Autobiographical note 10 страница

Dr. M. was pale, had a clean-shaven chin and walked with a limp. This was true to the extent that his unhealthy appearance often caused his friends anxiety. The two other features could only apply to someone else. I thought of my elder brother, who lives abroad, who is clean-shaven and whom, if I remembered right, the M. of the dream closely resembled. We had had news a few days earlier that he was walking with a limp owing to an arthritic affection of his hip. There must, I reflected, have been some reason for my fusing into one the two figures in the dream. I then remembered that I had a similar reason for being in an ill-humour with each of them: they had both rejected a certain suggestion I had recently laid before them.

My friend Otto was now standing beside the patient and my friend Leopold was examining her and indicated that there was a dull area low down on the left. My friend Leopold was also a physician and a relative of Otto’s. Since they both specialized in the same branch of medicine, it was their fate to be in competition with each other, and comparisons were constantly being drawn between them. Both of them acted as my assistants for years while I was still in charge of the neurological out-patients’ department of a children’s hospital. Scenes such as the one represented in the dream used often to occur there. While I was discussing the diagnosis of a case with Otto, Leopold would be examining the child once more and would make an unexpected contribution to our decision. The difference between their characters was like that between the bailiff Bräsig and his friend Karl: one was distinguished for his quickness, while the other was slow but sure. If in the dream I was contrasting Otto with the prudent Leopold, I was evidently doing so to the advantage of the latter. The comparison was similar to the one between my disobedient patient Irma and the, friend whom I regarded as wiser than she was. I now perceived another of the lines along which the chain of thought in the dream branched off: from the sick child to the children’s hospital. - The dull area low down on the left seemed to me to agree in every detail with one particular case in which Leopold had struck me by his thoroughness. I also had a vague notion of something in the nature of a metastatic affection; but this may also have been a reference to the patient whom I should have liked to have in the place of Irma. So far as I had been able to judge, she had produced an imitation of a tuberculosis.

A portion of the skin on the left shoulder was infiltrated. I saw at once that this was the rheumatism in my own shoulder, which I invariably notice if I sit up late into the night. Moreover the wording in the dream was most ambiguous: ‘I noticed this, just as he did....’ I noticed it in my own body, that is. I was struck, too, by the unusual phrasing: ‘a portion of the skin was infiltrated.’ We are in the habit of speaking of ‘a left upper posterior infiltration’, and this would refer to the lung and so once more to tuberculosis.

In spite of her dress. This was in any case only an interpolation. We naturally used to examine the children in the hospital undressed: and this would be a contrast to the manner in which adult female patients have to be examined. I remembered that it was said of a celebrated clinician that he never made a physical examination of his patients except through their clothes. Further than this I could not see. Frankly, I had no desire to penetrate more deeply at this point.

Dr. M. said: ‘Its an infection, but no matter. Dysentery will supervene and the toxin will be eliminated.’ At first this struck me as ridiculous. But nevertheless, like all the rest, it had to be carefully analysed. When I came to look at it more closely it seemed to have some sort of meaning all the same. What I discovered in the patient was a local diphtheritis. I remembered from the time of my daughter’s illness a discussion on diphtheritis and diphtheria, the latter being the general infection that arises from the local diphtheritis. Leopold indicated the presence of a general infection of this kind from the existence of a dull area, which might thus be regarded as a metastatic focus. I seemed to think, it is true, that metastases like this do not in fact occur with diphtheria: it made me think rather of pyaemia.

No matter. This was intended as a consolation. It seemed to fit into the context as follows. The content of the preceding part of the dream had been that my patient’s pains were due to a severe organic affection. I had a feeling that I was only trying in that way to shift the blame from myself. Psychological treatment could not be held responsible for the persistence of diphtheritic pains. Nevertheless I had a sense of awkwardness at having invented such a severe illness for Irma simply in order to clear myself. It looked so cruel. Thus I was in need of an assurance that all would be well in the end, and it seemed to me that to have put the consolation into the mouth precisely of Dr. M. had not been a bad choice. But here I was taking up a superior attitude towards the dream, and this itself required explanation.

