting them in her dreams. I mention this example, not because it is of interest for the psychology of our patient, but because it is the usual typical way by which normal and morbid individuals rid themselves in their dreams of persons who stand in their way. We can repeatedly confirm this in our analysis of dreams.
I content myself with these nine analyses, they ought to suffice for a general view of the patient's painfully accentuated complexes. Her principal sufferings play an important part, such as "the burdening system" and the "paralysis," etc. The following thoughts express themselves in the stereotypies: she suffers under the discipline inflicted by the doctors and under the treatment of the nurses. She is not recognized, and her merits are not rewarded in spite of the fact that she created the best of everything. Of great significance for the determination of various stereotypies is the complex of death-expectation which she attempts to appease by "affirming" an elixir of life. A person with vivid self-consciousness who was for any reason forced into such a hopeless and morally annihilating situation would probably dream in a similar manner. Every emotional and aspiring individual experiences moments of doubt and apprehension in the very hours of his keenest self-confidence, during which any reverses of his hopes seem exceptionally heavy. The ideas of injury are therefore the usual compensation for over-estimation, and we rarely meet one without the other.
C. The Sexual Complex.
The analyses thus far have shown us in the main the obverse and reverse of the social aspirations, but we have not as yet encountered the most frequent and most usual complex manifestations, namely, those of sexuality. Wherever there exists such a richly developed complex symbolism there can be no lack of the sexual complex. Indeed it is present and is also perfectly developed, as will be seen in the following analyses.
i. Stuart—I have the honor to be a Stuart—it is so described, when I once mentioned it Dr. B. said, why she was beheaded—von Stuart, Empress Alexander, von Escher, von Muralt—this is also the greatest tragedy in the world—our all potent deity in heaven, the Roman Mr. St.[9] expressed himself in the most painful expressions, and with the greatest indignation about this most abominable intention of the world which pursues the life of the innocent beings—thus my eldest sister had to come here so innocently (from America) so as to die—then I saw her head on the side of the Roman deity in heaven—why it is abominable that a world should come to light which pursues the life of innocent beings—Miss S. caused me consumption—it is for that reason that I saw her lying in the hearse, a Mrs. Sch. whose fault it is that I am here was near her—it is incredible that the world is not freed from such monsters. Mary Stuart was also such an unfortunate who had to die innocently.
The last sentence shows clearly why patient happened to condense herself with Mary Stuart. We again have here an analogy only. Miss S. is an inmate of the asylum with whom patient could not agree. She therefore, like the other person who was the cause of her confinement, is in the "hearse." Whether we deal here with a delusion, a dream, or a hallucination makes no difference, it is the same mechanism as above (Forel). A remarkable figure in this analysis is the "Roman Mr. St., the most potent deity in heaven." We have seen above that patient bestows upon herself the title "God," we have therefore in this connection a firm association with the idea of deity. Here we get another link, the name of the highest deity is "St." as is also the name of patient. The predicate "Roman" probably has to thank for its origin the vague analogy to "Pope." The deity like the Pope is of masculine gender and differentiates itself from the patient as "God." Next to the masculine deity, which name is apparently meant to express a close relation to her family, she sees the head of her deceased sister, a picture which reminds one of the two pagan deities Jupiter and Juno. She therefore in a way marries her sister to the godly Mr. St. This seems nothing more than an analogy, it is a presagement of her own ascension, where she will become (the sexually not indifferent) queen of heaven, Mary, mother of God, symbolizing the earthly mother. Such a sublimation of the very worldly matrimonial desire is, since the oldest Christian epochs, a loving toy of woman's dreams. From the Christian interpretation of the Song of Songs to the secret rapture of St. Catherine of Siena and the marriage of Hauptmann's "Hannele" it is always the same theme, it is the prelude in heaven to the earthly comedy. To represent one's own complexes in strange actors, as seen in dreams, is a recognized fact even by those investigators of dreams who absolutely reject Freud's theories. As transitivismus it is not at all unknown in psychopathology. The above intrepretations I express hypothetically, hoping to confirm them in the following analysis.
