freud case study method

Little Hans – Freudian Case Study

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

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Case Study Summary

• Little Hans was a 5-year-old boy with a phobia of horses. Like all clinical case studies, the primary aim was to treat the phobia.
• However, Freud’s therapeutic input in this case was minimal, and a secondary aim was to explore what factors might have led to the phobia in the first place, and what factors led to its remission.
• From around three years of age, little Hans showed an interest in ‘widdlers’, both his own penis and those of other males, including animals. His mother threatens to cut off his widdler unless he stops playing with it.
• Hans’s fear of horses worsened, and he was reluctant to go out in case he met a horse. Freud linked this fear to the horse’s large penis. The phobia improved, relating only to horses with black harnesses over their noses. Hans’s father suggested this symbolized his moustache.
• Freud’s interpretation linked Hans’s fear to the Oedipus complex , the horses (with black harnesses and big penises) unconsciously representing his fear of his father.
• Freud suggested Hans resolved this conflict as he fantasized about himself with a big penis and married his mother. This allowed Hans to overcome his castration anxiety and identify with his father.

Freud was interested in the role of infant sexuality in child development. He recognised that this approach may have appeared strange to people unfamiliar with his ideas but observed that it was inevitable for a psychoanalyst to see this as important. The case therefore focused on little Hans’s psychosexual development and it played a key role in the formulation of Freud’s ideas within the Oedipus Conflict , such as the castration complex.

‘Little Hans’ was nearly five when has was seen by Freud (on 30th March 1908) but letters from his father to Freud provide the bulk of the evidence for the case study. These refer retrospectively to when Hans was less than three years old and were supplied to Freud through the period January to May 1908 (by which time little Hans was five years old).

The first reports of Hans were when he was 3 years old when he developed an active interest in his ‘widdler’ (penis), and also those of other people. For example, on one occasion, he asked, ‘Mummy, have you got a widdler too?

Throughout this time, the main theme of his fantasies and dreams was widdlers and widdling.  When he was about three and a half years old his mother told him not to touch his widdler or else she would call the doctor to come and cut it off.

When Hans was almost 5, Hans’ father wrote to Freud explaining his concerns about Hans. He described the main problem as follows:

He is afraid a horse will bite him in the street, and this fear seems somehow connected with his having been frightened by a large penis’.

The father went on to provide Freud with extensive details of conversations with Hans. Together, Freud and the father tried to understand what the boy was experiencing and undertook to resolve his phobia of horses.

Freud wrote a summary of his treatment of Little Hans, in 1909, in a paper entitled “ Analysis of a Phobia in a Five-year-old Boy. “

Case History: Little Hans’ Phobia

Since the family lived opposite a busy coaching inn, that meant that Hans was unhappy about leaving the house because he saw many horses as soon as he went out of the door.

When he was first asked about his fear Hans said that he was frightened that the horses would fall down and make a noise with their feet.  He was most frightened of horses which were drawing heavily laden carts, and, in fact, had seen a horse collapse and die in the street one time when he was out with his nurse.

It was pulling a horse-drawn bus carrying many passengers and when the horse collapsed Hans had been frightened by the sound of its hooves clattering against the cobbles of the road.  He also suffered attacks of more generalized anxiety . Hans’ anxieties and phobia continued and he was afraid to go out of the house because of his phobia of horses.

When Hans was taken to see Freud (on 30th March 1908), he was asked about the horses he had a phobia of. Hans noted that he didn’t like horses with black bits around the mouth.

Freud believed that the horse was a symbol of his father, and the black bits were a mustache.  After the interview, the father recorded an exchange with Hans where the boy said ‘Daddy don’t trot away from me!

Over the next few weeks Hans” phobia gradually began to improve.  Hans said that he was especially afraid of white horses with black around the mouth who were wearing blinkers.  Hans” father interpreted this as a reference to his mustache and spectacles.

• In the first, Hans had several imaginary children. When asked who their mother was, Hans replied “Why, mummy, and you”re their Granddaddy”.
• In the second fantasy, which occurred the next day, Hans imagined that a plumber had come and first removed his bottom and widdler and then gave him another one of each, but larger.

Freud’s Interpretation of Hans’ Phobia

After many letters were exchanged, Freud concluded that the boy was afraid that his father would castrate him for desiring his mother. Freud interpreted that the horses in the phobia were symbolic of the father, and that Hans feared that the horse (father) would bite (castrate) him as punishment for the incestuous desires towards his mother.

Freud saw Hans” phobia as an expression of the Oedipus complex . Horses, particularly horses with black harnesses, symbolized his father. Horses were particularly suitable father symbols because of their large penises.

The fear began as an Oedipal conflict was developing regarding Hans being allowed in his parents” bed (his father objected to Hans getting into bed with them).

Hans told his father of a dream/fantasy which his father summarized as follows:

‘In the night there was a big giraffe in the room and a crumpled one: and the big one called out because I took the crumpled one away from it.  Then it stopped calling out: and I sat down on top of the crumpled one’.

Freud and the father interpreted the dream/fantasy as being a reworking of the morning exchanges in the parental bed.  Hans enjoyed getting into his parent’s bed in the morning but his father often objected (the big giraffe calling out because he had taken the crumpled giraffe – mother – away).

Both Freud and the father believed that the long neck of the giraffe was a symbol for the large adult penis.  However Hans rejected this idea.

The Oedipus Complex

Freud was attempting to demonstrate that the boy’s (Little Hans) fear of horses was related to his Oedipus complex .  Freud thought that, during the phallic stage (approximately between 3 and 6 years old), a boy develops an intense sexual love for his mothers.

Because of this, he sees his father as a rival, and wants to get rid of him.  The father, however, is far bigger and more powerful than the young boy, and so the child develops a fear that, seeing him as a rival, his father will castrate him.

Because it is impossible to live with the continual castration-threat anxiety provided by this conflict, the young boy develops a mechanism for coping with it, using a defense mechanis m known as identification with the aggressor .

He stresses all the ways that he is similar to his father, adopting his father’s attitudes, mannerisms and actions, feeling that if his father sees him as similar, he will not feel hostile towards him.

Freud saw the Oedipus complex resolved as Hans fantasized himself with a big penis like his father’s and married to his mother with his father present in the role of grandfather.

Hans did recover from his phobia after his father (at Freud’s suggestion) assured him that he had no intention of cutting off his penis.

Critical Evaluation

Case studies have both strengths and weaknesses. They allow for detailed examinations of individuals and often are conducted in clinical settings so that the results are applied to helping that particular individual as is the case here.

However, Freud also tries to use this case to support his theories about child development generally and case studies should not be used to make generalizations about larger groups of people.

The problems with case studies are they lack population validity. Because they are often based on one person it is not possible to generalize the results to the wider population.

The case study of Little Hans does appear to provide support for Freud’s (1905) theory of the Oedipus complex.  However, there are difficulties with this type of evidence.

There are several other weaknesses with the way that the data was collected in this study. Freud only met Hans once and all of his information came from Hans father. We have already seen that Hans’ father was an admirer of Freud’s theories and tried to put them into practice with his son.

This means that he would have been biased in the way he interpreted and reported Hans’ behavior to Freud. There are also examples of leading questions in the way that Hans’ father questioned Hans about his feelings. It is therefore possible that he supplied Hans with clues that led to his fantasies of marriage to his mother and his new large widdler.

Of course, even if Hans did have a fully-fledged Oedipus complex, this shows that the Oedipus complex exists but not how common it is.  Remember that Freud believed it to be universal.

At age 19, the not-so Little Hans appeared at Freud’s consulting room having read his case history.  Hans confirmed that he had suffered no troubles during adolescence and that he was fit and well.

He could not remember the discussions with his father, and described how when he read his case history it ‘came to him as something unknown’

Finally, there are problems with the conclusions that Freud reaches. He claims that Hans recovered fully from his phobia when his father sat him down and reassured him that he was not going to castrate him and one can only wonder about the effects of this conversation on a small child!

More importantly, is Freud right in his conclusions that Hans’ phobia was the result of the Oedipus complex or might there be a more straightforward explanation?

Hans had seen a horse fall down in the street and thought it was dead. This happened very soon after Hans had attended a funeral and was beginning to question his parents about death. A behaviorist explanation would be simply that Hans was frightened by the horse falling over and developed a phobia as a result of this experience.