And why was the consolation so nonsensical?

Dysentery. There seemed to be some remote theoretical notion that morbid matter can be eliminated through the bowels. Could it be that I was trying to make fun of Dr. M.’s fertility in producing far-fetched explanations and making unexpected pathological connections? Something else now occurred to me in relation to dysentery. A few months earlier I had taken on the case of a young man with remarkable difficulties associated with defaecating, who had been treated by other physicians as a case of ‘anaemia accompanied by malnutrition’. I had recognized it as a hysteria, but had been unwilling to try him with my psychotherapeutic treatment and had sent him on a sea voyage. Some days before, I had had a despairing letter from him from Egypt, saying that he had had a fresh attack there which a doctor had declared was dysentery. I suspected that the diagnosis was an error on the part of an ignorant practitioner who had allowed himself to be taken in by the hysteria. But I could not help reproaching myself for having put my patient in a situation in which he might have contracted some organic trouble on top of his hysterical intestinal disorder. Moreover, ‘dysentery’ sounds not unlike ‘diphtheria’ - a word of ill omen which did not occur in the dream.

Yes, I thought to myself, I must have been making fun of Dr. M. with the consoling prognosis ‘Dysentery will supervene’, etc.: for it came back to me that, years before, he himself had told an amusing story of a similar kind about another doctor. Dr. M. had been called in by him for consultation over a patient who was seriously ill, and had felt obliged to point out, in view of the very optimistic view taken by his colleague, that he had found albumen in the patient’s urine. The other, however, was not in the least put out: ‘No matter’, he had said, ‘the albumen will soon be eliminated!’ - I could no longer feel any doubt, therefore, that this part of the dream was expressing derision at physicians who are ignorant of hysteria. And, as though to confirm this, a further idea crossed my mind: ‘Does Dr. M. realize that the symptoms in his patient (Irma’s friend) which give grounds for fearing tuberculosis also have a hysterical basis? Has he spotted this hysteria? or has he been taken in by it?’

But what could be my motive for treating this friend of mine so badly? That was a very simple matter. Dr. M. was just as little in agreement with my ‘solution’ as Irma herself. So I had already revenged myself in this dream on two people: on Irma with the words ‘If you still get pains, it’s your own fault’, and on Dr. M. by the wording of the nonsensical consolation that I put into his mouth.

We were directly aware of the origin of the infection. This direct knowledge in the dream was remarkable. Only just before we had had no knowledge of it, for the infection was only revealed by Leopold.

When she was feeling unwell, my friend Otto had given her an injection. Otto had in fact told me that during his short stay with Irma’s family he had been called in to a neighbouring hotel to give an injection to someone who had suddenly felt unwell. These injections reminded me once more of my unfortunate friend who had poisoned himself with cocaine. I had advised him to use the drug internally only, while morphia was being withdrawn; but he had at once given himself cocaine injections.

A preparation of propyl... propyls... propionic acid. How could I have come to think of this? During the previous evening, before I wrote out the case history and had the dream, my wife had opened a bottle of liqueur, on which the word ‘Ananas’¹ appeared and which was a gift from our friend Otto: for he has a habit of making presents on every possible occasion. It was to be hoped, I thought to myself, that some day he would find a wife to cure him of the habit. This liqueur gave off such a strong smell of fusel oil that I refused to touch it. My wife suggested our giving the bottle to the servants, but I - with even greater prudence - vetoed the suggestion, adding in a philanthropic spirit that there was no need for them to be poisoned either. The smell of fusel oil (amyl...) evidently stirred up in my mind a recollection of the whole series - propyl, methyl, and so on - and this accounted for the propyl preparation in the dream. It is true that I carried out a substitution in the process: I dreamt of propyl after having smelt amyl. But substitutions of this kind are perhaps legitimate in organic chemistry.