2. Stereotype: "I came at first with the deaf and dumb Mr. W. from the city and first also with Uster." I came for example at first with the deaf and dumb Mr. W. from the city—you go here with Mrs. W. Uster—I am Uster—to guard against mistakes I state to you who must accept my interest draughts from Uster—a Mr. Grimm—Uster, Jud, Ith, and Guggenbühl have to accept my interest draughts—I came at first with the deaf and dumb Mr. W. from the city and first also with Uster—that is equal interest draughts—that is the equilibrium with the interest draughts from Uster. I affirm the churches of the city to guard the money. Mr. K. in M. manages my money in St. Peter. There I see the deaf and dumb Mr. W. near St. Peter, in dream one Sunday while I slept—Mr. W. can give information about the last penny belonging to me. Mr. W. belongs to the city and not to Uster—I came at first with the deaf and dumb Mr. W. from the city and at first also with Uster—that is double—equilibrium.
By "city" the patient naturally means Zürich. Uster is a small prosperous and industrious town near Zürich. Mr. W. is unknown to me, hence I cannot speak about his more intimate determinations. The essential content of the above analysis lies in the first three sentences. Mr. W. "can give information about the last penny" of patient. He is therefore in her dreams firmly associated with her wealth and indeed as it appears in the above analysis with her sums deposited in her Zürich churches. (The patient once dreamed that the church of St. Peter was filled for her up to the roof with five franc pieces.) This wealth is compared with that of Uster. We know already that everything pleasing to patient is affirmed. Among the things affirmed we find large business houses of the city, and among others the whole Bahnhof street of the town of Chur. It is therefore no wonder that she "affirms" also the prosperous factories in Uster, hence she says "I am Uster," she also says "I am Chur." Furthermore she said to me "You go with Mrs. W. Uster—I am Uster." This clears up matters. She simply indicates by this that she is married to Mr. W. Through this marriage she unites all the wealth of Zürich and Uster. "That is double equilibrium with the interest draught from Uster." I wish to recall the former use of "double" which was there incomprehensible; here we can attach to it a satisfying erotic sense. The marriage which in the former analysis was simply indicated by transcendental symbols is here effected in a rather prosaic manner. The real, I might say, the coarse symbols are still lacking. We shall, however, find them in the following analysis.
3. Amphi.—This word comes to the surface but rarely in the form of "doctor this is again too much amphi." Patient rather vaguely deduces this word from "amphibian." If she occasionally complains about being disturbed at night by amphi and when asked to explain it, she talks about "a ritze-ratze animal," which "gnaws the floor"; it is, however, impossible to discover what harm "amphi" occasions her.
Amphi—that expresses itself in hedge hog, so broad and so long (indicating about a foot in length and somewhat less in breadth)—one morning, Mr. Zuppinger, through pork sausages—now I don't know if the men purposely wish to bring to the world such an animal—I affirmed this through pork sausages—I
always hear: that is too much amphi. The animal might have
become so big only through mistake—it must be in the evacuation (stool)—instead of a factory in S. there was a building for
amphi—for productions—I saw in my dream in Weggen St. on
an arch it was written "only by well replenished tables after
supper"—I never saw such production—it requires a great
building—one seemed like in a theater—there above—I think
that all kinds of animals will be named—amphi expresses that
the animals have probably human reason—they can make themselves understood like human beings—they are really amphibians, snakes and that kind—the hedge hog is so long (indicates with her hands a little less than a foot), and Sunday morning it came creeping to the well—yes, Mr. Zuppinger—that was through pork sausages—Mr. Zuppinger ate pork sausages. While I once affirmed in my dream 1,000 millions, a green little snake came as far as my mouth—it had the finest, loveliest sense, just as if it had human reason, and wished to tell me something—just as if it wished to kiss me (at the phrase "a green little snake" patient manifested vivid symptoms of affect, such as blushing and timid laughing).
From the peculiar content of this material we ought to understand without anything further what the meaning of amphi is. Amphi is manifestly an animal of oblong form, it creeps, it is associated with amphibians, snakes, hedge hogs, probably also with "pork sausages." Moreover amphi is also associated with "men" ("whether the men purposely wished to bring to the world such an animal"), and especially by pork sausages with "Mr. Zuppinger," about whom I was unable to obtain any more information from patient. The comparison of two passages will be of special value for the explanations.
The hedge hog is so long and came on Sunday morning, creeping up to the well—yes Mr. Zuppinger that was through "pork sausages." Mr. Zuppinger has eaten pork sausages.