Gross cites an article by Slap (an American psychoanalyst) who argues that Hans’ phobia may have another explanation. Shortly after the beginning of the phobia (after Hans had seen the horse fall down) Hans had to have his tonsils out.

After this, the phobia worsened and it was then that he specifically identified white horses as the ones he was afraid of. Slap suggests that the masked and gowned surgeon (all in white) may have significantly contributed to Hans’ fears.

The Freud Archives

In 2004, the Freud Archives released a number of key documents which helped to complete the context of the case of little Hans (whose real name was Herbert Graf).

The released works included the transcript of an interview conducted by Kurt Eissler in 1952 with Max Graf (little Hans’s father) as well as notes from brief interviews with Herbert Graf and his wife  in 1959.

Such documents have provided some key details that may alter the way information from the original case is interpreted. For example, Hans’s mother had been a patient of Freud herself.

Another noteworthy detail was that Freud gave little Hans a rocking horse for his third birthday and was sufficiently well acquainted with the family to carry it up the stairs himself.

It is interesting to question why, in the light of Hans’s horse phobia, details of the presence of the gift were not mentioned in the case study (since it would have been possible to do so without breaking confidentiality for either the family or Freud himself).

Information from the archived documents reveal much conflict within the Graf family. Blum (2007, p. 749) concludes that:

“Trauma, child abuse [of Hans’s little sister], parental strife, and the preoedipal mother-child relationship emerge as important issues that intensified Hans’s pathogenic oedipal conflicts and trauma. With limited, yet remarkable help from his father and Freud, Little Hans nevertheless had the ego strength and resilience to resolve his phobia, resume progressive development, and forge a successful creative career.”

Support for Freud (Brown, 1965)

Brown (1965) examines the case in detail and provides the following support for Freud’s interpretation.

1 . In one instance, Hans said to his father –“ Daddy don”t trot away from me ” as he got up from the table. 2 . Hans particularly feared horses with black around the mouth.  Han’s father had a moustache. 3. Hans feared horses with blinkers on. Freud noted that the father wore spectacles which he took to resemble blinkers to the child. 4 . The father’s skin resembled white horses rather than dark ones.  In fact, Hans said, “Daddy, you are so lovely. You are so white”. 5 . The father and child had often played at “horses” together.  During the game the father would take the role of horse, the son that of the rider.

Ross (2007) reports that the interviews with Max and Herbert Graf provide evidence of the psychological problems experienced by Little Hans’s mother and her mistreatment of her husband and her daughter (who committed suicide as an adult).

Ross suggests that “Reread in this context, the text of “A Phobia in a Five-year-old Boy” provides ample evidence of Frau Graf’s sexual seduction and emotional manipulation of her son, which exacerbated his age-expectable castration and separation anxiety, and her beating of her infant daughter.

The boy’s phobic symptoms can therefore be deconstructed not only as the expression of oedipal fantasy, but as a communication of the traumatic abuse occurring in the home.

Blum, H. P. (2007). Little Hans: A centennial review and reconsideration . Journal of the American Psychoanalytic Association, 55 (3), 749-765.

Brown, R. (1965). Social Psychology . Collier Macmillan.

Freud, S. (1905). Three essays on the theory of sexuality . Se, 7.

Freud, S. (1909). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Graf, H. (1959). Interview by Kurt Eissler. Box R1, Sigmund Freud Papers. Sigmund Freud Collection, Manuscript Division, Library of Congress, Washington, DC.

Graf, M. (1952). Interview by Kurt Eissler. Box 112, Sigmund Freud Papers. Sigmund Freud Collection, Manuscript Division, Library of Congress, Washington, DC.

Ross, J.M. (2007). Trauma and abuse in the case of Little Hans: A contemporary perspective . Journal of the American Psychoanalytic Association, 55 (3), 779-797.

Further Information

• Sigmund Freud Papers: Interviews and Recollections, -1998; Set A, -1998; Interviews and; Graf, Max, 1952.
• Sigmund Freud Papers: Interviews and Recollections, -1998; Set A, -1998; Interviews and; Graf, Herbert, 1959.
• Wakefield, J. C. (2007). Attachment and sibling rivalry in Little Hans: The fantasy of the two giraffes revisited. Journal of the American Psychoanalytic Association, 55(3), 821-848.
• Bierman J.S. (2007) The psychoanalytic process in the treatment of Little Hans. Psychoanalytic Study of the Child, 62: 92- 110
• Re-Reading “Little Hans”: Freud’s Case Study and the Question of Competing Paradigms in Psychoanalysis
• An” Invisible Man”?: Little Hans Updated

FOCUSED REVIEW article

Clinical case studies in psychoanalytic and psychodynamic treatment.

This article mentions parts of:

Theoretical pluralism in psychoanalytic case studies

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• Centre for Psychoanalytic Studies, University of Essex, Colchester, UK

This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of psychoanalysis, and we clarify the unique strengths of this method and areas for improvement. Finally, based on the literature and on our own experience with case study research, we come to formulate nine guidelines for future case study authors: (1) basic information to include, (2) clarification of the motivation to select a particular patient, (3) information about informed consent and disguise, (4) patient background and context of referral or self-referral, (5) patient's narrative, therapist's observations and interpretations, (6) interpretative heuristics, (7) reflexivity and counter-transference, (8) leaving room for interpretation, and (9) answering the research question, and comparison with other cases.

Introduction

Psychoanalysis has always been, according to its inventor, both a research endeavor and a therapeutic endeavor. Furthermore it is clear from Freud's autobiography that he prioritized the research aspect; he did not become a doctor because he wished to cure people in ill health ( Freud, 2001 [1925] ). His invention of the psychoanalytic approach to therapy, involving the patient lying down and associating freely, served a research purpose as much as a therapeutic purpose. Through free association, he would be able to gain unique insight in the human mind. Next, he had to find a format to report on his findings, and this would be the case study. The case study method already existed in medicine ( Forrester, 2016 ), but Freud adjusted it considerably. Case studies in medical settings were more like case files, in which the patient was described or reduced to a number of medical categories: the patient became a case of some particular ailment ( Forrester, 2016 ). In Freud's hands, the case study developed into Kranken Geschichten in which the current pathology of the patient is related to the whole of his life, sometimes even over generations.

Although Freud's case studies have demonstrably provided data for generations of research by analysts ( Midgley, 2006a ) and various scholars ( Pletsch, 1982 ; Sealey, 2011 ; Damousi et al., 2015 ), the method of the case study has become very controversial. According to Midgley (2006b) , objections against the case study method can be grouped into three arguments. First there is the data problem: case studies provide no objective clinical data ( Widlöcher, 1994 ), they only report on what went right and disregard any confusion or mistakes ( Spence, 2001 ). Second, there is the data analysis problem: the way in which the observations of the case study are analyzed lack validity; case studies confirm what we already know ( Spence, 2001 ). Some go even so far to say that they are purely subjective: Michels calls case studies the “crystallization of the analyst's countertransference” ( Michels, 2000 , p. 373). Thirdly, there is the generalizability problem: it is not possible to gain generalizable insight from case studies. Reading, writing and presenting case studies has been described as being a group ritual to affirm analysts in their professional identity, rather than a research method ( Widlöcher, 1994 ).

These criticisms stand in contrast to the respect gained by the case study method in the last two decades. Since the 1990s there has been an increasing number of psychoanalytic and psychodynamic clinical case study and empirical case studies being published in scientific journals ( Desmet et al., 2013 ; Cornelis et al., in press ). It has also been signaled that the case study method is being revived more broadly in the social sciences. In the most recent, fifth edition of his seminal book on case study research, Yinn (2014) includes a figure showing the steady increase of the frequency with which the term “case study research” appears in published books in the period from 1980 to 2008.

KEY CONCEPT 1. Clinical case study A clinical case study is a narrative report by the therapist of what happened during a therapy together with the therapist's interpretations of what happened. It is possible that certain (semi)-structured assessment instruments, such as a questionnaire or a diagnostic interview are included in clinical case studies, yet it is still the therapist that uses these, interprets and discusses them.

KEY CONCEPT 2. Empirical case studies In an empirical case study data are gathered from different sources (e.g., self-report, observation,…) and there is a research team involved in the analyses of the data. This study can take place either in a naturalistic setting (systematic case study) or in a controlled experimental environment (single-case experiment).

