had the opinion (recognised later to be incorrect) that my task was
limited to informing patients of the hidden meaning of their symptoms.
Whether they then accepted or did not accept the solution upon which
success depended—for that I was not responsible. I am thankful to this
error, which fortunately has now been overcome, for making life easier
for me at a time when, with all my unavoidable ignorance, I was to
produce successful cures. But I see in the speech which I make to Irma
in the dream, that above all things I do not want to be to blame for the
pains which she still feels. If it is Irma’s own fault, it cannot be
mine. Should the purpose of the dream be looked for in this quarter?
_Irma’s complaints; pains in the neck, abdomen, and stomach; she is
drawn together._
Pains in the stomach belonged to the symptom-complex of my patient, but
they were not very prominent; she complained rather of sensations of
nausea and disgust. Pains in the neck and abdomen and constriction of
the throat hardly played a part in her case. I wonder why I decided upon
this choice of symptoms, nor can I for the moment find the reason.
_She looks pale and bloated._
My patient was always ruddy. I suspect that another person is here being
substituted for her.
_I am frightened at the thought that I must have overlooked some organic
affection._
This, as the reader will readily believe, is a constant fear with the
specialist, who sees neurotics almost exclusively, and who is accustomed
to ascribe so many manifestations, which other physicians treat as
organic, to hysteria. On the other hand, I am haunted by a faint doubt—I
know not whence it comes—as to whether my fear is altogether honest. If
Irma’s pains are indeed of organic origin, I am not bound to cure them.
My treatment, of course, removes only hysterical pains. It seems to me,
in fact, that I wish to find an error in the diagnosis; in that case the
reproach of being unsuccessful would be removed.
_I take her to the window in order to look into her throat. She resists
a little, like a woman who has false teeth. I think she does not need
them anyway._
I had never had occasion to inspect Irma’s aural cavity. The incident in
the dream reminds me of an examination, made some time before, of a
governess who at first gave an impression of youthful beauty, but who
upon opening her mouth took certain measures for concealing her teeth.
Other memories of medical examinations and of little secrets which are
discovered by them, unpleasantly for both examiner and examined, connect
themselves with this case. “She does not need them anyway,” is at first
perhaps a compliment for Irma; but I suspect a different meaning. In
careful analysis one feels whether or not the “background thoughts”
which are to be expected have been exhausted. The way in which Irma
stands at the window suddenly reminds me of another experience. Irma
possesses an intimate woman friend, of whom I think very highly. One
evening on paying her a visit I found her in the position at the window
reproduced in the dream, and her physician, the same Dr. M., declared
that she had a diphtheritic membrane. The person of Dr. M. and the
membrane return in the course of the dream. Now it occurs to me that
during the last few months, I have been given every reason to suppose
that this lady is also hysterical. Yes, Irma herself has betrayed this
to me. But what do I know about her condition? Only the one thing, that
like Irma she suffers from hysterical choking in dreams. Thus in the
dream I have replaced my patient by her friend. Now I remember that I
have often trifled with the expectation that this lady might likewise
engage me to relieve her of her symptoms. But even at the time I thought
it improbable, for she is of a very shy nature. _She resists_, as the
dream shows. Another explanation might be that _she does not need it_;
in fact, until now she has shown herself strong enough to master her
condition without outside help. Now only a few features remain, which I
can assign neither to Irma nor to her friend: _Pale, bloated, false
teeth_. The false teeth lead me to the governess; I now feel inclined to
be satisfied with bad teeth. Then another person, to whom these features
may allude, occurs to me. She is not my patient, and I do not wish her
to be my patient, for I have noticed that she is not at her ease with
me, and I do not consider her a docile patient. She is generally pale,
and once, when she had a particularly good spell, she was bloated.[U] I
have thus compared my patient Irma with two others, who would likewise
resist treatment. What can it mean that I have exchanged her for her
friend in the dream? Perhaps that I wish to exchange her; either the
other one arouses in me stronger sympathies or I have a higher opinion
of her intelligence. For I consider Irma foolish because she does not
accept my solution. The other one would be more sensible, and would thus
be more likely to yield. _The mouth then really opens without
difficulty_; she would tell more than Irma.[V]
_What I see in the throat; a white spot and scabby nostrils._
The white spot recalls diphtheria, and thus Irma’s friend, but besides
this it recalls the grave illness of my eldest daughter two years before
and all the anxiety of that unfortunate time. The scab on the nostrils
reminds me of a concern about my own health. At that time I often used
cocaine in order to suppress annoying swellings in the nose, and had
heard a few days before that a lady patient who did likewise had
contracted an extensive necrosis of the nasal mucous membrane. The
recommendation of cocaine, which I had made in 1885, had also brought
grave reproaches upon me. A dear friend, already dead in 1895, had
hastened his end through the misuse of this remedy.
