Chapter XII: Determinism, Chance, and Superstitious Beliefs 277 (5)

Similarly, to fall, to make a misstep, or to slip need not always be interpreted as an entirely accidental miscarriage of a motor action. The linguistic double meaning of these expressions points to diverse hidden fantasies, which may present themselves through the giving up of bodily equilibrium. I recall a number of lighter nervous ailments in women and girls which made their appearance after falling without injury, and which were conceived as traumatic hysteria as a result of the shock of the fall. At that time I already entertained the impression that these conditions had a different connection, that the fall was already a preparation of the neurosis, and an expression of the same unconscious fantasies of sexual content which may be taken as the moving forces behind the symptoms. Was not this very thing meant in the proverb which says, “When a maiden falls, she falls on her back?”

We can also add to these mistakes the case of one who gives a beggar a gold piece in place of a copper or a silver coin. The solution of such mishandling is simple: it is an act of sacrifice designed to mollify fate, to avert evil, and so on. If we hear a tender mother or aunt express concern regarding the health of a child, directly before taking a walk during which she displays her charity, contrary to her usual habit, we can no longer doubt the sense of this apparently undesirable accident. In this manner our faulty acts make possible the practice of all those pious and superstitious customs which must shun the light of consciousness, because of the strivings against them of our unbelieving reason.

(_f_) That accidental actions are really intentional will find no greater credence in any other sphere than in sexual activity, where the border between the intention and accident hardly seems discernible. That an apparently clumsy movement may be utilized in a most refined way for sexual purposes I can verify by a nice example from my own experience. In a friend’s house I met a young girl visitor who excited in me a feeling of fondness which I had long believed extinct, thus putting me in a jovial, loquacious, and complaisant mood. At that time I endeavoured to find out how this came about, as a year before this same girl made no impression on me.

As the girl’s uncle, a very old man, entered the room, we both jumped to our feet to bring him a chair which stood in the corner. She was more agile than I and also nearer the object, so that she was the first to take possession of the chair. She carried it with its back to her, holding both hands on the edge of the seat. As I got there later and did not give up the claim to carrying the chair, I suddenly stood directly back of her, and with both my arms was embracing her from behind, and for a moment my hands touched her lap. I naturally solved the situation as quickly as it came about. Nor did it occur to anybody how dexterously I had taken advantage of this awkward movement.

Occasionally I have had to admit to myself that the annoying, awkward stepping aside on the street, whereby for some seconds one steps here and there, yet always in the same direction as the other person, until finally both stop facing each other, that this “barring one’s way” repeats an ill-mannered, provoking conduct of earlier times and conceals erotic purposes under the mask of awkwardness. From my psychoanalysis of neurotics I know that the so-called naïveté of young people and children is frequently only such a mask, employed in order that the subject may say or do the indecent without restraint.

W. Stekel has reported similar observations in regard to himself: “I entered a house and offered my right hand to the hostess. In a most remarkable way I thereby loosened the bow which held together her loose morning-gown. I was conscious of no dishonourable intent, still I executed this awkward movement with the agility of a juggler.”

(_g_) The effects which result from mistakes of normal persons are, as a rule, of a most harmless nature. Just for this reason it would be particularly interesting to find out whether mistakes of considerable importance, which could be followed by serious results, as, for example, those of physicians or druggists, fall within the range of our point of view.

As I am seldom in a position to deal with active medical matters, I can only report one mistake from my own experience. I treated a very old woman, whom I visited twice daily for several years. My medical activities were limited to two acts, which I performed during my morning visits: I dropped a few drops of an eye lotion into her eyes and gave her a hypodermic injection of morphine. I prepared regularly two bottles--a blue one, containing the eye lotion, and a white one, containing the morphine solution. While performing these duties my thoughts were mostly occupied with something else, for they had been repeated so often that the attention acted as if free. One morning I noticed that the automaton worked wrong; I had put the dropper into the white instead of into the blue bottle, and had dropped into the eyes the morphine instead of the lotion. I was greatly frightened, but then calmed myself through the reflection that a few drops of a _two per cent_. solution of morphine would not likely do any harm even if left in the conjunctival sac. The cause of the fright manifestly belonged elsewhere.

In attempting to analyse the slight mistake I first thought of the phrase, “to seize the old woman by mistake,” which pointed out the short way to the solution. I had been impressed by a dream which a young man had told me the previous evening, the contents of which could be explained only on the basis of sexual intercourse with his own mother.[48] The strangeness of the fact that the Œdipus legend takes no offence at the age of Queen Jocasta seemed to me to agree with the assumption that in being in love with one’s mother we never deal with the present personality, but with her youthful memory picture carried over from our childhood. Such incongruities always show themselves where one fantasy fluctuating between two periods is made conscious, and is then bound to one definite period.