In addition to the controversy about the case study method, psychoanalysis has developed into a fragmented discipline. The different psychoanalytic schools share Freud's idea of the unconscious mind, but they focus on different aspects in his theoretical work. Some of the schools still operate under the wings of the International Psychoanalytic Association, while others have established their own global association. Each school is linked to one or several key psychoanalysts who have developed their own version of psychoanalysis. Each psychoanalytic school has a different set of theories but there are also differences in the training of new psychoanalysts and in the therapeutic techniques that are applied by its proponents.

Based on this heterogeneity of perspectives in psychoanalysis, a research group around the Single Case Archive investigated the current status of case study research in psychoanalysis ( Willemsen et al., 2015a ). They were particularly interested to know more about the output and methodology of case studies within the different psychoanalytic schools.

KEY CONCEPT 3. Single case archive The Single Case Archive is an online archive of published clinical and empirical case studies in the field of psychotherapy ( http://www.singlecasearchive.com ). The objective of this archive is to facilitate the study of case studies for research, clinical, and teaching purposes. The online search engine allows the identification of sets of cases in function of specific clinical or research questions.

Our Survey Among Case Study Authors About their Psychoanalytic School

In order to investigate and compare case studies from different psychoanalytic schools, we first had to find a way of identifying to which school the case studies belonged. This is very difficult to judge straightforwardly on the basis of the published case study: the fact that someone cites Winnicott or makes transference interpretations doesn't place him or her firmly within a particular psychoanalytic school. The best approach was to ask the authors themselves. Therefore, we contacted all case study authors included in the Single Case Archive (since the time of our original study in 2013, the archive has expanded). We sent emails and letters in different languages to 445 authors and received 200 replies (45% response rate). We asked them the following question: “ At the time you were working on this specific case, to which psychoanalytic school(s) did you feel most attached? ” Each author was given 10 options: (1) Self Psychology (1.a Theory of Heinz Kohut, 1.b Post-Kohutian Theories, 1.c Intersubjective psychoanalysis), (2) Relational psychoanalysis, (3) Interpersonal psychoanalysis, (4) Object relational psychoanalysis (4.a Theory of Melanie Klein, 4.b Theory of Donald W. Winnicott, 4.c Theory of Wilfred R. Bion, 4.d Theory of Otto F. Kernberg), (5) Ego psychology (or) “Classic psychoanalysis” (5.a Theories of Sigmund Freud, 5.b Ego psychology, 5.c Post-Ego psychology), (6) Lacanian psychoanalysis, (7) Jungian psychoanalysis, (8) National Psychological Association for Psychoanalysis (NPAP) related theory, (9) Modern psychoanalysis related to the Boston or New York Graduate School of Psychoanalysis (BGSP/NYGSP), (10) Other. Respondents could indicate one or more options.

Analysis of the responses indicated that the two oldest schools in psychoanalysis, Object-relations psychoanalysis and Ego psychology, dominate the field in relation to case studies that are published in scientific journals. More than three quarters of all case study authors (77%) reported these schools of thought to be the ones with which they considered themselves most affiliated. Three more recent schools were also well-represented among case studies: Self Psychology, Relational Psychoanalysis, and Interpersonal Psychoanalysis. Lacanian Psychoanalysis, Jungian Psychoanalysis, NPAP related Theory and Modern Psychoanalysis related to the BGSP/NYGSP were only rarely mentioned by case study authors as their school of thought. This does not mean that clinicians or researchers within these latter schools do not write any case studies. It only means that they publish few case studies in the scientific journals included in ISI-ranked journals indexed in Web of Science. But they might have their own journals in which they publish clinical material.

Our survey demonstrated that the majority of case study authors (59%) feel attached to more than one psychoanalytic school. This was in fact one of the surprising findings in our study. It seems that theoretical pluralism is more rule than exception among case study authors. There were some differences between the psychoanalytic schools though in terms of pluralism. Case study authors who feel attached to Self Psychology and Interpersonal Psychoanalysis are the most pluralistic: 92 and 86%, respectively also affiliate with one or more other psychoanalytic schools. Case study authors who feel attached to Object Relations Psychoanalysis are the “purest” group: only 69% of them affiliate with one or more other psychoanalytic schools.

KEY CONCEPT 4. Theoretical pluralism A situation in which several, potentially contradicting, theories coexist. It is sometimes interpreted as a sign of the immaturity of a science, under the assumption that a mature science should arrive at one single coherent truth. Others see theoretical pluralism as unavoidable for any applied discipline, as each theory can highlight only part of reality.

Psychoanalytic Pluralism and the Case Study Method

We were not really surprised to find that Object Relations psychoanalysis and Ego psychology were the most dominant schools in the field of psychoanalytic case studies, as they are very present in European, Latin-American and North-American psychoanalytic institutes. We were more surprised to find such a high degree of pluralism among these case study authors, given the fact that disputes between analysts from different schools can be quite ardent ( Green, 2005 ; Summers, 2008 ). Others have compared the situation of psychoanalytic schools with the Tower of Babel ( Steiner, 1994 ).

It has been argued that the case study method contributes to the degree of theoretical pluralism within psychoanalysis. The reason for this is situated in the reasoning style at the basis of case study research ( Chiesa, 2010 ; Fonagy, 2015 ). The author of a psychoanalytic case study makes a number of observations about the patient within the context of the treatment, and then moves to a conclusion about the patient's psychodynamics in general. The conclusion he or she arrives at inductively gains its “truth value” from the number and quality of observations it is based on. This style of reasoning in case study research is very similar to how clinicians reason in general. Clinicians look for patterns within patients and across patients. If they make similar observations in different patients, or if other psychoanalysts make similar observations in their patients, the weight of the conclusion becomes greater and greater. The problem with this reasoning style is that one can never arrive at definite conclusions: even if a conclusion is based on a large number of observations, it is always possible that the next observation disconfirms the conclusion. Therefore, it could be said, it is impossible to attain “true” knowledge.

The above argument is basically similar to objections against any kind of qualitative research. To this, we argue with Rustin (2003) that there is not one science and no hierarchy of research methods. Each method comes with strengths and weaknesses, and what one gains in terms of control and certainty in a conventional experimental setup is lost in terms of external validity and clinical applicability. Numerous researchers have pleaded for the case study approach as one method among a whole range of research methods in the field of psychoanalysis ( Rustin, 2003 ; Luyten et al., 2006 ; Midgley, 2006b ; Colombo and Michels, 2007 ; Vanheule, 2009 ; Hinshelwood, 2013 ). Leuzinger-Bohleber makes a distinction between clinical research and extra-clinical research ( Leuzinger-Bohleber, 2015 ). Clinical research is the idiographic type of research conducted by a psychoanalyst who is working with a patient. Unconscious phantasies and conflicts are symbolized and put into words at different levels of abstraction. This understanding then molds the perception of the analyst in subsequent clinical situations; even though the basic psychoanalytic attitude of “not knowing” is maintained. The clinical case study is clinical research par excellence . Extra-clinical research consists in the application of different methodologies developed in the natural and human sciences, to the study of the unconscious mind. Leuzinger-Bohleber refers to empirical psychotherapy research, experimental research, literature, cultural studies, etc. We believe that the clinical case study method should step up and claim its place in psychoanalytic research, although we agree that the method should be developed further. This paper and a number of others such as Midgley (2006b) should facilitate this methodological improvement. The clinical research method is very well-suited to address any research question related to the description of phenomena and sequences in psychotherapy (e.g., manifestation and evolution of symptoms and therapeutic relationship over time). It is not suitable for questions related to causality and outcome.

We also want to point out that there is a new evolution in the field of psychotherapy case study research, which consists in the development of methodologies for meta-studies of clinical case studies ( Iwakabe and Gazzola, 2009 ). The evolution builds on the broader tendency in the field of qualitative research to work toward integration or synthesis of qualitative findings ( Finfgeld, 2003 ; Zimmer, 2006 ). The first studies which use this methodology have been published recently: Widdowson (2016) developed a treatment manual for depression, Rabinovich (2016) studied the integration of behavioral and psychoanalytic treatment interventions, and Willemsen et al. (2015b) investigated patterns of transference in perversion. The rich variety of research aims demonstrates the potential of these meta-studies of case studies.

KEY CONCEPT 5. Meta-studies of clinical case studies A meta-study of clinical case studies is a research approach in which findings from cases are aggregated and more general patterns in psychotherapeutic processes are described. Several methodologies for meta-studies have been described, including cross-case analysis of raw data, meta-analysis, meta-synthesis, case comparisons, and review studies in general.