Trimethylamin. I saw the chemical formula of this substance in my dream, which bears witness to a great effort on the part of my memory. Moreover, the formula was printed in heavy type, as though there had been a desire to lay emphasis on some part of the context as being of quite special importance. What was it, then, to which my attention was to be directed in this way by trimethylamin? It was to a conversation with another friend who had for many years been familiar with all my writings during the period of their gestation, just as I had been with his. He had at that time confided some ideas to me on the subject of the chemistry of the sexual processes, and had mentioned among other things that he believed that one of the products of sexual metabolism was trimethylamin. Thus this substance led me to sexuality, the factor to which I attributed the greatest importance in the origin of the nervous disorders which it was my aim to cure. My patient Irma was a young widow; if I wanted to find an excuse for the failure of my treatment in her case, what I could best appeal to would no doubt be this fact of her widowhood, which her friends would be so glad to see changed. And how strangely, I thought to myself, a dream like this is put together! The other woman, whom I had as a patient in the dream instead of Irma, was also a young widow.

¹ I must add that the sound of the word ‘Ananas’ bears a remarkable resemblance to that of my patient Irma’s family name.

I began to guess why the formula for trimethylamin had been so prominent in the dream. So many important subjects converged upon that one word. Trimethylamin was an allusion not only to the immensely powerful factor of sexuality, but also to a person whose agreement I recalled with satisfaction whenever I felt isolated in my opinions. Surely this friend who played so great a part in my life must appear again elsewhere in these trains of thought. Yes. For he had a special knowledge of the consequences of affections of the nose and its accessory cavities; and he had drawn scientific attention to some very remarkable connections between the turbinal bones and the female organs of sex. (Cf. the three curly structures in Irma’s throat.) I had had Irma examined by him to see whether her gastric pains might be of nasal origin. But he suffered himself from suppurative rhinitis, which caused me anxiety; and no doubt there was an allusion to this in the pyaemia which vaguely came into my mind in connection with the metastases in the dream.

Injections of that sort ought not to be made so thoughtlessly. Here an accusation of thoughtlessness was being made directly against my friend Otto. I seemed to remember thinking something of the same kind that afternoon when his words and looks had appeared to show that he was siding against me. It had been some such notion as: ‘How easily his thoughts are influenced! How thoughtlessly he jumps to conclusions!’ -Apart from this, this sentence in the dream reminded me once more of my dead friend who had so hastily resorted to cocaine injections. As I have said, I had never contemplated the drug being given by injection. I noticed too that in accusing Otto of thoughtlessness in handling chemical substances I was once more touching upon the story of the unfortunate Mathilde, which gave grounds for the same accusation against myself. Here I was evidently collecting instances of my conscientiousness, but also of the reverse.

And probably the syringe had not been clean. This was yet another accusation against Otto, but derived from a different source. I had happened the day before to meet the son of an old lady of eighty-two, to whom I had to give an injection of morphia twice a day. At the moment she was in the country and he told me that she was suffering from phlebitis. I had at once thought it must be an infiltration caused by a dirty syringe. I was proud of the fact that in two years I had not caused a single infiltration; I took constant pains to be sure that the syringe was clean. In short, I was conscientious. The phlebitis brought me back once more to my wife, who had suffered from thrombosis during one of her pregnancies; and now three similar situations came to my recollection involving my wife, Irma and the dead Mathilde. The identity of these situations had evidently enabled me to substitute the three figures for one another in the dream.

I have now completed the interpretation of the dream.¹ While I was carrying it out I had some difficulty in keeping at bay all the ideas which were bound to be provoked by a comparison between the content of the dream and the concealed thoughts lying behind it. And in the meantime the ‘meaning’ of the dream was borne in upon me. I became aware of an intention which was carried into effect by the dream and which must have been my motive for dreaming it. The dream fulfilled certain wishes which were started in me by the events of the previous evening (the news given me by Otto and my writing out of the case history). The conclusion of the dream, that is to say, was that I was not responsible for the persistence of Irma’s pains, but that Otto was. Otto had in fact annoyed me by his remarks about Irma’s incomplete cure, and the dream gave me my revenge by throwing the reproach back on to him. The dream acquitted me of the responsibility for Irma’s condition by showing that it was due to other factors - it produced a whole series of reasons. The dream represented a particular state of affairs as I should have wished it to be. Thus its content was the fulfilment of a wish and its motive was a wish.