Deep in thoughts of this kind, I came to my patient of over ninety; I must have been well on the way to grasp the universal character of the Œdipus fable as the correlation of the fate which the oracle pronounces, for I made a blunder in reference to or on the old woman. Here, again, the mistake was harmless; of the two possible errors, taking the morphine solution for the eye, or the eye lotion for the injection, I chose the one by far the least harmful. The question still remains open whether in mistakes in handling things which may cause serious harm we can assume an unconscious intention as in the cases here discussed.

The following case from Brill’s experience corroborates the assumption that even serious mistakes are determined by unconscious intentions: “A physician received a telegram informing him that his aged uncle was very sick. In spite of important family affairs at home he at once repaired to that distant town because his uncle was really his father, who had cared for him since he was one and a half years old, when his own father had died. On reaching there he found his uncle suffering from pneumonia, and, as the old man was an octogenarian, the doctors held out no hope for his recovery. ‘It was simply a question of a day or two,’ was the local doctor’s verdict. Although a prominent physician in a big city, he refused to co-operate in the treatment, as he found that the case was properly managed by the local doctor, and he could not suggest anything to improve matters.

“Since death was daily expected, he decided to remain to the end. He waited a few days, but the sick man struggled hard, and although there was no question of any recovery, because of the many new complications which had arisen, death seemed to be deferred for a while. One night before retiring he went into the sick-room and took his uncle’s pulse. As it was quite weak, he decided not to wait for the doctor, and administered a hypodermic injection. The patient grew rapidly worse and died within a few hours. There was something strange in the last symptoms, and on later attempting to replace the tube of hypodermic tablets into the case, he found to his consternation that he had taken out the wrong tube, and instead of a small dose of digitalis he had given a large dose of hyoscine.

“This case was related to me by the doctor after he read my paper on the Œdipus Complex.[49] We agreed that this mistake was determined not only by his impatience to get home to his sick child, but also by an old resentment and unconscious hostility toward his uncle (father).”

It is known that in the more serious cases of psychoneuroses one sometimes finds self-mutilations as symptoms of the disease. That the psychic conflict may end in suicide can never be excluded in these cases. Thus I know from experience, which some day I shall support with convincing examples, that many apparently accidental injuries happening to such patients are really self-inflicted. This is brought about by the fact that there is a constantly lurking tendency to self-punishment, usually expressing itself in self-reproach, or contributing to the formation of a symptom, which skilfully makes use of an external situation. The required external situation may accidentally present itself or the punishment tendency may assist it until the way is open for the desired injurious effect.

Such occurrences are by no means rare even in cases of moderate severity, and they betray the portion of unconscious intention through a series of special features--for example, through the striking presence of mind which the patients show in the pretended accidents.[50]

I will report exhaustively one in place of many such examples from my professional experience. A young woman broke her leg below the knee in a carriage accident so that she was bedridden for weeks. The striking part of it was the lack of any manifestation of pain and the calmness with which she bore her misfortune. This calamity ushered in a long and serious neurotic illness, from which she was finally cured by psychotherapy. During the treatment I discovered the circumstances surrounding the accident, as well as certain impressions which preceded it. The young woman with her jealous husband spent some time on the farm of her married sister, in company with her numerous other brothers and sisters with their wives and husbands. One evening she gave an exhibition of one of her talents before this intimate circle; she danced artistically the “cancan,” to the great delight of her relatives, but to the great annoyance of her husband, who afterward whispered to her, “Again you have behaved like a prostitute.” The words took effect; we will leave it undecided whether it was just on account of the dance. That night she was restless in her sleep, and the next forenoon she decided to go out driving. She chose the horses herself, refusing one team and demanding another. Her youngest sister wished to have her baby with its nurse accompany her, but she opposed this vehemently. During the drive she was nervous; she reminded the coachman that the horses were getting skittish, and as the fidgety animals really produced a momentary difficulty she jumped from the carriage in fright and broke her leg, while those remaining in the carriage were uninjured. Although after the disclosure of these details we can hardly doubt that this accident was really contrived, we cannot fail to admire the skill which forced the accident to mete out a punishment so suitable to the crime. For as it happened “cancan” dancing with her became impossible for a long time.

Concerning self-inflicted injuries of my own experience, I cannot report anything in calm times, but under extraordinary conditions I do not believe myself incapable of such acts. When a member of my family complains that he or she has bitten his tongue, bruised her finger, and so on, instead of the expected sympathy I put the question, “Why did you do that?” But I have most painfully squeezed my thumb, after a youthful patient acquainted me during the treatment with his intention (naturally not to be taken seriously) of marrying my eldest daughter, while I knew that she was then in a private hospital in extreme danger of losing her life.

One of my boys, whose vivacious temperament was wont to put difficulties in the management of nursing him in his illness, had a fit of anger one morning because he was ordered to remain in bed during the forenoon, and threatened to kill himself: a way out suggested to him by the newspapers. In the evening he showed me a swelling on the side of his chest which was the result of bumping against the door knob. To my ironical question why he did it, and what he meant by it, the eleven-year-old child explained, “That was my attempt at suicide which I threatened this morning.” However, I do not believe that my views on self-inflicted wounds were accessible to my children at that time.