_I quickly call Dr. M., who repeats the examination._
This would simply correspond to the position which M. occupied among us.
But the word “quickly” is striking enough to demand a special
explanation. It reminds me of a sad medical experience. By the continued
prescription of a remedy (sulfonal) which was still at that time
considered harmless, I had once caused the severe intoxication of a
woman patient, and I had turned in great haste to an older, more
experienced colleague for assistance. The fact that I really had this
case in mind is confirmed by an accessory circumstance. The patient, who
succumbed to the intoxication, bore the same name as my eldest daughter.
I had never thought of this until now; now it seems to me almost like a
retribution of fate—as though I ought to continue the replacement of the
persons here in another sense; this Matilda for that Matilda; an eye for
an eye, a tooth for a tooth. It is as though I were seeking every
opportunity to reproach myself with lack of medical conscientiousness.
_Dr. M. is pale, without a beard on his chin, and he limps._
Of this so much is correct, that his unhealthy appearance often awakens
the concern of his friends. The other two characteristics must belong to
another person. A brother living abroad occurs to me, who wears his chin
clean-shaven, and to whom, if I remember aright, M. of the dream on the
whole bears some resemblance. About him the news arrived some days
before that he was lame on account of an arthritic disease in the hip.
There must be a reason why I fuse the two persons into one in the dream.
I remember that in fact I was on bad terms with both of them for similar
reasons. Both of them had rejected a certain proposal which I had
recently made to them.
_My friend Otto is now standing next to the sick woman, and my friend
Leopold examines her and calls attention to a dulness on the left
below._
My friend Leopold is also a physician, a relative of Otto. Since the two
practise the same specialty, fate has made them competitors, who are
continually being compared with each other. Both of them assisted me for
years, while I was still directing a public dispensary for nervous
children. Scenes like the one reproduced in the dream have often taken
place there. While I was debating with Otto about the diagnosis of a
case, Leopold had examined the child anew and had made an unexpected
contribution towards the decision. For there was a difference of
character between the two similar to that between Inspector Brassig and
his friend Charles. The one was distinguished for his brightness, the
other was slow, thoughtful, but thorough. If I contrast Otto and the
careful Leopold in the dream, I do it, apparently, in order to extol
Leopold. It is a comparison similar to the one above between the
disobedient patient Irma and her friend who is thought to be more
sensible. I now become aware of one of the tracks along which the
thought association of the dream progresses; from the sick child to the
children’s asylum. The dulness to the left, below, recalls a certain
case corresponding to it, in every detail in which Leopold astonished me
by his thoroughness. Besides this, I have a notion of something like a
metastatic affection, but it might rather be a reference to the lady
patient whom I should like to have instead of Irma. For this lady, as
far as I can gather, resembles a woman suffering from tuberculosis.
_An infiltrated portion of skin on the left shoulder._
I see at once that this is my own rheumatism of the shoulder, which I
always feel when I have remained awake until late at night. The turn of
phrase in the dream also sounds ambiguous; something which I feel ... in
spite of the dress. “Feel on my own body” is intended. Moreover, I am
struck with the unusual sound of the term “infiltrated portion of skin.”