¹ [Footnote added 1909] Though it will be understood that I have not reported everything that occurred to me during the process of interpretation.

Thus much leapt to the eyes. But many of the details of the dream also became intelligible to me from the point of view of wish-fulfilment. Not only did I revenge myself on Otto for being too hasty in taking sides against me by representing him as being too hasty in his medical treatment (in giving the injection); but I also revenged myself on him for giving me the bad liqueur which had an aroma of fusel oil. And in the dream I found an expression which united the two reproaches: the injection was of a preparation of propyl. This did not satisfy me and I pursued my revenge further by contrasting him with his more trustworthy competitor. I seemed to be saying: ‘I like him better than you.’ But Otto was not the only person to suffer from the vials of my wrath. I took revenge as well on my disobedient patient by exchanging her for one who was wiser and less recalcitrant. Nor did I allow Dr. M. to escape the consequences of his contradiction but showed him by means of a clear allusion that he was an ignoramus on the subject. (‘Dysentery will supervene’, etc.) Indeed I seemed to be appealing from him to someone else with greater knowledge (to my friend who had told me of trimethylamin) just as I had turned from Irma to her friend and from Otto to Leopold. ‘Take these people away! Give me three others of my choice instead! Then I shall be free of these undeserved reproaches!’ The groundlessness of the reproaches was proved for me in the dream in the most elaborate fashion. I was not to blame for Irma’s pains, since she herself was to blame for them by refusing to accept my solution. I was not concerned with Irma’s pains, since they were of an organic nature and quite incurable by psychological treatment. Irma’s pains could be satisfactorily explained by her widowhood (cf. the trimethylamin) which I had no means of altering. Irma’s pains had been caused by Otto giving her an incautious injection of an unsuitable drug - a thing I should never have done. Irma’s pains were the result of an injection with a dirty needle, like my old lady’s phlebitis - whereas I never did any harm with my injections. I noticed, it is true, that these explanations of Irma’s pains (which agreed in exculpating me) were not entirely consistent with one another, and indeed that they were mutually exclusive. The whole plea - for the dream was nothing else - reminded one vividly of the defence put forward by the man who was charged by one of his neighbours with having given him back a borrowed kettle in a damaged condition. The defendant asserted first, that he had given it back undamaged; secondly, that the kettle had a hole in it when he borrowed it; and thirdly, that he had never borrowed a kettle from his neighbour at all. So much the better: if only a single one of these three lines of defence were to be accepted as valid, the man would have to be acquitted.

Certain other themes played a part in the dream, which were not so obviously connected with my exculpation from Irma’s illness: my daughter’s illness and that of my patient who bore the same name, the injurious effect of cocaine, the disorder of my patient who was travelling in Egypt, my concern about my wife’s health and about that of my brother and of Dr. M., my own physical ailments, my anxiety about my absent friend who suffered from suppurative rhinitis. But when I came to consider all of these, they could all be collected into a single group of ideas and labelled, as it were, ‘concern about my own and other people’s health - professional conscientiousness’. I called to mind the obscure disagreeable impression I had had when Otto brought me the news of Irma’s condition. This group of thoughts that played a part in the dream enabled me retrospectively to put this transient impression into words. It was as though he had said to me: ‘You don’t take your medical duties seriously enough. You’re not conscientious; you don’t carry out what you’ve undertaken.’ Thereupon, this group of thoughts seemed to have put itself at my disposal, so that I could produce evidence of how highly conscientious I was, of how deeply I was concerned about the health of my relations, my friends and my patients. It was a noteworthy fact that this material also included some disagreeable memories, which supported my friend Otto’s accusation rather than my own vindication. The material was, as one might say, impartial; but nevertheless there was an unmistakable connection between this more extensive group of thoughts which underlay the dream and the narrower subject of the dream which gave rise to the wish to be innocent of Irma’s illness.