Whoever believes in the occurrence of semi-intentional self-inflicted injury--if this awkward expression be permitted--will become prepared to accept through it the fact that aside from conscious intentional suicide there also exists semi-intentional annihilation--with unconscious intention--which is capable of aptly utilizing a threat against life and masking it as a casual mishap. Such mechanism is by no means rare. For the tendency to self-destruction exists to a certain degree in many more persons than in those who bring it to completion. Self-inflicted injuries are, as a rule, a compromise between this impulse and the forces working against it, and even where it really comes to suicide the inclination has existed for a long time with less strength or as an unconscious and repressed tendency.

Even suicide consciously committed chooses its time, means, and opportunity; it is quite natural that unconscious suicide should wait for a motive to take upon itself one part of the causation and thus free it from its oppression by taking up the defensive forces of the person.[51] These are in no way idle discussions which I here bring up; more than one case of apparently accidental misfortune (on a horse or out of a carriage) has become known to me whose surrounding circumstances justified the suspicion of suicide.

For example, during an officers’ horse-race one of the riders fell from his horse and was so seriously injured that a few days later he succumbed to his injuries. His behaviour after regaining consciousness was remarkable in more than one way, and his conduct previous to the accident was still more remarkable. He had been greatly depressed by the death of his beloved mother, had crying spells in the society of his comrades, and to his trusted friend had spoken of the _tædium vitæ_. He had wished to quit the service in order to take part in a war in Africa which had no interest for him.[52] Formerly a keen rider, he had later evaded riding whenever possible. Finally, before the horse-race, from which he could not withdraw, he expressed a sad foreboding, which most expectedly in the light of our conception came true. It may be contended that it is quite comprehensible without any further cause that a person in such a state of nervous depression cannot manage a horse as well as on normal days. I quite agree with that, only I should like to look for the mechanism of this motor inhibition through “nervousness” in the intention of self-destruction here emphasized.

Dr. Ferenczi has left to me for publication the analysis of an apparently accidental injury by shooting which he explained as an unconscious attempt at suicide. I can only agree with his deduction:--

“J. Ad., 22 years old, carpenter, visited me on the 18th of January, 1908. He wished to know whether the bullet which pierced his left temple March 20, 1907, could or should be removed by operation. Aside from occasional, not very severe, headaches, he felt quite well, also the objective examination showed nothing besides the characteristic powder wound on the left temple, so that I advised against an operation. When questioned concerning the circumstances of the case he asserted that he injured himself accidentally. He was playing with his brother’s revolver, and _believing that it was not loaded_ he pressed it with his left hand against the left temple (he is not left-handed), put his finger on the trigger, and the shot went off. _There were three bullets in the six-shooter._

“I asked him how he came to carry the revolver, and he answered that it was at the time of his army conscription, that he took it to the inn the evening before because he feared fights. At the army examination he was considered unfit for service on account of varicose veins, which caused him much mortification. He went home and played with the revolver. He had no intention of hurting himself, but the accident occurred. On further questioning whether he was otherwise satisfied with his fortune, he answered with a sigh, and related a love affair with a girl who loved him in return, but nevertheless left him. She emigrated to America out of sheer avariciousness. He wanted to follow her, but his parents prevented him. His lady-love left on the 20th of January, 1907, just two months before the accident.

“Despite all these suspicious elements the patient insisted that the shot was an ‘accident.’ I was firmly convinced, however, that the neglect to find out whether the revolver was loaded before he began to play with it, as well as the self-inflicted injury, were psychically determined. He was still under the depressing effects of the unhappy love affair, and apparently wanted ‘to forget everything’ in the army. When this hope, too, was taken away from him he resorted to playing with the weapon--that is, to an unconscious attempt at suicide. The fact that he did not hold the revolver in the right but in the left hand speaks conclusively in favour of the fact that he was really only ‘playing’--that is, he did not wish consciously to commit suicide.”

Another analysis of an apparently accidental self-inflicted wound, detailed to me by an observer, recalls the saying, “He who digs a pit for others falls in himself.”[53]

“Mrs. X., belonging to a good middle-class family, is married and has three children. She is somewhat nervous, but never needed any strenuous treatment, as she could sufficiently adapt herself to life. One day she sustained a rather striking though transitory disfigurement of her face in the following manner: She stumbled in a street that was in process of repair and struck her face against the house wall. The whole face was bruised, the eyelids blue and œdematous, and as she feared that something might happen to her eyes she sent for the doctor. After she was calmed I asked her, ‘But why did you fall in such a manner?’ She answered that just before this accident she warned her husband, who had been suffering for some months from a joint affection, to be very careful in the street, and she often had the experience that in some remarkable way those things occurred to her against which she warned others.