While I once in my dream affirmed 1,000 millions, a green little snake came up to my mouth, it had the finest, loveliest sense, as if it had human reason and wished to say something, as if it wanted to kiss me.
It is no difficult task for the dream to condense, much less to make an analogy of two objects having an external resemblance. Such an analogy seems to exist between the kissing snake and the eating of pork sausages. The word "kiss" which produced a vivid affect in patient gives to the analogy the unmistakable sexual tinge. If a real plastic presentation is made of the process how the snake creeps to the mouth in order to kiss it, one will inevitably be struck by the symbol of coitus. According to the known mechanism of Freud "the transposition from below to above," this localization and interpretation of the act of coitus is a preferred one. This mechanism we have found in a number of both normal and psychological cases.[10] If the symbol of coitus is localized in the mouth the vague dreamlike fancy readily merges in the direction of eating, and it is for this reason that this act too is frequently drawn into the symbolism of coitus.[11] Hence it is readily understood why under this constellation the snake is changed into an edible sausage.[12] "Eating" should therefore be the analogue of kissing. The hedge hog plays the special part of an oblong animal. By its creeping to the well it seems to be blended with the snake presentation. Mouth, however, is represented by "well." Mouth can be understood as a sexual symbol if one assumes a "transposition from below to above," "well" on the contrary only if one assumes no transposition, but a figurative metaphoric designation on the basis of familiar analogy which the ancients have already applied to their fountains. Here then we encounter the "coarse sexual" symbols which we have thus far missed and which are as a rule extraordinarily prominent. Considering it from this point of view the individual details of the above association can be understood without any great difficulty. That "amphi" has human reason is not at all remarkable when it is meant to represent a man. Likewise can it be understood how the animal is "in the evacuation" (stool). There seems to be a vague analogy to an intestinal worm; the essential, however, is the localization of the symbol in the cloaca (Freud), which has already been expressed by another symbol, the "well." The obscure passage "only after a well-replenished table after the supper" belongs to the
sexual symbolism of eating. The nuptial night generally follows
a good supper. As an old maid, the patient is able to say calmly,
"I never saw such a production." In the expression "theater"
and "animals of all kinds," one gets the feeling as though there
is a presentation of a menagerie. The expression "a factory
in S." also points to this, as S. near Zürich is the usual location
for menageries, carrousels, etc.
4. Maria Theresa.—I belong to the synagogue in Löwen street
since 1886, I am a Jewess since 1886—world proprietress—I am
therefore three Empresses—I am also Maria Theresa as von
Planta—that is conclusion—in my dream I was at a table with
omelets and dried plums—then there was a dam with speaking
trumpets in it—then there were four horses with mustaches over
their tails—they stood near the speaking trumpets—the third
Emperor has already legalized this—I am Emperor Francis from
the city of Vienna—in spite of that I am a woman—my Liesel
rises early and yodles in the morning—it is also there—every
horse stood near a speaking trumpet—(Patient suddenly goes
through the gestures of embracing someone and on being questioned she states that she once dreamed that a man took her in
his arms.)
This analysis, unlike the preceding one, was constantly interrupted
by obstructions (thought-deprivations) and motor stereotypies
(embracing), from which we may conclude that it concerns
particularly markedly repressed thoughts. The patient for
example described for some time with her index finger a circle
in the air, "she must show the speaking trumpets" or she designated
small half moons with both hands "these are the mustaches."
Besides this the "telephone" made mocking remarks,
to which we shall return later.
By "Maria Theresa" patient again understands a particular
quality of her greatness. This part of the analysis therefore
interests us no longer. We have here a peculiar dream formation which ends with "I am Emperor Francis." Emperor
Francis was the husband of Maria Theresa. Patient is Maria
Theresa and at the same time Emperor Francis, "in spite of her
being a woman." She condenses therefore the relations of both
persons into her own, which in her hazy way of talking probably signifies nothing more than that both persons stand in connection to each other and that this has some resemblance to her. The erotic reference, especially the wish to have a distinguished husband, is very prominent. That it is most probably erotic we can see by the association immediately following which is an erotic song, "my Liesel rises early in the morning." This song is immediately followed by the horses which "stood near the speaking trumpets." Horses as well as bulls, dogs and cats appearing in dreams are often sexual symbols, because it is with these animals that one is likely to see the coarse sexual procedures, a thing which even impresses children. In a similar manner patient connects the horses with Emperor Francis. This justifies the suspicion of an erotic complex. The horses have "mustaches on their tails." This symbol probably represents the masculine genitals and thus we can explain their relation to "Emperor Francis," the symbolic husband. Every horse stands near a speaking trumpet in a "dam."[13] I took pains to discover whether the patient was acquainted with the anatomical meaning of the word dam, but I was unable to come to any conclusion without using suggestive questions. I am therefore leaving the question in suspenso. But considering the patient's otherwise fair education the fact that she might know the meaning cannot be disregarded. The sense of speaking trumpets would then be a very definite one. In the gesture of embracing and the mentioning of the sexual dream, the situation takes on a definite erotic coloring, which elucidates much of the dark symbolisms of the aforesaid pictures.