“An infiltration behind on the upper left” is what we are accustomed to;
this would refer to the lung, and thus again to tuberculosis patients.
_In spite of the dress._
This, to be sure, is only an interpolation. We, of course, examine the
children in the clinic undressed; it is some sort of contradiction to
the manner in which grown-up female patients must be examined. The story
used to be told of a prominent clinician that he always examined his
patients physically only through the clothes. The rest is obscure to me;
I have, frankly, no inclination to follow the matter further.
_Dr. M. says: “It is an infection, but it does not matter. Dysentery
will develop, and the poison will he excreted._”
This at first seems ridiculous to me; still it must be carefully
analysed like everything else. Observed more closely, it seems, however,
to have a kind of meaning. What I had found in the patient was local
diphtheritis. I remember the discussion about diphtheritis and
diphtheria at the time of my daughter’s illness. The latter is the
general infection which proceeds from local diphtheritis. Leopold proves
the existence of such general infection by means of the dulness, which
thus suggests a metastatic lesion. I believe, however, that just this
kind of metastasis does not occur in the case of diphtheria. It rather
recalls pyæmia.
_It does not matter_, is a consolation. I believe it fits in as follows:
The last part of the dream has yielded a content to the effect that the
pains of the patient are the result of a serious organic affection. I
begin to suspect that with this I am only trying to shift the blame from
myself. Psychic treatment cannot be held responsible for the continued
presence of diphtheritic affection. But now, in turn, I am disturbed at
inventing such serious suffering for Irma for the sole purpose of
exculpating myself. It seems cruel. I need (accordingly) the assurance
that the result will be happy, and it does not seem ill-advised that I
should put the words of consolation into the mouth of Dr. M. But here I
consider myself superior to the dream, a fact which needs explanation.
But why is this consolation so nonsensical?
_Dysentery_:
Some sort of far-fetched theoretical notion that pathological material
may be removed through the intestines. Am I in this way trying to make
fun of Dr. M.’s great store of far-fetched explanations, his habit of
finding curious pathological relationships? Dysentery suggests something
else. A few months ago I had in charge a young man suffering from
remarkable pains during evacuation of the bowels, a case which
colleagues had treated as “anæmia with malnutrition.” I realised that it
was a question of hysteria; I was unwilling to use my psychotherapy on
him, and sent him off on a sea voyage. Now a few days before I had
received a despairing letter from him from Egypt, saying that while
there he had suffered a new attack, which the physician had declared to
be dysentery. I suspect, indeed, that the diagnosis was only an error of
my ignorant colleague, who allows hysteria to make a fool of him; but
still I cannot avoid reproaching myself for putting the invalid in a
position where he might contract an organic affection of the bowels in
addition to his hysteria. Furthermore, dysentery sounds like diphtheria,
a word which does not occur in the dream.
Indeed it must be that, with the consoling prognosis: “Dysentery will
develop, &c.,” I am making fun of Dr. M., for I recollect that years ago
he once jokingly told a very similar story of another colleague. He had
been called to consult with this colleague in the case of a woman who
was very seriously ill and had felt obliged to confront the other
physician, who seemed very hopeful, with the fact that he found albumen
in the patient’s urine. The colleague, however, did not let this worry
him, but answered calmly: “That does not matter, doctor; the albumen
will without doubt be excreted.” Thus I can no longer doubt that
derision for those colleagues who are ignorant of hysteria is contained
in this part of the dream. As though in confirmation, this question now
arises in my mind: “Does Dr. M. know that the symptoms of his patient,
of our friend Irma, which give cause for fearing tuberculosis, are also
based on hysteria? Has he recognised this hysteria, or has he stupidly
ignored it?”
But what can be my motive in treating this friend so badly? This is very
simple: Dr. M. agrees with my solution as little as Irma herself. I have
thus already in this dream taken revenge on two persons, on Irma in the
words, “If you still have pains, it is your own fault,” and on Dr. M. in
the wording of the nonsensical consolation which has been put into his
mouth.