“I was not satisfied with this as the determination of her accident, and asked her whether she had not something else to tell me. ‘Yes, just before the accident she noticed a nice picture in a shop on the other side of the street, which she suddenly desired as an ornament for her nursery, and wished to buy it at once. She thereupon walked across to the shop without looking at the street, stumbled over a heap of stones, and fell with her face against the wall without making the slightest effort to shield herself with her hands. The intention to buy the picture was immediately forgotten, and she walked home in haste.’

“‘But why were you not more careful?’ I asked.

“‘Oh!’ she answered, ‘perhaps it was only a punishment for that episode which I confided to you!’

“‘Has this episode still bothered you?’

“‘Yes, later I regretted it very much; I considered myself wicked, criminal, and immoral, but at the time I was almost crazy with nervousness.’

“She referred to an abortion which was started by a quack and had to be brought to completion by a gynecologist. This abortion was initiated with the consent of her husband, as both wished, on account of their pecuniary circumstances, to be spared from being additionally blessed with children.

“She said: ‘I had often reproached myself with the words, “You really had your child killed,” and I feared that such a crime could not remain unpunished. Now that you have assured me that there is nothing seriously wrong with my eyes I am quite assured I have already been sufficiently punished.’

“This accident, therefore, was, on the one hand, a retribution for her sin, but, on the other hand, it may have served as an escape from a more dire punishment which she had feared for many months. In the moment that she ran to the shop to buy the picture the memory of this whole history, with its fears (already quite active in her unconscious at the time she warned her husband), became overwhelming and could perhaps find expression in words like these: ‘But why do you want an ornament for the nursery?--you who had your child killed! You are a murderer! The great punishment is surely approaching!’

“This thought did not become conscious, but instead of it she made use of the situation--I might say of the psychologic moment--to utilize in a commonplace manner the heap of stones to inflict upon herself this punishment. It was for this reason that she did not even attempt to put out her arms while falling and was not much frightened. The second, and probably lesser, determinant of her accident was obviously the self-punishment for her unconscious wish to be rid of her husband, who was an accessory to the crime in this affair. This was betrayed by her absolutely superfluous warning to be very careful in the street on account of the stones. For, just because her husband had a weak leg, he was very careful in walking.”

If such a rage against one’s own integrity and one’s own life can be hidden behind apparently accidental awkwardness and motor insufficiency, then it is not a big step forward to grasp the possibility of transferring the same conception to mistakes which seriously endanger the life and health of others. What I can put forward as evidence for the validity of this conception was taken from my experience with neurotics, and hence does not fully meet the demands of this situation. I will report a case in which it was not an erroneously carried-out action, but what may be more aptly termed a symbolic or chance action that gave me the clue which later made possible the solution of the patient’s conflict.

I once undertook to improve the marriage relations of a very intelligent man, whose differences with his tenderly attached young wife could surely be traced to real causes, but as he himself admitted could not be altogether explained through them. He continually occupied himself with the thought of a separation, which he repeatedly rejected because he dearly loved his two small children. In spite of this he always returned to that resolution and sought no means to make the situation bearable to himself. Such an unsettlement of a conflict served to prove to me that there were unconscious and repressed motives which enforced the conflicting conscious thoughts, and in such cases I always undertake to end the conflict by psychic analysis. One day the man related to me a slight occurrence which had extremely frightened him. He was sporting with the older child, by far his favourite. He tossed it high in the air and repeated this tossing till finally he thrust it so high that its head almost struck the massive gas chandelier. Almost, but not quite, or say “just about!” Nothing happened to the child except that it became dizzy from fright. The father stood transfixed with the child in his arms, while the mother merged into an hysterical attack. The particular facility of this careless movement, with the violent reaction in the parents, suggested to me to look upon this accident as a symbolic action which gave expression to an evil intention toward the beloved child.

I could remove the contradiction of the actual tenderness of this father for his child by referring the impulse to injure it to the time when it was the only one, and so small that as yet the father had no occasion for tender interest in it. Then it was easy to assume that this man, so little pleased with his wife at that time, might have thought: “If this small being for whom I have no regard whatever should die, I would be free and could separate from my wife.” The wish for the death of this much loved being must therefore have continued unconsciously. From here it was easy to find the way to the unconscious fixation of this wish.

There was indeed a powerful determinant in a memory from the patient’s childhood: it referred to the death of a little brother, which the mother laid to his father’s negligence, and which led to serious quarrels with threats of separation between the parents. The continued course of my patient’s life, as well as the therapeutic success confirmed my analysis.

IX

SYMPTOMATIC AND CHANCE ACTIONS

The actions described so far, in which we recognize the execution of an unconscious intention, appeared as disturbances of other unintended actions, and hid themselves under the pretext of awkwardness. Chance actions, which we shall now discuss, differ from erroneously carried out actions only in that they disdain the support of a conscious intention and really need no pretext. They appear independently and are accepted because one does not credit them with any aim or purpose. We execute them “without thinking anything of them,” “by mere chance,” “just to keep the hands busy,” and we feel confident that such information will be quite sufficient should one inquire as to their significance. In order to enjoy the advantage of this exceptional position these actions which no longer claim awkwardness as an excuse must fulfil certain conditions: they must not be striking, and their effects must be insignificant.