I will not pretend that I have completely uncovered the meaning of this dream or that its interpretation is without a gap. I could spend much more time over it, derive further information from it and discuss fresh problems raised by it. I myself know the points from which further trains of thought could be followed. But considerations which arise in the case of every dream of my own restrain me from pursuing my interpretative work. If anyone should feel tempted to express a hasty condemnation of my reticence, I would advise him to make the experiment of being franker than I am. For the moment I am satisfied with the achievement of this one piece of fresh knowledge. If we adopt the method of interpreting dreams which I have indicated here, we shall find that dreams really have a meaning and are far from being the expression of a fragmentary activity of the brain, as the authorities have claimed. When the work of interpretation has been completed, we perceive that a dream is the fulfilment of a wish.

CHAPTER III A DREAM IS THE FULFILMENT OF A WISH

When, after passing through a narrow defile, we suddenly emerge upon a piece of high ground, where the path divides and the finest prospects open up on every side, we may pause for a moment and consider in which direction we shall first turn our steps. Such is the case with us, now that we have surmounted the first interpretation of a dream. We find ourselves in the full daylight of a sudden discovery. Dreams are not to be likened to the unregulated sounds that rise from a musical instrument struck by the blow of some external force instead of by a player’s hand; they are not meaningless, they are not absurd; they do not imply that one portion of our store of ideas is asleep while another portion is beginning to wake. On the contrary, they are psychical phenomena of complete validity - fulfilments of wishes; they can be inserted into the chain of intelligible waking mental acts; they are constructed by a highly complicated activity of the mind.

But no sooner have we begun to rejoice at this discovery than we are assailed by a flood of questions. If, as we are told by dream-interpretation, a dream represents a fulfilled wish, what is the origin of the remarkable and puzzling form in which the wish-fulfilment is expressed? What alteration have the dream thoughts undergone before being changed into the manifest dream which we remember when we wake up? How does that alteration take place? What is the source of the material that has been modified into the dream? What is the source of the many peculiarities that are to be observed in the dream-thoughts - such, for instance, as the fact that they may be mutually contradictory? (Cf. the analogy of the borrowed kettle on p. 106.) Can a dream tell us anything new about our internal psychical processes? Can its content correct opinions we have held during the day?

I propose that for the moment we should leave all these questions on one side and pursue our way further along one particular path. We have learnt that a dream can represent a wish as fulfilled. Our first concern must be to enquire whether this is a universal characteristic of dreams or whether it merely happened to be the content of the particular dream (the dream of Irma’s injection) which was the first that we analysed. For even if we are prepared to find that every dream has a meaning and a psychical value, the possibility must remain open of this meaning not being the same in every dream. Our first dream was the fulfilment of a wish; a second one might turn out to be a fulfilled fear; the content of a third might be a reflection; while a fourth might merely reproduce a memory. Shall we find other wishful dreams besides this one? or are there perhaps no dreams but wishful ones?

It is easy to prove that dreams often reveal themselves without any disguise as fulfilments of wishes; so that it may seem surprising that the language of dreams was not understood long ago. For instance, there is a dream that I can produce in myself as often as I like - experimentally, as it were. If I eat anchovies or olives or any other highly salted food in the evening, I develop thirst during the night which wakes me up. But my waking is preceded by a dream; and this always has the same content, namely, that I am drinking. I dream I am swallowing down water in great gulps, and it has the delicious taste that nothing can equal but a cool drink when one is parched with thirst. Then I wake up and have to have a real drink. This simple dream is occasioned by the thirst which I become aware of when I wake. The thirst gives rise to a wish to drink, and the dream shows me that wish fulfilled. In doing so it is performing a function - which it was easy to divine. I am a good sleeper and not accustomed to be woken by any physical need. If I can succeed in appeasing my thirst by dreaming that I am drinking, then I need not wake up in order to quench it. This, then, is a dream of convenience. Dreaming has taken the place of action, as it often does elsewhere in life. Unluckily my need for water to quench my thirst cannot be satisfied by a dream in the same way as my thirst for revenge against my friend Otto and Dr. M.; but the good intention is there in both cases. Not long ago this same dream of mine showed some modification. I had felt thirsty even before I fell asleep, and I had emptied a glass of water that stood on the table beside my bed. A few hours later during the night I had a fresh attack of thirst, and this had inconvenient results. In order to provide myself with some water I should have had to get up and fetch the glass standing on the table by my wife’s bed. I therefore had an appropriate dream that my wife was giving me a drink out of a vase; this vase was an Etruscan cinerary urn which I had brought back from a journey to Italy and had since given away. But the water in it tasted so salty (evidently because of the ashes in the urn) that I woke up. It will be noticed how conveniently everything was arranged in this dream. Since its only purpose was to fulfil a wish, it could be completely egoistical. A love of comfort and convenience is not really compatible with consideration for other people. The introduction of the cinerary urn was probably yet another wish-fulfilment. I was sorry that the vase was no longer in my possession - just as the glass of water on my wife’s table was out of my reach. The urn with its ashes fitted in, too, with the salty taste in my mouth which had now grown stronger and which I knew was bound to wake me.¹