_We have immediate knowledge of the origin of the infection._
This immediate knowledge in the dream is very remarkable. Just before we
did not know it, since the infection was first demonstrated by Leopold.
_My friend Otto has recently given her an injection when she felt ill._
Otto had actually related that in the short time of his visit to Irma’s
family, he had been called to a neighbouring hotel in order to give an
injection to some one who fell suddenly ill. Injections again recall the
unfortunate friend who has poisoned himself with cocaine. I had
recommended the remedy to him merely for internal use during the
withdrawal of morphine, but he once gave himself injections of cocaine.
_With a propyl preparation ... propyls ... propionic acid._ How did this
ever occur to me? On the same evening on which I had written part of the
history of the disease before having the dream, my wife opened a bottle
of cordial labelled “Ananas,”[W] (which was a present from our friend
Otto. For he had a habit of making presents on every possible occasion;
I hope he will some day be cured of this by a wife).[X] Such a smell of
fusel oil arose from this cordial that I refused to taste it. My wife
observed: “We will give this bottle to the servants,” and I, still more
prudent, forbade it, with the philanthropic remark: “They mustn’t be
poisoned either.” The smell of fusel oil (amyl ...) has now apparently
awakened in my memory the whole series, propyl, methyl, &c., which has
furnished the propyl preparation of the dream. In this, it is true, I
have employed a substitution; I have dreamt of propyl, after smelling
amyl, but substitutions of this kind are perhaps permissible, especially
in organic chemistry.
_Trimethylamin._ I see the chemical formula of this substance in the
dream, a fact which probably gives evidence of a great effort on the
part of my memory, and, moreover, the formula is printed in heavy type,
as if to lay special stress upon something of particular importance, as
distinguished from the context. To what does this trimethylamin lead,
which has been so forcibly called to my attention? It leads to a
conversation with another friend who for years has known all my
germinating activities, as I have his. At that time he had just informed
me of some of his ideas about sexual chemistry, and had mentioned, among
others, that he thought he recognised in trimethylamin one of the
products of sexual metabolism. This substance thus leads me to
sexuality, to that factor which I credit with the greatest significance
for the origin of the nervous affections which I attempt to cure. My
patient Irma is a young widow; if I am anxious to excuse the failure of
her cure, I suppose I shall best do so by referring to this condition,
which her admirers would be glad to change. How remarkably, too, such a
dream is fashioned! The other woman, whom I take as my patient in the
dream instead of Irma, is also a young widow.
I suspect why the formula of trimethylamin has made itself so prominent
in the dream. So many important things are gathered up in this one word:
Trimethylamin is not only an allusion to the overpowering factor of
sexuality, but also to a person whose sympathy I remember with
satisfaction when I feel myself forsaken in my opinions. Should not this
friend, who plays such a large part in my life, occur again in the chain
of thoughts of the dream? Of course, he must; he is particularly
acquainted with the results which proceed from affections of the nose
and its adjacent cavities, and has revealed to science several highly
remarkable relations of the turbinated bones to the female sexual organs
(the three curly formations in Irma’s throat). I have had Irma examined
by him to see whether the pains in her stomach might be of nasal origin.
But he himself suffers from suppurative rhinitis, which worries him, and
to this perhaps there is an allusion in pyæmia, which hovers before me
in the metastases of the dream.
_Such injections are not made so rashly._ Here the reproach of
carelessness is hurled directly at my friend Otto. I am under the
impression that I had some thought of this sort in the afternoon, when
he seemed to indicate his siding against me by word and look. It was
perhaps: “How easily he can be influenced; how carelessly he pronounces
judgment.” Furthermore, the above sentence again points to my deceased
friend, who so lightly took refuge in cocaine injections. As I have
said, I had not intended injections of the remedy at all. I see that in
reproaching Otto I again touch upon the story of the unfortunate
Matilda, from which arises the same reproach against me. Obviously I am
here collecting examples of my own conscientiousness, but also of the
opposite.