I have collected a large number of such “chance actions” from myself and others, and after thoroughly investigating the individual examples, I believe that the name “symptomatic actions” is more suitable. They give expression to something which the actor himself does not suspect in them, and which as a rule he has no intention of imparting to others, but aims to keep to himself. Like the other phenomena considered so far, they thus play the part of symptoms.

The richest output of such chance or symptomatic actions is above all obtained in the psychoanalytic treatment of neurotics. I cannot deny myself the pleasure of showing by two examples of this nature how far and how delicately the determination of these plain occurrences are swayed by unconscious thoughts. The line of demarcation between the symptomatic actions and the erroneously carried out actions is so indefinite that I could have disposed of these examples in the preceding chapter.

(_a_) During the analysis a young woman reproduced this idea which suddenly occurred to her. Yesterday while cutting her nails “she had cut into the flesh while engaged in trimming the cuticle.” This is of so little interest that we ask in astonishment why it is at all remembered and mentioned, and therefore come to the conclusion that we deal with a symptomatic action. It was really the finger upon which the wedding-ring is worn which was injured through this slight awkwardness. It happened, moreover, on her wedding-day, which thus gives to the injury of the delicate skin a very definite and easily guessed meaning. At the same time she also related a dream which alluded to the awkwardness of her husband and her anesthesia as a woman. But why did she injure the ring finger of her left hand when the wedding-ring is worn on the right? Her husband is a jurist, a “Doctor of Laws” (_Doktor der Rechte_, literally a Doctor of Rights), and her secret affection as a girl belonged to a physician who was jokingly called _Doktor der Linke_ (literally Doctor of Left). Incidentally a left-handed marriage has a definite meaning.

(_b_) A single young woman relates: “Yesterday, quite unintentionally, I tore a hundred-dollar note in two pieces and gave half to a woman who was visiting me. Is that, too, a symptomatic action?” After closer investigation the matter of the hundred-dollar note elicited the following associations: She dedicated a part of her time and her fortune to charitable work. Together with another woman she was taking care of the rearing of an orphan. The hundred dollars was the contribution sent her by that woman, which she enclosed in an envelope and provisionally deposited on her writing-desk.

The visitor was a prominent woman with whom she was associated in another act of charity. This woman wished to note the names of a number of persons to whom she could apply for charitable aid. There was no paper, so my patient grasped the envelope from her desk, and without thinking of its contents tore it in two pieces, one of which she kept, in order to have a duplicate list of names, and gave the other to her visitor.

Note the harmlessness of this aimless occurrence. It is known that a hundred-dollar note suffers no loss in value when it is torn, provided all the pieces are produced. That the woman would not throw away the piece of paper was assumed by the importance of the names on it, and there was just as little doubt that she would return the valuable content as soon as she noticed it.

But to what unconscious thought should this chance action, which was made possible through forgetfulness, give expression? The visitor in this case had a very definite relation to my patient and myself. It was she who at one time had recommended me as physician to the suffering girl, and if I am not mistaken my patient considered herself indebted for this advice. Should this halved hundred-dollar note perhaps represent a fee for her mediation? That still remained enigmatic.

But other material was added to this beginning. Several days before a woman mediator of a different sort had inquired of a relative whether the gracious young lady wished to make the acquaintance of a certain gentleman, and that morning, some hours before the woman’s visit, the wooing letter of the suitor arrived, giving occasion for much mirth. When therefore the visitor opened the conversation with inquiries regarding the health of my patient, the latter could well have thought: “You certainly found me the right doctor, but if you could assist me in obtaining the right husband (and a child) I should be still more grateful.”

Both mediators became fused into one in this repressed thought, and she handed the visitor the fee which her fantasy was ready to give the other. This resolution became perfectly convincing when I add that I had told her of such chance or symptomatic actions only the previous evening. She then took advantage of the next occasion to produce an analogous action.

We can undertake a grouping of these extremely frequent chance and symptomatic actions according to their occurrence as habitual, regular under certain circumstances, and as isolated ones. The first group (such as playing with the watch-chain, fingering one’s beard, and so on), which can almost serve as a characteristic of the person concerned, is related to the numerous tic movements, and certainly deserves to be dealt with in connection with the latter. In the second group I place the playing with one’s cane, the scribbling with one’s pencil, the jingling of coins in one’s pocket, kneading dough and other plastic materials, all sorts of handling of one’s clothing, and many other actions of the same order.

These playful occupations during psychic treatment regularly conceal sense and meaning to which other expression is denied. Generally the person in question knows nothing about it; he is unaware whether he is doing the same thing or whether he has imitated certain modifications in his customary playing, and he also fails to see or hear the effects of these actions. For example, he does not hear the noise which is produced by the jingling of coins, and he is astonished and incredulous when his attention is called to it. Of equal significance to the physician, and worthy of his observation, is everything that one does with his clothing often without noticing it. Every change in the customary attire, every little negligence, such as an unfastened button, every trace of exposure means to express something that the wearer of the apparel does not wish to say directly, usually he is entirely unconscious of it.