5. Empress Alexander.—That speaks of von Escher and von Muralt—world proprietress—as Empress Alexander I become the proprietress of the silver island—Mrs. F. told me that I must send one thousand milliards to the family of the Russian Czar—I have ordered that they should make money exclusively of the silver islands—I am three Empresses, von Stuart, von Muralt, von Planta and von Kugler—because I am world proprietress I am Empress Alexander—I am three excellencies—I am the highest Russian lady—catheter, chartreuse, schatedral, carreau—I saw a carreau (square) of white horses on the hill—under the skin they had the half moon like little locks—they were hungry—Emperor von Muralt was also up there—I betrothed myself to him in my dream—these are Russians, that was a battle attack—on the horses were men like Mr. Sch. of U. with long lances—like a battle attack.
The first associations refer again to the grandiose ideas. The peculiar collection of sound associations like catheter, chartreuse, etc., leads over to a carreau of white horses, which although they had no half moon shaped mustaches over their tails, had however "half moons" under the skin "like little locks." We probably deal here with a similar but a more concealed sexual symbol. The horses are hungry; the association nearest to it is to eat. "Hunger" indicates a desire, perhaps a sexual desire (this recalls the sexual symbol "hungry dog" in Beitrag, VIII, Diagnost. Assoz.-Stud.). Unlike the former analysis the association does not touch the direct symbolic husband "Emperor Francis," but a similar distinguished synonym "Emperor von Muralt." The associations again go from the horse to the husband and this time the sexual reference to the man is obvious, inasmuch as patient asserts that she has betrothed herself to "Emperor von Muralt." The horses, too, now receive a characteristic attribute; they are mounted by men with "long lances"—like a battle attack. Whoever has analyzed dreams knows that whenever women dream of manly figures who come in the night into their rooms armed with daggers, swords, lances and revolvers, it is without exception a sexual symbol, in which the pricking or wounding weapons symbolically represent the penis. This dream symbolism can be encountered repeatedly in normal persons and in the diseased. I shall cite a case that I recently saw at the polyclinic. It is the case of a young girl who out of submission to her parents discontinued her love affair. She then suffered from depression with sporadic sexual excitements. Nightly she had stereotyped anxious dreams in which "someone" always came into the room with a long spear and struck her in the breast. In a similar case the patient repeatedly dreamed that she walked the street at night and that someone waylaid and shot her in the leg with a revolver. In dementia præcox we often find sensory hallucinations of knives in the genitals. The sexual significance of the horses in both this and the preceding analysis, as well as the meaning of "battle attack," ought to be quite obvious after the above explanation. The transition of the associations to "Russians" is not so remote in spite of the fact that mounted lancers are at present quite an unknown spectacle in Switzerland. The "Russians," especially the Cossacks of Suwarow from the days of the battle of Zürich, 1799, are, however, living figures of popular tradition to which many reminiscences of the older generations are attached. The "battle attack" is probably a synonym for the embrace of the former analysis. The word "hunger" probably conceals the thought of virile activity.
This analysis agrees in contents with the former, only the speech and the figurative symbols are changed.
The analyses thus far occupy themselves with the betrothal, wedding and coitus. The patient has plastically and forcefully elaborated all the details of the wedding celebration; she summarizes it in the expression: "I am the lilac—new—red—sea wonder and the blue." I withhold the representation of this dream formation, not wishing to indefinitely increase this already extensive analysis (the wedding celebration alone fills ten closely-written folios). What we lack now is the result of this sexual union, the children. These, however, appear in the following analysis.