Lack of Basic Information in Psychoanalytic Case Studies

The second research question of our study ( Willemsen et al., 2015a ) concerned the methodological, patient, therapist, and treatment characteristics of published psychoanalytic case studies. All studies included in the Single Case Archive are screened by means of a coding sheet for basic information, the Inventory of Basic Information in Single Cases (IBISC). The IBISC was designed to assess the presence of basic information on patient (e.g., age, gender, reasons to consult), therapist (e.g., age, gender, level of experience), treatment (e.g., duration, frequency, outcome), and the methodology (e.g., therapy notes or audio recoding of sessions). The IBISC coding revealed that a lot of basic information is simply missing in psychoanalytic case studies ( Desmet et al., 2013 ). Patient information is fairly well-reported, but information about therapist, treatment and methodology are often totally absent. Training and years of experience are not mentioned in 84 and 94% of the cases, respectively. The setting of the treatment is not mentioned in 61% of the case studies. In 80% of the cases, it was not mentioned whether the writing of the case studies was on the basis of therapy notes, or audiotapes. In 91% of the cases, it was not mentioned whether informed consent was obtained.

Using variables on which we had more comprehensive information, we compared basic information of case studies from different psychoanalytic schools. This gave us a more detailed insight in the type of case studies that have been generated within each psychoanalytic school, and into the difference between these schools in terms of the kind of case study they generate. We found only minimal differences. Case studies in Relational Psychoanalysis stand out because they involve older patients and longer treatments. Case studies in Interpersonal Psychoanalysis tend to involve young, female patients and male therapists. Case study authors from both these schools tend to report on intensive psychoanalysis in terms of session frequency. But for the rest, it seems that the publication of case studies throughout the different psychoanalytic schools has intensified quite recently.

Guidelines for Writing Clinical Case Studies

One of the main problems in using psychoanalytic case studies for research purposes is the enormous variability in quality of reporting and inconsistency in the provision of basic information about the case. This prevents the reader from contextualizing the case study and it obstructs the comparison of one case study with another. There have been attempts to provide guidelines for the writing of case studies, especially in the context of analytic training within the American Psychoanalytic Association ( Klumpner and Frank, 1991 ; Bernstein, 2008 ). However, these guidelines were never enforced for case study authors by the editors from the main psychoanalytic journals. Therefore, the impact of these guidelines on the field of case study research has remained limited.

Here at the end of our focused review, we would like to provide guidelines for future case study authors. Our guidelines are based on the literature and on our experience with reading, writing, and doing research with clinical case studies. We will include fragments of existing case studies to clarify our guidelines. These guidelines do not provide a structure or framework for the case study; they set out basic principles about what should be included in a case study.

Basic Information

First of all, we think that a clinical case study needs to contain basic information about the patient, the therapist, the treatment, and the research method. In relation to the patient , it is relevant to report on gender, age (or an age range in which to situate the patient), and ethnicity or cultural background. The reader needs to know these characteristics in order to orientate themselves as to who the patient is and what brings them to therapy. In relation to the therapist , it is important to provide information about professional training, level of professional experience, and theoretical orientation. Tuckett (2008) emphasizes the importance for clinicians to be explicit about the theory they are using and about their way of practicing. It is not sufficient to state membership of a particular group or school, because most groups have a wide range of different ways of practicing. In relation to the treatment itself, it is important to be explicit about the kind of setting, the duration of treatment, the frequency of sessions, and details about separate sequences in the treatment (diagnostic phase, follow-up etc.). These are essential features to share, especially at a time when public sector mental health treatment is being subjected to tight time restrictions and particular ways of practising are favored over others. For example short-term psychotherapies are being implemented in public services for social and economic reasons. While case studies carried out in the public sector can give us information on those short-term therapies, private practice can offer details about the patient's progress on a long-term basis. Moreover, it is important to report whether the treatment is completed. To our astonishment, there are a considerable number of published case studies on therapies that were not finished ( Desmet et al., 2013 ). As Freud (2001 [1909] , p. 132) already advised, it is best to wait till completion of the treatment before one starts to work on a case study. Finally, in relation to the research method , it is crucial to mention which type of data were collected (therapy notes taken after each session, audio-recordings, questionnaires, etc.), whether informed consent was given, and in what way the treatment was supervised. Clinicians who would like to have help with checking whether they included all necessary basic information case use the Inventory for Basic Information in Single Cases (IBISC), which is freely available on http://www.singlecasearchive.com/resources .

Motivation to Select a Particular Patient

First of all, it is crucial to know what the motivation for writing about a particular case comes from. Some of the following questions should be kept in mind and made explicit from the beginning of the case presentation. Why is it interesting to look at this case? What is it about this case or the psychotherapist's work that can contribute to the already existing knowledge or technique?

“This treatment resulted in the amelioration of his [obsessive-compulsive] symptoms, which remained stable eight years after treatment ended. Because the standard of care in such cases has become largely behavioral and pharmacological, I will discuss some questions about our current understanding of obsessive-compulsive phenomena that are raised by this case, and some of the factors that likely contributed to the success of psychoanalytic treatment for this child ( McGehee, 2005 , p. 213–214).”

This quotation refers to a case that has been selected on the basis of its successful outcome. The author is then interested to find out what made this case successful.

Informed Consent and Disguise

As regulations on privacy and ethics are becoming tighter, psychotherapists find themselves with a real problem in deciding what is publishable and what is not. Winship (2007) points out that there is a potential negative effect of research overregulation as clinicians may be discouraged from reporting ordinary and everyday findings from their clinical practice. But he also offers very good guidelines for approaching the issue of informed consent. A good practice is asking for consent either at the start of the treatment or after completion of the treatment: preferably not during treatment. It is inadvisable to complete the case study before the treatment has ended. It is also advisable that the process of negotiating consent with the patient is reported in the case study.

“To be sure that Belle's anonymity was preserved, I contacted her while writing this book and told her it would not be published without her complete approval. To do this, I asked if she would review every word of every draft. She has ( Stoller, 1986 , p. 217).”

In relation to disguise, one has to strike a balance between thin and thick disguise. Gabbard (2000) suggests different useful approaches to disguising the identity of the patient.

Patient Background and Context of Referral or Self-Referral

It is important to include relevant facts about the patient's childhood, family history, siblings, any trauma or losses and relationship history (social and romantic) and the current context of the patient's life (family, working, financial). The context of referral is also key to understanding how and why the patient has come to therapy. Was the patient encouraged to come or had wanted to come? Has there been a recent crisis which prompted the intervention or an on-going problem which the patient had wanted to address for some time?

“Michael was one of the youngest children in his family of origin. He had older brothers and sisters who had been received into care before his birth. His parents separated before he was born. There had been some history of violence between them and Michael was received into care on a place of safety order when he was an infant because his mother had been unable to show consistent care toward him ( Lykins Trevatt, 1999 , p. 267).”

Patient's Narrative, Therapist's Observations, and Interpretations

A case study should contain detailed accounts of key moments or central topics, such as a literal transcription of an interaction between patient and therapist, the narration of a dream, a detailed account of associations, etc. This will increase the fidelity of the case studied, especially when both patient's and therapist's speech are reported as carefully as possible.

“Martha spoke in a high-pitched voice which sounded even more tense than usual. She explained that her best friend's mum had shouted at her for being so withdrawn; this made her angry and left her feeling that she wanted to leave their home for good. I told Martha that she often tried to undo her bad feelings by acting quickly on her instincts, as she did not feel able to hold her feelings in her mind and bring them to her therapy to think about with me. Martha nodded but it was not clear whether she could really think about what I just said to her. She then said that she was being held in the hospital until a new foster placement could be found. “In the meantime,” she said in a pleased tone, “I have to be under constant supervision” ( Della Rosa, 2015 , p. 168).”

In this example, observations of nonverbal behavior and tonality are also included, which helps to render a lively picture of the interaction.

Interpretative Heuristics

In which frame of reference is the writer operating? It is important to know what theories are guiding the therapist's thinking and what strategies he employs in order to deal with the clinical situation he is encountering. Tuckett (1993) writes about the importance of knowing what “explanatory model” is used by the therapist in order to make sense of the patient and to relate his own thinking to a wider public for the purpose of research. This idea is also supported by Colombo and Michels (2007) who believe that making theoretical orientations as explicit as possible would make the case studies intelligible and more easily employed by the research community. This can be done by the therapists explaining why they have interpreted a particular situation in the way they have. For example, Kegerreis in her paper on time and lateness (2013) stresses throughout how she is working within the object-relations framework and looking out for the patient's use of projective mechanisms.

