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.