6. Bazaar: double bazaar—I affirm two bazaars—W. bazaar in the Bahnhof St. and one on the strand—ladies work—the most wonderful tinware, glassware, all jewels, toilet soaps, purses, etc. Once in my dream Mr. Zuppinger shot out of my mouth as a little doll boy—he had no uniform but the others had military uniforms—these are Czars, the sons of the highest in Russia, represented as Czars, therefore the word bazaar—bazaars are extraordinarily good business—czars are dressed for such business, they have their incomes from these bazaars, because they are the sons of world proprietors and proprietresses—also a little girl jumped out of my mouth, with a little brown dress and a little apron—the little daughter was allotted to me—oh, God, the representation—it is the representation, the end of the insane asylum came out of mouth—the little daughter was shot out of the mouth until the end of the insane asylum—it is already slightly paralyzed, sewn together with rags—it belongs to a bazaar—do you know these businesses have a great income, I came first as double, as the only world proprietress, first with the deaf and dumb Mr. W. from the city and then with Uster—I am the double bazaar. (In a later partial repetition of the analysis patient says: "Both children look like dolls, their names I also have from the bazaar.")
As is shown by the contents of this analysis there is no dout that the delusions also created children for the patient. The more intimate circumstances and determinations of these delusional formations are especially interesting. While prolixly enumerating the contents of the show cases of the bazaar (only slightly indicated above) patient stated that in her dreams Mr. Zuppinger shot out of her mouth as a little doll boy. It recalls the third analysis of this paragraph where Mr. Zuppinger is firmly associated with all kinds of sexual symbols. We apparently deal here with the results of these delusional references. This peculiar way of representation is historical with the patient. As early as in 1897 it is noted in patient's history that the first assistant, Dr. D., who was at that time revered by the patient, "came out of her mouth"; that is, "the very tiny D., the son of the Emperor Barbarossa." Dr. D. had a reddish beard which probably aided the formation of "Barbarossa." The advancement to the position of Emperor, which is probably a symbol of high estimation as well as veneration, has been transferred to Dr. von Muralt, the successor to Dr. D. (Emperor Muralt, with whom patient betrothed herself). The above passage can be easily conceived as the birth of a son from Dr. D. The event with Mr. Zuppinger is construed on the same plan. The manner of birth, that is, the child stepping out of her mouth, is an evident confirmation of the "transposition from below to above," and therefore firmly supports our view about the snake and the mouth as given under "amphi." That the little boy, Mr. Zuppinger, has some connection with this gentleman agrees perfectly with the sexual significance advanced above. Referring to the child as "little doll boy" is explained by its connection with "bazaar" in the show windows of which dolls can be frequently seen. Just as the mouth is a complex-representative for genitals, so is "doll" a more harmless complex-representative for "child," a thing quite usual in ordinary life. "He had no uniform on," "they are Czars," etc.—these sentences seem to contain a reminiscence from the preceding analysis, No. 5, where the critical "battle attack" of the lancers stands in close associative connection with the "Russians," hence the transition to Czar. By sound-association the patient again finds the way back to "bazaar," a very characteristic train of thought in the obscure ideation of dementia præcox. The sentences "the bazaars are extraordinarily good business," and "the Czars have their incomes from these bazaars," in which is the sound-association Czar—bazaar, give to the patient an apparently sensible connection. She says "the sons of the highest in Russia represented as Czars, therefore the word bazaar." This formation is another "contamination." Patient "affirms" all bazaars as her property just as she "affirms" all good business houses. She is a Czarina just as she is all the other eminent personalities.
The special determination of this dignity emanates perhaps from the lancers. These two diverse trains of thought apparently flow together by clang-association, and so we have the Czars as owners of bazaars. As the "battle attack" of the lancers results in a son this son becomes a Czar and is furnished with a bazaar.