The interpretation of these trifling chance actions, as well as the proof for their interpretation, can be demonstrated every time with sufficient certainty from the surrounding circumstances during the treatment, from the themes under discussion, and from the ideas that come to the surface when attention is directed to the seeming accident. Because of this connection I will refrain from supporting my assertions by reporting examples with their analyses; but I mention these matters because I believe that they have the same meaning in normal persons as in my patients.

I cannot, however, refrain from showing by at least one example how closely an habitually accomplished symbolic action may be connected with the most intimate and important part of the life of a normal individual.[54]

“As Professor Freud has taught us, the symbolism in the infantile life of the normal plays a greater rôle than was expected from earlier psychoanalytic experiences. In view of this the following brief analysis may be of general interest, especially on account of its medical aspects.

“A doctor on rearranging his furniture in a new house came across a straight, wooden stethoscope, and, after pausing to decide where he should put it, was impelled to place it on the side of his writing-desk in such a position that it stood exactly between his chair and the one reserved for his patients. The act in itself was certainly odd, for in the first place the straight stethoscope served no purpose, as he invariably used a binaural one; and in the second place all his medical apparatus and instruments were always kept in drawers, with the sole exception of this one. However, he gave no thought to the matter until one day it was brought to his notice by a patient who had never seen a wooden stethoscope, asking him what it was. On being told, she asked why he kept it there. He answered in an offhand way that that place was as good as any other. This, however, started him thinking, and he wondered whether there had been an unconscious motive in his action. Being interested in the psychoanalytic method, he asked me to investigate the matter.

“The first memory that occurred to him was the fact that when a medical student he had been struck by the habit his hospital interne had of always carrying in his hand a wooden stethoscope on his ward visits, although he never used it. He greatly admired this interne, and was much attached to him. Later on, when he himself became an interne he contracted the same habit, and would feel very uncomfortable if by mistake he left the room without having the instrument to swing in his hand. The aimlessness of the habit was shown, not only by the fact that the only stethoscope he ever used was a binaural one, which he carried in his pocket, but also in that it was continued when he was a surgical interne and never needed any stethoscope at all.

“From this it was evident that the idea of the instrument in question had in some way or other become invested with a greater psychic significance than normally belongs to it--in other words, that to the subject it stood for more than it does for other people. The idea must have got unconsciously associated with some other one, which it symbolized, and from which it derived its additional fulness of meaning. I will forestall the rest of the analysis by saying what this secondary idea was--namely, a phallic one; the way in which this curious association had been formed will presently be related. The discomfort he experienced in hospital on missing the instrument, and the relief and assurance the presence of it gave him, was related to what is known as a ‘castration-complex’--namely, a childhood fear, often continued in a disguised form into adult life, lest a private part of his body should be taken away from him, just as playthings so often were. The fear was due to paternal threats that it would be cut off if he were not a good boy, particularly in a certain direction. This is a very common complex, and accounts for a great deal of general nervousness and lack of confidence in later years.

“Then came a number of childhood memories relating to his family doctor. He had been strongly attached to this doctor as a child, and during the analysis long-buried memories were recovered of a double phantasy he had in his fourth year concerning the birth of a younger sister--namely, that she was the child (1) of himself and his mother, the father being relegated to the background, and (2) of the doctor and himself; in this he thus played both a masculine and feminine part.[55] At the time, when his curiosity was being aroused by the event, he could not help noticing the prominent share taken by the doctor in the proceedings, and the subordinate position occupied by the father: the significance of this for his later life will presently be pointed out.

“The stethoscope association was formed through many connections. In the first place, the physical appearance of the instrument--a straight, rigid, hollow tube, having a small bulbous summit at one extremity and a broad base at the other--and the fact of its being the essential part of the medical paraphernalia, the instrument with which the doctor performed his magical and interesting feats, were matters that attracted his boyish attention. He had had his chest repeatedly examined by the doctor at the age of six, and distinctly recollected the voluptuous sensation of feeling the latter’s head near him pressing the wooden stethoscope into his chest, and of the rhythmic to-and-fro respiratory movement. He had been struck by the doctor’s habit of carrying his stethoscope inside his hat; he found it interesting that the doctor should carry his chief instrument concealed about his person, always handy when he went to see patients, and that he only had to take off his hat (_i.e_., a part of his clothing) and ‘pull it out.’ At the age of eight he was impressed by being told by an older boy that it was the doctor’s custom to get into bed with his women patients. It is certain that the doctor, who was young and handsome, was extremely popular among the women of the neighbourhood, including the subject’s own mother. The doctor and his ‘instrument’ were therefore the objects of great interest throughout his boyhood.