“She was 10 minutes late. Smiling rather smugly to herself she told me that the wood supplied for her new floor had been wrongly cut. The suppliers were supposed to come and collect it and hadn't done so, so she had told them she was going to sell it to a friend, and they are now all anxious and in a hurry to get it.

I said she now feels as if she has become more powerful, able to get a response. She agrees, grinning more, telling me she does have friends who would want it, that it was not just a ploy.

She said she had found it easier to get up today but was still late. I wondered if she had a sense of what the lateness was about. She said it was trying to fit too much in. She had been held up by discussing the disposal of rubble with her neighbors.

I said I thought there was a link here with the story about the wood. In that she had turned the situation around. She had something that just didn't work, had a need for something, but it was turned around into something that was the suppliers' problem. They were made to feel the urgency and the need. Maybe when she is late here she is turning it around, so it is me who is to be uncertain and waiting, not her waiting for her time to come.

We maybe learn here something of her early object relationships, in which being in need is felt to be unbearable, might lead to an awful awareness of lack and therefore has to be exported into someone else. One could go further and surmise that in her early experience she felt teased and exploited by the person who has the power to withhold what you need ( Kegerreis, 2013 , p. 458).”

There can be no doubt reading this extract about the theoretical framework which is being used by the therapist.

Reflexivity and Counter-Transference

A good case study contains a high degree of reflexivity, whereby the therapist is able to show his feelings and reactions to the patient's communication in the session and an ability to think about it later with hindsight, by himself or in supervision. This reflexivity needs to show the pattern of the therapist's thinking and how this is related to his school of thought and to his counter-transferential experiences. How has the counter-transference been dealt with in a professional context? One can also consider whether the treatment has been influenced by supervision or discussion with colleagues.

“Recently for a period of a few days I found I was doing bad work. I made mistakes in respect of each one of my patients. The difficulty was in myself and it was partly personal but chiefly associated with a climax that I had reached in my relation to one particular psychotic (research) patient. The difficulty cleared up when I had what is sometimes called a ‘healing’ dream. […] Whatever other interpretations might be made in respect of this dream the result of my having dreamed it and remembered it was that I was able to take up this analysis again and even to heal the harm done to it by my irritability which had its origin in a reactive anxiety of a quality that was appropriate to my contact with a patient with no body ( Winnicott, 1949 , p. 70).”

Leaving Room for Interpretation

A case study is the therapist's perspective on what happened. A case study becomes richer if the author can acknowledge aspects of the story that remain unclear to him. This means that not every bit of reported clinical material should be interpreted and fitted within the framework of the research. There should be some loose ends. Britton and Steiner (1994) refer to the use of interpretations where there is no room for doubt as “soul murder.” A level of uncertainty and confusion make a case study scientifically fruitful ( Colombo and Michels, 2007 ). The writer can include with hindsight what he thinks he has not considered during the treatment and what he thinks could have changed the course for the treatment if he had been aware or included other aspects. This can be seen as an encouragement to continue to be curious and maintain an open research mind.

Answering the Research Question, and Comparison with Other Cases

As in any research report, the author has to answer the research question and relate the findings to the existing literature. Of particular interest is the comparison with other similar cases. Through comparing, aggregating, and contrasting case studies, one can discover to what degree and under what conditions, the findings are valid. In other words, the comparison of cases is the start of a process of generalization of knowledge.

“Although based on a single case study, the results of my research appear to concur with the few case studies already in the field. In reviewing the literature on adolescent bereavement, it was the case studies that had particular resonance with my own work, and offered some of the most illuminating accounts of adolescent bereavement. Of special significance was Laufer's (1966) case study that described the narcissistic identifications of ‘Michael’, a patient whose mother had died in adolescence. Both Laufer's research and my own were conducted using the clinical setting as a basis and so are reflective of day-to-day psychotherapy practice ( Keenan, 2014 , p. 33).”

As Yinn (2014) has argued for the social sciences, the case study method is the method of choice when one wants to study a phenomenon in context, especially when the boundaries between the phenomenon and the context are fussy. We are convinced that the same is true for case study methodology in the fields of psychoanalysis and psychotherapy. The current focused review has positioned the research method within these fields, and has given a number of guidelines for future case study researchers. The authors are fully aware that giving guidelines is a very tricky business, because while it can channel and stimulate research efforts it can as well-limit creativity and originality in research. Moreover, guidelines for good research change over time and have to be negotiated over and over again in the literature. A similar dilemma is often pondered when it comes to qualitative research ( Tracy, 2010 ). However, our first impetus for providing these guidelines is pedagogical. The three authors of this piece are experienced psychotherapists who also work in academia. A lot of our students are interested in doing case study research with their own patients, but they struggle with the methodology. Our second impetus is to improve the scientific credibility of the case study method. Our guidelines for what to include in the written account of a case study, should contribute to the improvement of the quality of the case study literature. The next step in the field of case study research is to increase the accessibility of case studies for researchers, students and practitioners, and to develop methods for comparing or synthesizing case studies. As we have described above, efforts in that direction are being undertaken within the context of the Single Case Archive.

Author Contributions

JW has written paragraphs 1–4; ER and JW have written paragraph 5 together; SK has contributed to paragraph 5 and revised the whole manuscript.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author Biography

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Keywords: clinical case study, methodology, psychotherapy research, psychoanalysis, psychoanalytic schools, theoretical pluralism, review

Citation: Willemsen J, Della Rosa E and Kegerreis S (2017) Clinical Case Studies in Psychoanalytic and Psychodynamic Treatment. Front. Psychol . 8:108. doi: 10.3389/fpsyg.2017.00108

Received: 29 November 2016; Accepted: 16 January 2017; Published: 02 February 2017.

Reviewed by:

Copyright © 2017 Willemsen, Della Rosa and Kegerreis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Freud (1909)

Last updated 10 Feb 2023

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Analysis of a Phobia of a Five-Year Old Boy.

Background & Aim

Little Hans’ father was a supporter of Freud and when his son developed a phobia, he referred him to Freud. Freud agreed to help and believed Hans’ phobia was due to things going on in his unconscious mind. Freud used the study of Little Hans to support his views on the origins of phobias, childhood sexuality and the Oedipus complex , as well as his belief in psychoanalysis as an effective therapy. Freud believed Hans’ fears, dreams and fantasies were symbolic of his unconscious passing through the phallic stage of psychosexual development .

As this was a detailed study of a single individual (Little Hans was Herbert Graf) over a period of time, we can classify it as a longitudinal case study . The study describes Hans’ fears from when he was three years old until he was five. He was five years old at the time of this study, but historical information from when Little Hans was three years old was also used. Qualitative data was gathered by Little Hans’ father through observations of and conversations with his son. This information was then sent to Freud by letter, who replied with interpretations of Hans’ behaviour and with advice.

During his correspondences with Freud, Hans’ father reported some of the following information about his son: Just before the age of three, Hans started to develop an active interest in his ‘widdler’ and he started to masturbate. This caused his mother to threaten to send for Dr A. to cut it off. At three and a half Hans’ sister Hanna was born; he resented her and hoped she would drown in the bath. A short time afterwards Hans developed a fear of white horses and being bitten by them. This seemed to relate to two key incidents: Firstly, overhearing a man say to his child “Don’t put your finger to the white horse or it will bite you”; secondly, seeing a horse that was pulling a carriage fall down. As a result, Hans’ phobia was generalised to carts and buses.

It was also reported that before and after the development of the phobia, Hans was anxious that his mother would leave and he experienced fantasies including one about a giraffe, two plumber fantasies and finally a parenting fantasy. The analysis/ investigation of Little Hans ended soon after the final fantasy when the phobia stopped due to the help he was given by Freud.

The information about Little Hans was analysed by Freud and he came up with the following findings: Because Han’s was experiencing the Oedipus complex (a sexual desire for his mother and rivalry with his father) he was subconsciously scared of his father. This fear was manifested in a fear of horses, particularly those with dark around the mouth (representing his father’s beard) and blinkers (which represented his glasses). Hans’ obsession with his ‘widdler’ was another sign of being in the phallic stage of development and experiencing the Oedipus complex. Other behaviours relating to the Oedipus Complex also included the giraffe fantasy which represented the desire to take his mother away from his father; the plumber fantasy was interpreted as him identifying with his father, as was the fantasy of becoming a father. The final family fantasy was interpreted as the resolution of the Oedipus Complex.