¹ Weygandt (1893, 41) was aware of the occurrence of thirst dreams, for he writes: ‘The sensation of thirst is perceived with greater precision than any other; it always gives rise to an idea of its being quenched. The manner in which the thirst is represented as being quenched in the dream varies, and derives its special form from some near-by memory. Another general feature in these cases is that immediately after the idea of the thirst being quenched there follows a disappointment over the small effect produced by the imaginary refreshment.’ Weygandt, however, overlooks the fact that this reaction of a dream to a stimulus is one which holds good universally. Other people who are attacked by thirst in the night may wake up without having had a dream; but that is no objection to my experiment. It merely shows that they are worse sleepers than I am. - Compare in this connection Isaiah xxix, 8: ‘It shall even be as when an hungry man dreameth, and, behold, he eateth; but he awaketh, and his soul is empty: or as when a thirsty man dreameth, and, behold, he drinketh; but he awaketh, and, behold, he is faint, and his soul hath appetite.’

Dreams of convenience like these were very frequent in my youth. Having made it a practice as far back as I can remember to work late into the night, I always found it difficult to wake early. I used then to have a dream of being out of bed and standing by the washing-stand; after a while I was no longer able to disguise from myself the fact that I was really still in bed, but in the meantime I had had a little more sleep. A slothful dream of this kind, which was expressed in a particularly amusing and elegant form, has been reported to me by a young medical colleague who seems to share my liking for sleep. The landlady of his lodgings in the neighbourhood of the hospital had strict instructions to wake him in time every morning but found it no easy job to carry them out. One morning sleep seemed peculiarly sweet. The landlady called through the door: ‘Wake up, Herr Pepi! It’s time to go to the hospital!’ In response to this he had a dream that he was lying in bed in a room in the hospital, and that there was a card over the bed on which was written: ‘Pepi H., medical student, age 22.’ While he was dreaming, he said to himself ‘As I’m already in the hospital, there’s no need for me to go there ' - and turned over and went on sleeping. In this way he openly confessed the motive for his dream.

Here is another dream in which once again the stimulus produced its effect during actual sleep. One of my women patients, who had been obliged to undergo an operation on her jaw which had taken an unfavourable course, was ordered by her doctors to wear a cooling apparatus on the side of her face day and night. But as soon as she fell asleep she used to throw it off. One day, after she had once more thrown the apparatus on the floor, I was asked to speak to her seriously about it. ‘This time I really couldn’t help it’, she answered. ‘It was because of a dream I had in the night. I dreamt I was in a box at the opera and very much enjoying the performance. But Herr Karl Meyer was in the nursing-home and complaining bitterly of pains in his jaw. So I told myself that as I hadn’t any pain I didn’t need the apparatus; and I threw it away.’ The dream of this poor sufferer seems almost like a concrete representation of a phrase that sometimes forces its way on to people’s lips in unpleasant situations: ‘I must say I could think of something more agreeable than this.’ The dream gives a picture of this more agreeable thing. The Herr Karl Meyer on to whom the dreamer transplanted her pains was the most indifferent young man of her acquaintance that she could call to mind.

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