The strong tendency of dreams to analogical formations leads, just as in the other sexual symbols, to the formation of a second delusional birth, a little girl is born out of the mouth. It wears "a little brown dress with a little black apron." That is the way the patient generally dressed. This way of dressing has since long been displeasing to her; hence she often complains, and in her dreams she has already "affirmed" a very rich wardrobe. The passage "just as sewn together with rags" refers to this. The similarity of mother and daughter is crowned by the fact that the child is already slightly paralyzed. It is therefore subjected to the same afflictions as the patient. The child was allotted to her "as a representative," that is, by virtue of which resemblance it, so to speak, takes upon itself the vicissitudes of the patient. Through it the patient becomes absolved from the suffering of the insane asylum; hence patient can in a transposing sense say "the end of the insane asylum came out of my mouth." In another rather remotely transposed sense patient says that the child is the "Socrates representation." As will be recalled the patient identifies herself with Socrates, as he, just as she, was unjustly imprisoned and suffered. He was imprisoned, while she is in an insane asylum. The daughter then takes the part of Socrates, and hence she becomes a Socrates representation. This explains perfectly that peculiar and rather incomprehensible neologism. In order to complete the analogy the little daughter by way of indemnity receives a bazaar, as did also the son, the Czar. The idea of the double bestowing of bazaars leads to the expression of patient, "I came first as double—I am the double bazaar." She adds to it a well-known Uster stereotype which has a distinct sexual sense. "Double " may also have a variously determined sexual sense, that is, the sense of marriage.
In the further course of this analysis, which for the sake of brevity I have not reported in extenso, the patient continues to develop the thought of caring for her children and expands it also to include her parents who died in poverty. "With me the parents are dressed, the severely tried mother—I sat with her at the table—covered with white sheet—with abundance."
D. Summary.
The preceding documents show us how the patient brought up under sad domestic conditions, amid distress and hard labor, creates in her insanity an enormously complicated, wholly confused and senseless fantastic formation. The analysis which we have made, precisely as we would a dream analysis, shows a material which is centered in certain "dreamy thoughts," that is, in thoughts which, considering the personality and circumstances, can psychologically be readily understood. The first division of the analysis discusses the afflictions and their symbols, the second the wishes and their realization in symbolic pictures and events, while the third division treats of the intimate erotic wishes and the solution of this problem in the resignation of her power and suffering to the children.
Like a poet impelled by his inner impulses, the patient pictures to us in her symptoms the hopes and disappointments of her life. The poet, however, even in his metaphors, speaks the language of the normal brain, and therefore most normal persons understand him and recognize in his psychic productions the true reflections of his joys and sorrows. Our patient, however, speaks as if in dreams—I know of no better expression. The nearest analogy to her method of thinking is that of normal dreams which make use of the same or at least similar psychological mechanisms, and which no one can understand without paying homage to Freud's analytic method. The poet creates by means of rich expressions and mostly consciously, his thought follows a definite trend, whereas this uneducated and scantily-endowed patient thinks without any directing idea, in obscure dreamlike pictures and amid indistinct expressions. All this contributes to making the stream of thought as incomprehensible as possible. That every person is unconsciously a poet—especially in dreams—is a banal expression. In dreams he coins his complexes into symbolic forms, to be sure, but it is only in an aphoristic manner, and it only seldom reaches a more extensive or a more connected formation, as this requires complexes of poetic—or hysteric force. In our patient, however, we have long and extensively elaborated fancies which on the one hand are comparable to a great poem and on the other to the romances and fantastic pictures of somnambulists. The waking state of our patient just like that of the poet, is filled with fanciful formations, while in somnambulists the extension and the elaboration of the system mostly results in the dissociated "other" state of consciousness. But just as somnambulists prefer to translate into exquisite fantastic and many mystic forms, and often allow their pictures to fade into dreamlike imperfections, so does our patient preferably express herself in monstrous and grotesquely distorted metaphors, which resemble much more the normal dream with its characteristic absurdities. What our patient has therefore in common with the "conscious" poet and the "unconscious" poet, the somnambulist, is only the extension and constant elaboration of the phantasms, while the absurd, the grotesque, in brief the lack of all that is beautiful, appears to be taken from the dream of the average normal person. The psyche of the patient stands therefore psychologically about midway between the psychic state of a normal dreamer and a somnambulist, but with the exception that through serious injury of the "fonction du réel" and adaptation to the surroundings, the dream persistently replaces the waking state. How dream formations may grow out of complexes I showed for the first time in the little book, "Zur Psychologie und Pathologie sogenannter okkulter Phänomene.[14] I am obliged to refer the readers to this book, as it would lead me too far should I attempt to enter into this special domain. Flournoy[15] has at least indicated the complex-roots of the dreams of the familiar Helene Smith. For an understanding of the problems here touched upon I consider a knowledge of these phenomena indispensable.