Conclusions

Freud concluded that the study of Little Hans provided support for his theory of psychosexual development and childhood sexuality, including the idea that boys in the phallic stage experience the Oedipus complex. He also concluded that phobias are caused by unconscious anxiety being displaced onto harmless external objects. Furthermore, Hans is an example of unconscious determinism which suggests that people are not consciously aware of the causes of their behaviour. Finally, Freud claims that psychoanalysis was an effective treatment for Little Hans because it identifies the unconscious cause of the abnormality which is then brought into the conscious to be discussed and resolved.

A strength of the case study method is that in-depth qualitative data can be gained through various methods such as observations and interviews. This allowed Freud to make detailed conclusions. However, as the data was gained by Hans’ father, who was also a fan of Freud, it may lack objectivity. There may also have been bias in the questions that were asked and in the recording of the data.

Furthermore, as the sample was only a single individual the study lacks population validity and therefore it is questionable as to whether the findings concerning the Oedipus Complex and psychosexual development can be generalised to all children. This is especially true as Hans was a middle class European boy in the early 20 th Century. It can be suggested that this study and much of Freud’s other research is ethnocentric.

As Little Hans was a five-year old boy he was unable to give informed consent; however, Hans’ father clearly did. Some of the questions Hans’ father asked his son may have caused psychological harm and the detailed description of Hans’ personal information within the research article would be invasion of privacy. On the other hand, Hans’ father was very open with his son and told him that notes he was taking were for the professor who was going to fix Hans’ ‘nonsense’, which he seemed to do!

• Unconscious
• Psychosexual

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The freudian case studies.

Freudian Psychoanalysis is not a set of theories developed by a psychology professor in some Oxford or Harvard University library. Freud was a medical doctor and neurologist who sought to relieve neurotic patients of their obsessions, anxieties and depression. In other words, he developed his ideas based on his experiences with patients. And he left behind some remarkable descriptions of these encounters, known as his ‘case studies’. Freud was a gifted writer and these studies, far from dry and clinical, often seem more like bizarre, macabre short stories.

The Case Studies

Of course, Freud is not the only person to have published such case studies. In 1941, for example, the American psychiatrist Hervey Cleckley published his classic Mask of Sanity , a dramatic and novelistic description of the psychopathic individuals he met in an institution for the criminally insane. The British psychiatrist R.D. Laing also published a collection of case studies under the title Sanity, Madness and the Family. Laing interviewed the parents of young schizophrenics, mostly in and around London, to show how mental illness can be triggered by life in a dysfunctional family.

When reading Freud’s studies, the reader is immediately struck by the astonishing complexity of a neurotic illness. And this complexity may explain why Freud wrote up so few case histories. Over the whole of his career, he only published five of real depth and significance, and all were written before the First World War.

During the day, she experienced hallucinations and at night fell into a trance and mumbled to herself. Breuer found that by encouraging her to describe these hallucinations and say aloud the words she normally mumbled, he could bring her some relief. Later, she developed a fear of water and was unable to drink for days at a time. During one of her trances, she recalled watching an English tourist allow her dog to drink water from a glass. After she had described this sight and released the emotion connected to it (in this case disgust), she was able to drink once more. Again and again Breuer found that by tracing a symptom back to its source it could be removed. For example, Anna had wanted to cry while sitting by her father, but she thought her tears would disturb him. And when she wanted to check the time, she had to squint. This had led to her impaired vision. The paralysis was traced once again to her father’s bedside. One night she had seen a black snake. Obviously, she couldn’t scream because it would have upset and frightened her father. She was so afraid that the right side of her body seemed to go numb, and she found that she couldn’t move her right arm.

Dora, whose real name was Ida Bauer, was 18 when her father first brought her to see Freud. Like Anna O, she was diagnosed as hysteric. In Dora’s case, however, she seems to have suffered with hysterical symptoms since childhood.

Like Anna, Dora suffered from multiple symptoms, including migraines, depression, breathing difficulties, nervous cough, and inexplicable voice loss. Her parents were unhappily married and her father had begun an affair with the wife of a close friend (whom Freud names Mrs K). The husband (Mr K) had made sexual suggestions to Dora, who suspected her father of secretly offering her to Mr K in return for his wife (something Freud did not believe).

Freud concluded that her symptoms derived from jealousy. In other words, it was a classic Oedipal (or rather Electra) conflict: Dora was jealous of Mrs K and wished to replace her. Freud also suspected a great deal of ambivalence towards Mr K and a possible lesbian attraction to Mrs K.

Little Hans

Of all the case studies, this was perhaps the simplest and most successful. Hans was a 5-year-old boy who had developed such an intense fear of horses that he refused to leave the house in case one bit him. The phobia began after the birth of his little sister, when Hans was around three and a half. He was an intelligent, inquisitive child and her birth started him on a train of thoughts about where babies came from and the differences between male and female anatomy. Hans then became more and more interested in his penis and frightened that he would be castrated.

Again, this was an Oedipal conflict. Hans desired his mother and feared that his father would castrate him in revenge. Horses had come to symbolize his father. The fear of being bitten was in fact a fear of being castrated. In other words, he had displaced the fear of his father on to a fear of horses.

Freud later argued that children undergo a latency period in which the psychosexual stages of development, which take place between around 3 months and 5-years-old and culminate in the Oedipus conflict, are forgotten. Fourteen years later, Hans paid a visit to Freud. He could remember nothing of his phobia or his treatment.

The Rat Man

This was a case of obsessional neurosis, beginning in October 1907. The patient was a 29-year-old lawyer who had been drafted into the army. Freud saw him over an 11 month period and regarded the case as largely successful. The patient was later killed in the First World War.

The nickname ‘rat man’ came from the man’s obsession with a punishment used in Asia. An officer had described to him the way criminals were tortured by having rats burrow into their anus. The patient became obsessed by this and began to fear that such a punishment may befall his girlfriend and father. To prevent it, he developed a series of defences. For example, he saw a stone on the road down which his girlfriend was due to travel. He feared the carriage might run over the stone and crash, so he removed it, changed his mind, and then became obsessed with replacing it in the exact same spot.

Freud delved into his childhood and discovered the usual sexual explorations and fears of being punished for them by his father. There was also the common ambivalence towards the father figure: even after his father had died, the rat man would study until late then, at 1 a.m., the time his father often returned, he would go and look at his penis in the mirror, thus seeking both to please his father (by studying) and to defy him (by exposing himself). His obsessional neurosis was traced back to a fixation at the anal stage of psychosexual development. This would make sense since it is the stage overseen by the parents and characterized by sadistic urges (hence the obsession with the rat torture).

The rat man’s behavior made no sense because he was acting in response to the past. And this is key. As Freud famously put it, the neurotic repeats something from the past instead of remembering it. The punishment he claimed to fear for others was punishment he really feared for himself. He also revealed that as a child he had believed his parents could read his thoughts.

Of course, the Freudian case studies are vastly more complex than is suggested here. Reading them, you cannot help but be struck by the depth and complexity of the unconscious mind or the web in which the mentally ill are often caught.

The Wolf Man

Perhaps the most famous, and certainly the best, of Freud’s case studies is that of the so-called ‘Wolf Man’. The wolf man was in fact a wealthy, 23-year-old Russian. In many respects he was the most severely affected of all the cases, a man so neurotically ill he could barely dress himself. Treatment took place over a five year period, beginning in 1909, and was successful.

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• Freudian Psychology

Anna O: Sigmund Freud's Case History

The life and case study of anna o: how sigmund freud was influenced by one woman's experiences..

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• Sigmund Freud

Anna O (Breuer and Freud’s pseudonym for Bertha Pappenheim), was born on 27th February, 1859 in Vienna, Austria to Siegmund and Recha Pappenheim. Her family adhered to Orthodox Judaism and were relatively privileged. Anna had a younger brother, Wilhelm Pappenheim, and two older sisters. In 1867, when she was just 8 years old, her sister, Henriette, died from tuberculosis.

The age and society within which Anna grew up limited women’s opportunities and she left school to take up leisurely activities such as sewing, rather continuing her education.