_Probably also the syringe was not clean._ Another reproach directed at
Otto, but originating elsewhere. The day before I happened to meet the
son of a lady eighty-two years of age whom I am obliged to give daily
two injections of morphine. At present she is in the country, and I have
heard that she is suffering from an inflammation of the veins. I
immediately thought that it was a case of infection due to contamination
from the syringe. It is my pride that in two years I have not given her
a single infection; I am constantly concerned, of course, to see that
the syringe is perfectly clean. For I am conscientious. From the
inflammation of the veins, I return to my wife, who had suffered from
emboli during a period of pregnancy, and now three related situations
come to the surface in my memory, involving my wife, Irma, and the
deceased Matilda, the identity of which three persons plainly justifies
my putting them in one another’s place.
I have now completed the interpretation of the dream.[Y] In the course
of this interpretation I have taken great pains to get possession of all
the notions to which a comparison between the dream content and the
dream thoughts hidden behind it must have given rise. Meanwhile, the
“meaning” of the dream has dawned upon me. I have become conscious of a
purpose which is realised by means of the dream, and which must have
been the motive for dreaming. The dream fulfils several wishes, which
have been actuated in me by the events of the preceding evening (Otto’s
news, and the writing down of the history of the disease). For the
result of the dream is that I am not to blame for the suffering which
Irma still has, and that Otto is to blame for it. Now Otto has made me
angry by his remark about Irma’s imperfect cure; the dream avenges me
upon him by turning the reproach back upon himself. The dream acquits me
of responsibility for Irma’s condition by referring it to other causes,
which indeed furnish a great number of explanations. The dream
represents a certain condition of affairs as I should wish it to be;
_the content of the dream is thus the fulfilment of a wish; its motive
is a wish_.
This much is apparent at first sight. But many things in the details of
the dream become intelligible when regarded from the point of view of
wish-fulfilment. I take revenge on Otto, not only for hastily taking
part against me, in that I accuse him of a careless medical operation
(the injection), but I am also avenged on him for the bad cordial which
smells like fusel oil, and I find an expression in the dream which
unites both reproaches; the injection with a preparation of propyl.
Still I am not satisfied, but continue my revenge by comparing him to
his more reliable competitor. I seem to say by this: “I like him better
than you.” But Otto is not the only one who must feel the force of my
anger. I take revenge on the disobedient patient by exchanging her for a
more sensible, more docile one. Nor do I leave the contradiction of Dr.
M. unnoticed, but express my opinion of him in an obvious allusion, to
the effect that his relation to the question is that of _an ignoramus_
(“_dysentery will develop_,” _&c._).
It seems to me, indeed, as though I were appealing from him to some one
better informed (my friend, who has told me about trimethylamin); just
as I have turned from Irma to her friend, I turn from Otto to Leopold.
Rid me of these three persons, replace them by three others of my own
choice, and I shall be released from the reproaches which I do not wish
to have deserved! The unreasonableness itself of these reproaches is
proved to me in the dream in the most elaborate way. Irma’s pains are
not charged to me, because she herself is to blame for them, in that she
refuses to accept my solution. Irma’s pains are none of my business, for
they are of an organic nature, quite impossible to be healed by a
psychic cure. Irma’s sufferings are satisfactorily explained by her
widowhood (trimethylamin!); a fact which, of course, I cannot alter.
Irma’s illness has been caused by an incautious injection on the part of
Otto, with an ill-suited substance—in a way I should never have made an
injection. Irma’s suffering is the result of an injection made with an
unclean syringe, just like the inflammation of the veins in my old lady,
while I never do any such mischief with my injections. I am aware,
indeed, that these explanations of Irma’s illness, which unite in
acquitting me, do not agree with one another; they even exclude one
another. The whole pleading—this dream is nothing else—recalls vividly
the defensive argument of a man who was accused by his neighbour of
having returned a kettle to him in a damaged condition. In the first
place, he said, he had returned the kettle undamaged; in the second, it
already had holes in it when he borrowed it; and thirdly, he had never
borrowed the kettle from his neighbour at all. But so much the better;
if even one of these three methods of defence is recognised as valid,
the man must be acquitted.