The conscious psychic activity of the patient restricts itself to the creation of a systematic wish-fulfillment, as it were, as an equivalent for a life of labor and deprivation and for the depressing effects of an unhappy family milieu.
On the other hand the unconscious psychic activity is totally under the influence of the repressed contrasting complexes, on the one side under the complex of injury and derogation, on the other under the remaining fragments of normal censorship.[16] The entrance of fragments of these dissociated series into consciousness asserts itself principally in the shape of hallucinations in the manner described by Gross and from psychological roots as conjectured by Freud.
The associative phenomena correspond to the expositions of Pelletier, Stransky and Kraepelin. The associations, though following a vague theme, are without any directing presentation, and therefore show all manifestations of the "abaissement du niveau mental" of Janet, viz., liberations of automatisms (thought-deprivation and pathological fancies) and the diminution of attention. The result of the last is inability for clear presentations. The presentations being indistinct, no proper differentiation takes place and hence there result many errors—condensations, contaminations, metaphors, etc. The condensations result principally according to the laws of similarity of picture or sound, through which the connections of meaning are quite completely abolished. The metaphoric variations of the complexes result in a near analogy on the one side to the normal dream, on the other to the wish-dreams of hysterical somnambulists.
The analysis of this case of paranoid dementia therefore confirms in extenso the theoretical hypotheses set forth in the antecedent chapter.
E. Supplement.
In conclusion I take the privilege of calling attention to two special points. Let us first consider the expressions of speech. As is the case with normal speech, our patient's speech, too, shows a tendency to change. The new creations of language are in the main technical terms serving to designate in concise form certain complicated domains of ideation. In normal speech the formation of and habituation to new terms is usually a very slow process and their application is generally dependent on certain limits of intelligence and logic. The new speech formation and habituation process in the patient merged into a pathological acceleration and intensity reaching far beyond the understanding of her environment. The process of building up pathological terms shows a resemblance to the principles of change in normal language. Recall, for example, the changes of interpretation of the "Languedoc" dialect.[17] Many similar examples may be found in the history of language. Unfortunately I am not at home in this domain and do not dare search for further analogies. I feel, however, that a philologist would be able to make many important observations among patients with confused speech which would be of use in the study of the changes that have taken place in normal language in historical times.
Hallucinations of hearing play a particular part in the case of our patient. She elaborates her wishes of the day in the waking state, and at night in her dreams. It seems that she finds pleasure in this occupation, for it follows the direction corresponding to the inner inclinations of her personality. He whose thoughts run exclusively and perseveringly in a very definite and limited direction is forced to repress contrasting ideas. We know that in normal persons, or at least in tolerably normal individuals, such as moody men, though the same mood may continue for a long time, it is apt to be interrupted suddenly by an invasion with almost elemental force from another sphere of thought. We see this in its highest development in hysterics with dissociation of consciousness, where one state is not seldom suddenly replaced by the contrasting one. The contrasting state often manifests itself through hallucinations or other automatisms (comp. Flournoy), just as every split-off complex is wont to disturb the activity of another simultaneously existing complex. This may be compared to the disturbance caused by an invisible planet moving in the orbit of a visible one. The stronger the split-off complex, the more intensely will the automatic disturbances assert themselves. The best examples are offered by the so-called teleological hallucinations to illustrate which I should like to report three examples from my experience.
1. A patient in the first stages of progressive paralysis wished in his despair to kill himself by jumping from a high window. He got upon the window ledge, but at this moment there suddenly appeared in front of the window a powerful light, which practically threw him back into the room.
2. A psychopathic individual to whom, on account of some misfortunes, life became unbearable wished to commit suicide by inhaling gas from an open jet. He inhaled the gas forcibly for a few seconds, when he suddenly felt a heavy hand grasp him by the chest which threw him to the floor, where he gradually recovered from his fright. The hallucination was so impressive that the following day he could still indicate the place where he was grasped by the five fingers.
3. A Russian-Jew student, who later developed a paranoid form of dementia præcox, related to me the following: Under pressure of great unhappiness, he resolved to become converted to Christianity, although he was orthodox and entertained strong religious scruples against changing his faith. Finally, after a hard struggle, he determined to take the step. With this thought he fell asleep and dreamed that his dead mother appeared to him and admonished him against it. After his dream his religious scruples became stronger, so that he was unable to make up his mind to go over to Christianity. Thus he was wretchedly tormented for a few weeks longer until forced by his persistent distress he once more decided to apply for conversion. That night his mother again appeared to him in a dream and said, "If you do this I will choke you." This dream had such a terrifying effect on him that he definitely decided to desist from becoming a convert, and to escape his misery he emigrated to a foreign land. We see how in this case the repressed religious scruples made use of the strongest symbolic arguments, i. e., the veneration for the dead mother, and in this manner repressed the ego-complex.