In 1880, Anna’s father contracted tuberculosis and Anna devoted herself to caring for him whilst he was limited to his bed. Unfortunately, her father’s illness was fatal and he died in April of the following year. However, it was whilst he had been ill that his daughter also fell ill, albeit with different symptoms. Anna began to consult Josef Breuer for the symptoms relating to her illness.

Freud noted that, prior to her illness, Anna had lived a healthy life and was intelligent, with an active imagination, regularly daydream as she undertook household chores. Her devotion to caring for her sick father began to take its toll on her, however, until a point where Anna was prevented from seeing him.

Stages of Anna O’s Illness

Breuer summarised the illness of Anna O in four stages:

• “Latent Incubation” Beginning in July, 1880 and lasting until around December 10th of the same year, Anna’s illness started. Freud states that in other patients, the signs of the illness would not be noticeable but the exceptional symptoms seen in Anna resulted in it being clearly observable by others.
• “Manifest Illness" Symptoms are at their most severe. Anna began to make a recovery but this was interrupted in April, 1881 when her ill father passed away - an event which affected Anna severely. On 7th June, 1881, concern at her suicidal tendencies led to her being moved from the third floor residence to a house in Vienna.
• Intermittent Somnambulism Between April and December, 1881, Anna switched between experiencing periodic somnambulism (sleep walking) and apparently normal behavior.
• Recovery Breuer claims that, following his treatment, Anna undertook a slow recovery from her illness which lasted until around June, 1882.

The symptoms exhibited by Anna herself were wide ranging, from a cough to behavior-related symptoms including sleep walking:

• Paralysis : Paralysis in Anna’s right arm and leg.
• Involuntary eye movements : Including vision problems and, in December, 1881, a squint.
• Hydrophobia : An aversion to food and to water (hydrophobia), which left Anna unable to drink for days at a time.
• Lethargy : By the afternoon, sleeping in the evenings but an opposite, excitable state afterwards. Between December 11th, 1881 and April 1st the following year, Anna was bed-bound.
• Language Difficulties : Halfway through a sentence, Anna would repeat the last word and pause before completing it. A polyglot, she began to speak in a variety of languages, including English to her carers, much to their confusion. However, Anna herself was apparently unaware of what she was doing, and was eventually unable to speak for two weeks.

“Tormenting, Tormenting”

Eventually Anna was diagnosed with hysteria , and spent much of the daytime in a state of anxiety experiencing hallucinations such as those of skeletons and black snakes, possibly resulting from seeing her own hair. During the day she would also awake from naps in a state of discomfort, crying, “tormenting, tormenting”.

After sunset, Anna entered a state of deep hypnosis. Freud noted that, if she was able to describe the hallucinations of the day in her trance-like state in the evening, she would be able to awake normally and spend the rest of the evening more at ease.

Breuer’s Talking Cure

Noticing the benefit that the release of anxious thoughts had on Anna, Breuer began treatment with what would eventually be described as “talking therapy” (referred to Anna as “chimney sweeping”) - engaging in conversations with his patient on a daily basis, talking to her about her problems in search of a psychological basis for the hysteria.

Anna’s habit of storytelling provided Breuer with an intriguing insight into her state of mind. These fairytale-like tales reminded him of Hans Christian Anderson’s work, and were generally of a unhappy nature. Many of the stories that she would tell involved sitting by a sick person’s bedside, echoing Anna’s experience in caring for her father.

She also relayed a dream similar in subject matter, in which a black snake approached the person in the bed. Anna felt paralysed in the dream, and was unable to protect the bed-bound patient from the creature. Freud concluded that the paralysis that she experienced in reality was linked to that which she had experienced in an anxious state during the dream.

During her meetings with her therapist, Anna also recalled an occasion when she was younger and had a glass of water. She recalled seeing her nanny’s dog, whom she did not like, approach the glass and take a drink from it, causing her to be repulsed at the thought of sharing her glass with the dog. Breuer attributed this traumatic experience to her inability to drink water - Anna had formed an association between the water and the negative event earlier in her life.

Recovery and Later Life

Breuer and Freud believed that bringing unconscious anxieties, such as hallucinations and traumatic experiences, to the conscious attention, Anna could overcome any related symptoms. Over time, her problems ceased and she made a gradual recovery, was given a pet dog to look after and engaged in charity work helping other ill people.

• Psychodynamic Approach

Anna's treatment led both to emphasise the impact of previous traumas and subconscious ideas on the conscious mind, and gave rise to the use of “talking therapy”, along with hypnosis and regression , to identify the possible causes of mental illnesses.

Later in her life, Anna became a prominent figure in the feminist movement in Austria and Germany, which she believed passionately in following her restrictive upbringing. She founded the League for Jewish Women in 1904 and was an active supporter of the the cause until she died in 1936.

• Freud, S. and Breuer, J. (1895). Studies on Hysteria . Leipzig and Wien: Franz Deuticke.

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Case Studies: The ‘Ratman’ – Sigmund Freud

From unconscious to conscious.

When Sigmund Freud began working with the young educated man featured in this review, he didn’t realize the strange paths his treatment would follow. His patient complained about long standing compulsive ideas that were getting worse. “The main content of his suffering is his fear that something will befall two people whom he greatly loves, his father and a lady whom he admires. In addition he experiences  compulsive urges, for example to cut his throat with a razor, and imposes  prohibitions on himself relating to matters of indifference.” At this point in Freud’s career he was becoming well known as a sex expert, and patients were beginning to seek him out, hoping that sexual insights from childhood and adolescence would reveal more about their neurosis.

At this early stage in Freud’s career, his treatment style was still developing. What was written in his paper Some Remarks on a Case of Obsessive-compulsive Neurosis , betrays Freud’s self-promotion more by what he left out rather than what he left in. This was what later analysts had to avoid in order to update psychoanalysis to their fresh clinical observations. A great tool to help readers of Freud’s “Ratman” study is the well researched Freud and the Rat Man by Patrick J. Mahony. Patrick was able to compare the original process notes with the published case, make improved translations, and correct some of the chronology. He also studied the life histories of the influential people in the subject’s life to piece out missed opportunities that Freud wasn’t able to explore. Psychoanalysis is a long process, and Freud was unfortunately not able to produce published case studies that were long enough to affect a full cure, despite his claims of achieving cures. Part of the difficulty was the need to be discreet to hide the patient’s identity. In a letter to Carl Jung, Freud told him that he wanted to publish his case on the “Ratman” that he discussed in meetings at the International Psychoanalytic Congress in the Hotel Bristol in Salzburg. “I suddenly feel like writing up the Salzburg Rat Man…It will not be long because in print I shall have to be much more discreet than in a lecture.” Jung was supportive of Freud in publishing the story, and enthusiastic about the presentation Freud gave at the Congress.

Some of the misgivings that Freud had were not entirely out of modesty. His oral report to the Congress was a success, but much was removed in print. In Freud and the culture of psychoanalysis  by Steven Marcus, Freud’s paper is described both as “one of the richest, most complex and opaque pieces”, but lacking in “the coherence, expository fullness, narrative virtuosity, and sustained sinuosity of episodic, incremental development.” The importance of understanding as much of this case study as possible is due to the notion of “cure” in psychoanalysis. The more unconscious intentions are made conscious to the patient, the more understanding there is, and the more the patient understands how counter-productive their thinking patterns are, the more they are motivated to cease them. For example, the inhibitions due to superstitious beliefs and omnipotent rituals to control reality, that this patient believed in, were draining his energy and misdirecting it away from his needed work. A true cure would be to get any patient to think more scientifically and act more assertively about their projects. Since this applies to everyone, a more comprehensive cure would have to also analyze how bias and prejudice from the analyst would interfere with a deeper cure. Seeing how defenses can transfer from past targets onto new targets is a transference insight that can help patients see their neurosis in action, but Freud was only beginning to see how his own transference was limiting his case studies. He readily admitted to preferring to develop theories rather than actively treating patients.

“…I get tired of people…I am  not basically interested in therapy, and I usually find that I am engaged – in any particular case – with the theoretical problems with which I happen to be interested at the time.” Raymond de Saussure added that “Freud was not a good psychoanalytic clinician. Since he had not been analyzed himself, he tended to commit two kinds of errors. First, he had practiced suggestion too long not to have been materially affected by it. When he was persuaded of the truth of something, he had considerable difficulty in waiting until this verity became clear to his patient. Freud wanted to convince him immediately. Because of that, he talked too much. Second, one rapidly sensed what special theoretical question preoccupied him, for often during the analytic hour he developed at length new points of view he was clarifying in his own mind. This was a gain for the discipline, but not always for the patient’s treatment.”

