Part 18

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.

“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. 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 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,’

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.