“It is probable that, as in many other cases, unconscious identification with the family doctor had been a main motive in determining the subject’s choice of profession. It was here doubly conditioned (1) by the superiority of the doctor on certain interesting occasions to the father, of whom the subject was very jealous, and (2) by the doctor’s knowledge of forbidden topics[56] and his opportunity for illicit indulgence. The subject admitted that he had on several occasions experienced erotic temptations in regard to his women patients; he had twice fallen in love with one, and finally had married one.

“The next memory was of a dream, plainly of a homosexual-masochistic nature; in it a man, who proved to be a replacement figure of the family doctor, attacked the subject with a ‘sword.’ The idea of a sword, as is so frequently the case in dreams, represented the same idea that was mentioned above to be associated with that of a wooden stethoscope. The thought of a sword reminded the subject of the passage in the _Nibelung Saga_, where Sigurd sleeps with his naked sword (_Gram_) between him and Brunhilda, an incident that had always greatly struck his imagination.

“The meaning of the symptomatic act now at last became clear. The subject had placed his wooden stethoscope between him and his patients, just as Sigurd had placed his sword (an equivalent symbol) between him and the maiden he was not to touch. The act was a compromise-formation; it served both to gratify in his imagination the repressed wish to enter into nearer relations with an attractive patient (interposition of phallus), and at the same time to remind him that this wish was not to become a reality (interposition of sword). It was, so to speak, a charm against yielding to temptation.

“I might add that the following passage from Lord Lytton’s _Richelieu_ made a great impression on the boy:--

‘_Beneath the rule of men entirely great
The pen is mightier than the sword_,’[57]

and that he became a prolific writer and uses an unusually large fountain-pen. When I asked him what need he had of this pen, he replied in a characteristic manner, ‘I have so much to express.’

“This analysis again reminds us of the profound views that are afforded us in the psychic life through the ‘harmless’ and ‘senseless’ actions, and how early in life the tendency to symbolization develops.”

I can also relate an experience from my psychotherapeutic practice in which the hand, playing with a mass of bread-crumbs, gave evidence of an eloquent declaration. My patient was a boy not yet thirteen years of age, who had been very hysterical for two years. I finally took him for psychoanalytic treatment, after a lengthy stay at a hydrotherapeutic institution had proved futile. My supposition was that he must have had sexual experiences, and that, corresponding to his age, he had been troubled by sexual questions; but I was cautious about helping him with explanations as I wished to test further my assumption. I was therefore curious as to the manner in which the desired material would evince itself in him.

One day it struck me that he was rolling something between the fingers of his right hand; he would thrust it into his pocket and there continue playing with it, then would draw it out again, and so on. I did not ask what he had in his hand; but as he suddenly opened his hand he showed it to me. It was bread-crumbs kneaded into a mass. At the next session he again brought along a mass, and in the course of our conversation, although his eyes were closed, modelled a figure with an incredible rapidity which excited my interest. Without doubt it was a manikin like the crudest prehistoric idols, with a head, two arms, two legs, and an appendage between the legs which he drew out to a long point.

This was scarcely completed when he kneaded the manikin together again: later he allowed it to remain, but modelled an identical appendage on the flat of the back and on other parts in order to veil the meaning of the first. I wished to show him that I had understood him, but at the same time I wanted to deprive him of the evasion that he had thought of nothing while actively forming these figures. With this intention I suddenly asked him whether he remembered the story of the Roman king who gave his son’s envoy a pantomimic answer in his garden.

The boy did not wish to recall what he must have learned so much more recently than I. He asked if that was the story of the slave on whose bald skull the answer was written. I told him, “No, that belonged to Greek history,” and related the following: “King Tarquinius Superbus had induced his son Sextus to steal into a Latin city. The son, who had later obtained a foothold in the city, sent a messenger to the king asking what steps he should take next. The king gave no answer, but went into his garden, had the question repeated there, and silently struck off the heads of the largest and most beautiful poppies. All that the messenger could do was to report this to Sextus, who understood his father, and caused the most distinguished citizens of the city to be removed by assassination.”

While I was speaking the boy stopped kneading, and as I was relating what the king did in his garden, I noticed that at the words “silently struck” he tore off the head of the manikin with a movement as quick as lightning. He therefore understood me, and showed that he was also understood by me. Now I could question him directly, and gave him the information that he desired, and in a short time the neurosis came to an end.

The symptomatic actions which we observe in inexhaustible abundance in healthy as well as in nervous people are worthy of our interest for more than one reason. To the physician they often serve as valuable indications for orienting himself in new or unfamiliar conditions; to the keen observer they often betray everything, occasionally even more than he cares to know. He who is familiar with its application sometimes feels like King Solomon, who, according to the Oriental legend, understood the language of animals.