The psychological life at all times is rich in such examples. As will be remembered, the Daemon of Socrates also played a teleological rôle. We may recall for example the anecdote in which the Daemon warned the philosopher against a herd of swine (in Flournoy we find similar examples). Dreams, the hallucinoses of normal life, are nothing more than a hallucinatory representation of repressed complexes. Thus we see that split-off thoughts have a tendency to crowd themselves into consciousness as hallucinations. It is therefore to be expected that we find in our patients that all contrasting complexes as a result of repression should effect consciousness by means of hallucinations. Their voices are therefore almost exclusively of a disagreeable and derogatory content, also the paræsthesias and other automatic phenomena have by preference a disagreeable character. As usual we also find in a patient near the complex of grandeur the one of injury or derogation. To the derogation also belongs the normal censorship of the grotesque grandiose ideas. That a censorship still exists seems a priori possible, for we see that patients who intellectually and emotionally are less well preserved than our patient still have an extensive insight into the disease. The censorship naturally contrasts with the grandiose complex which completely fills consciousness; it therefore probably acts from the repression by means of hallucinations. This really seems to be the case since at least some observations speak in favor of it. While the patient was telling me what a misfortune it would be for humanity if she as world proprietress should have to die before the payments the "telephone" suddenly said "it would do no harm, they would simply take another world proprietress."
While the patient during the association of the neologism "million Hufeland" was constantly troubled by thought-deprivation, and was unable to elicit anything definite, the "telephone" to the great chagrin of the patient called out "the doctor should not be bothered with such things." At the neologism "Zähringer," when the patient was having some difficulty with the associations, the "telephone" said "she is embarrassed and therefore she can say nothing." During an analysis when the patient remarked that "she was Switzerland" and I was forced to laugh, the "telephone" called out "that is going somewhat too far." During the association-test connected with the neologism "Maria Theresa," the patient was especially impeded and I could not follow her; things were really too complicated. The following colloquy took place:
Telephone: "You lead the doctor about the whole forest."
Patient: "Because it goes so far."
Telephone: "You are too smart."
At the neologism "Emperor Francis," the patient as usual began to whisper, so that I could not understand her. She was therefore required to repeat over aloud many sentences. I became somewhat nervous at this and told her impatiently to talk louder, to which she answered rather irritably. The "telephone" then said "now they will probably begin to pull each other's hair." Patient once said, emphatically, "I am the key stone, the monopoly, and Schiller's Bell," to which the "telephone" remarked: "This is so important as to cause a drop in the markets."
In these examples the "telephone" has the character of an ironical correcting spectator or censor, who is thoroughly convinced of the uselessness of the morbid machinations, and therefore mocks the patient's assertions in a rather superior tone. Such voices give the impression of a personified self-irony. Unfortunately in spite of zealous search I lack the necessary material for a closer characterization of this interesting dissociated personality. But this small material allows us at least the conjecture that besides the complexes of grandeur and injury, there exists still another complex which retains a certain normal censorship, but is prevented from reproduction by the complex of grandeur, so that no direct intercourse can be had with it. (Direct intercourse can be had with such personalities in somnambulists by means of automatic writing.)
This apparently three-fold division gives material for reflection, not only from the psychological, but also from the clinical side of dementia præcox. In our case intercourse with the outer world is controlled by the complex of grandeur. This could be quasi-accidental. We know many cases where the reproductions are controlled by the derogatory or persecutory complex and where we receive only intimations of the presence of grandiose delusions. Finally there are cases where a certain corrective, ironical, and fairly normal ego-remnant is in evidence, while the other two complexes perform in the unconscious and are only made evident by hallucinations. Single cases may from time to time vary according to this scheme. In Schreber for example we see during convalescence the reassertion of itself by the critical ego-fragment.
↑"Yes" as a complex indicator we found in an epileptic. See Beitrag III, Diagnost. Assoz.-Stud.