One day I was to examine a strange young man at his mother’s home. As he came towards me I was attracted by a large stain on his trousers, which by its peculiar stiff edges I recognized as one produced by albumen. After a moment’s embarrassment the young man excused this stain by remarking that he was hoarse and therefore drank a raw egg, and that some of the slippery white of the egg had probably fallen on his clothes. To confirm his statements he showed the eggshell which could still be seen on a small plate in the room. The suspicious spot was thus explained in this harmless way; but as his mother left us alone I thanked him for having so greatly facilitated the diagnosis for me, and without further procedure I took as the topic of our discussion his confession that he was suffering from the effects of masturbation.

Another time I called on a woman as rich as she was miserly and foolish, who was in the habit of giving the physician the task of working his way through a heap of her complaints before he could reach the simple cause of her condition. As I entered she was sitting at a small table engaged in arranging silver dollars in little piles: as she rose she tumbled some of the pieces of money to the floor. I helped her pick them up, but interrupted the recitation of her misery by remarking: “Has your good son-in-law been spending so much of your money again?” She bitterly denied this, only to relate a few moments later the lamentable story of the aggravation caused by her son-in-law’s extravagances. And she has not sent for me since. I cannot maintain that one always makes friends of those to whom he tells the meaning of their symptomatic actions.

He who observes his fellow-men while at table will be able to verify in them the nicest and most instructive symptomatic actions.

Dr. Hans Sachs relates the following:--

“I happened to be present when an elderly couple related to me partook of their supper. The lady had stomach trouble and was forced to follow a strict diet. A roast was put before the husband, and he requested his wife, who was not allowed to partake of this food, to give him the mustard. The wife opened the closet and took out the small bottle of stomach drops, and placed it on the table before her husband. Between the barrel-shaped mustard-glass and the small drop-bottle there was naturally no similarity through which the mishandling could be explained; yet the wife only noticed the mistake after her husband laughingly called her attention to it. The sense of this symptomatic action needs no explanation.”

For an excellent example of this kind which was very skilfully utilized by the observer, I am indebted to Dr. Bernh. Dattner (Vienna):--

“I dined in a restaurant with my colleague H., a doctor of philosophy. He spoke about the injustice done to probationary students, and added that even before he finished his studies he was placed as secretary to the ambassador, or rather the extraordinary plenipotentiary Minister to Chili. ‘But,’ he added, ‘the minister was afterwards transferred, and I did not make any effort to meet the newly appointed.’ While uttering the last sentence he was lifting a piece of pie to his mouth, but he let it drop as if out of awkwardness. I immediately grasped the hidden sense of this symptomatic action, and remarked to my colleague, who was unacquainted with psychoanalysis, ‘You really allowed a very choice morsel to slip from you.’ He did not realize, however, that my words could equally refer to his symptomatic action, and he repeated the same words I uttered with a peculiarly agreeable and surprising vividness, as if I had actually taken the words from his mouth: ‘It was really a very choice morsel that I allowed to get away from me.’ He then followed this remark with a detailed description of his clumsiness, which has cost him this very remunerative position.

“The sense of this symbolic action becomes clearer if we remember that my colleague had scruples about telling me, almost a perfect stranger, concerning his precarious material situation, and his repressed thought took on the mask of symptomatic action which expressed symbolically what was meant to be concealed, and the speaker thus got relief from his unconscious.”

That the taking away or taking along things without any apparent intention may prove to be senseful may be shown by the following examples.

I. Dr. B. Dattner relates: “An acquaintance paid the first after-marriage visit to a highly regarded lady friend of his youth. He told me of this visit and expressed his surprise at the fact that he failed in his resolution to visit with her only a short time, and then reported to me a rather strange faulty act which happened to him there.

“The husband of this friend, who took part in the conversation, was looking for a box of matches which he was sure was on the table when he came there. My acquaintance, too, looked through his pockets to ascertain whether he had not put it in his pocket, but without avail. Some time later he actually found it in his pocket, and was struck by the fact that there was only one match in the box.

“A dream a few days later showing the box symbolism in reference to the friend of his youth confirmed my explanation. With the symptomatic action my acquaintance meant to announce his priority-right and the exclusiveness of his possession (it contained only one match).”

Dr. Hans Sachs relates the following: “Our cook is very fond of a certain kind of pie. There is no possible doubt about this, as it is the only kind of pastry which she always prepares well. One Sunday she brought this pie to the table, took it off the pie-plate, and proceeded to remove the dishes used in the former course, but on the top of this pile she placed the pie, and disappeared with it into the kitchen. We first thought that she had something to improve on the pie, but as she failed to appear my wife rang the bell and asked, ‘Betty, what happened to the pie?’ to which the girl answered, without comprehending the question, ‘How is that?’ We had to call her attention to the fact that she carried the pie back to the kitchen. She had put it on the pile of dishes, taken it out, and put it away ‘without noticing it.’

“The next day, when we were about to consume the rest of the pie, my wife noticed that there was as much of it as we had left the day before--that is, the girl had disdained to eat the portion of her favourite dish which was rightly hers. Questioned why she did not eat the pie, she answered, somewhat embarrassed, that she did not care for it.