Countertransference

One of the insights of the “Ratman” case is seeing how perception can find similarities in people and environments that trigger painful complexes. The associations that the patient makes gives clues to the sore spot in the mind hiding in the unconscious. This is a universal aspect to anyone sensitive enough to feel bad about themselves. Gradually as the sore-spot is exposed, many associations are revealed. They include inhibitions, envy, desire and useless rituals that drain energy. What can limit an analyst’s ability to catch these insights is their own lack of understanding. One of the big ones is a lack of understanding of the opposite sex. Like a male patient going to a female psychologist without the proper experience, or in the case of Freud, his lack of understanding of female psychology, limited his ability to discover insights based on female influences on his patients. “…I am also too patriarchal to be a good analyst.” Thankfully Mahony brings that back in with his research of Freud’s patient Ernst Lanzer, the Austrian Lawyer. Theories about Ernst’s interactions with his mother and sisters are introduced to provide a wider picture of his neurosis. Freud himself, according to Mahony, self-described as an “obsessional type” which would condition his interest, and sympathy with patients like him. The problem of a positive transference is that there will be too much regard which can prevent increasing depth in the case study.

The ‘Ratman’

Ernst Lanzer’s recounting of his life history to Freud began with significant encounters with females at an early age, but also included his ambivalence over whether to marry the love of his life, Gisela Adler, not related to the psychotherapist Alfred Adler. Gisela being from a family that his mother did not approve of, and would eventually become infertile, created a lot of ambivalence in his choice. Freud said that Ernst “…gives the impression of being clear-headed and perceptive. When I ask what causes him to put particular emphasis on information about his sexual life he replies that that is what he knows about my theories. Apart from this he has read nothing of what I have written, but when leafing through one of my books he recently came across an explanation of bizarre associations of words that reminded him so much of his own ‘mental efforts’ with regard to his own ideas that he resolved to entrust himself to me for treatment.”

The Psychopathology of Everyday Life – Sigmund Freud: https://rumble.com/v1gtl55-the-psychopathology-of-everyday-life-sigmund-freud.html

Like a lot of Freud’s patients, they tried different therapies to no avail. “None of the cures he has attempted have done him any good except for one course of hydropathic treatment in a clinic…but this was no doubt only because he struck up an acquaintance there that led to regular sexual intercourse. He has no such opportunities here and has intercourse rarely and at irregular intervals. Prostitutes are repugnant to him. His sex life has been altogether wretched, and masturbation has played only a minor role, when he was 16 or 17. His potency is normal, he claims; he first had intercourse at the age of 26.” To get behind the repression Freud warned the patient that the treatment required that he would have to let go of tough resistances and “tell everything that came into his mind, even if he found this unpleasant , and even if the thoughts seemed  unimportant, irrelevant  or  nonsensical… “

Early sexual life

Mahony traces Lanzer’s sexual trajectory that moved from physical contact to only watching. “Overall, the sensuality of Ernst’s childhood considerably diminished through puberty, and limited tactile eroticism gave way to voyeurism as the main source of sexual pleasure.” Freud recounts Lanzer’s monologue: “My sexual life began very early. I remember a scene that took place when I was 3 or 4 years old, which came into my mind quite clearly years later. We had a pretty young governess called Fräulein [Rudolf]. One evening she was lying on the sofa reading, quite scantily dressed; I was lying next to her and asked for permission to crawl under her petticoats. She said I could, provided that I did not tell anyone. She was not wearing much, and I touched her genitals and her belly, which I found rather odd. Since then I have felt a burning, tormenting curiosity to see the female body. I can still remember with what feeling of suspense I waited at the Baths, where I was still allowed to go with my sisters and governess, for our governess to take off her clothes and enter the water. From the age of 5 I can remember more. We had another governess then, also young and pretty, who had abscesses on her bottom which she used to squeeze every evening. I would wait furtively for that moment to ease my curiosity. The same was true at the Baths, although Fräulein [Paula] was more reserved than the other one. (In answer to my interpolated question he replied: ‘I did not sleep regularly in her bedroom, but mostly with my parents.’) I remember a scene that took place when I must have been about 7 years old. We were all sitting together one evening, the governess, the cook, another girl, my brother who was 18 months younger, and myself. I suddenly caught a snatch of the girls’ conversation and heard Fräulein Paula say: “You could do that with the little one, but [he] is too clumsy, he would be bound to get it wrong.” I did not understand very clearly what was meant, but did understand that the remark was a disparaging one, and began to cry. Paula comforted me and told me that a girl who had done something similar with a little lad in her care had been locked up for several months. I do not think she got up to any mischief with me, but I was allowed to take all sorts of liberties with her. When I came into her bedroom I would pull the covers off her and touch her and she would never try to stop me. She was not very intelligent and obviously very needy sexually.”

The beginning of obsession

Sensitive at perceived slights, he recalled another slight from an older friend. “…he had taken a great fancy to him and done wonders for his self-esteem, so that he had thought himself almost a genius. This student later became his private tutor and changed his attitude towards him quite suddenly, treating him like the worst kind of fool. Finally he realized that the man was in fact interested in one of his sisters and had only taken up with him in order to gain an entrée into the house.” Freud’s patient was feeling what many people have felt, a feeling of being used, but his mind turned into a direction that was much more pathological. “At the age of 6 I was already troubled by erections and I know that I once went to my mother to complain to her about this. I remember too that I had to overcome certain scruples in order to do so, for I already sensed that there was some connection with my fantasies and my curiosity and for some time back then harboured a morbid notion that my parents knew what I was thinking, which I explained to myself by saying that I had articulated my thoughts without hearing them myself. I see this as the beginning of my illness. There were people, girls, that I liked the look of and whom I had an urgent wish  to see naked.  These desires were accompanied, however, by  an uncanny feeling that something would happen if I allowed myself such thoughts and that I had to do all sorts of things to prevent this.”

When asked what he thought would happen, “ my father would die… From an early age I was preoccupied by thoughts of my father’s death; this made me melancholy for a long time.’ On this occasion I learn with astonishment that the father, who, even today, is the object of his compulsive fears, has been dead for several years.” Freud saw firstly that his patient’s desire to see females naked triggered embarrassment and a fear of something bad that might happen. “If I harbour the wish to see a woman naked, my father must die.” The conflict is early on in his life, but Freud hints at the mechanism of the “I” and how it can gradually develop repressive power towards wishes and impulses. “…If it does not yet have its compulsive character this is because the ‘I’ ( Ich ) has not yet set itself up in complete contradiction to it, [and] does not yet sense it to be something alien.” The fear begins to motivate a superstitious need to avert disaster that Freud calls “defensive measures” or “parrying actions.”

Rat torture

Freud wrestled with the vague “I articulated my thoughts without hearing them” as a projection to the outside world that people can know his thoughts better than he knows himself. To Freud it was like he had an unconscious perception of what was repressed but it could not become clear, other than it vaguely involved his father. Eventually Freud’s patient opened up about his increasing intensity of his compulsions. When doing military exercises, which helped him to calm compulsive ideas, he wanted to prove his worth to career officers in his outfit. In a halt during a march he lost his pince-nez glasses, and carried on without them. “During this same halt I sat down between two officers, one of whom, a captain with a Czech name, was to become a significant figure for me. I felt a certain fear of this man, for he obviously took pleasure in cruelty . I am not saying that he was a bad man, but in the officers’ mess he had spoken repeatedly in favour of introducing whipping as a punishment, so that I had been obliged to oppose him quite forcefully. Now, during the halt we got into conversation and the captain told me that he had read about a particularly terrible form of punishment practised in the Orient…'” He broke off from the unpleasant details, but with Freud’s insistence he explained that “the condemned man was tied up…with an upturned pot over his behind, into which rats were then put, which once again [Lanzer] stood up, showing every sign of horror and resistance – bored their way in. Into the anus, I added, helping him out.” Freud provided suggestions a lot more than therapists are willing to do to day, but this was the beginning of Psychoanalysis. The patient, displayed a mixed facial expression to Freud that signaled “… horror at the pleasure he does not even know he feels .”

The ‘Ratman’ continued that an “ idea flashed through my mind that  this might happen to someone who was dear to me.”  Freud guessed at this point that it was the lady that he admires “to whom this ‘idea’ applies.” Freud targeted the idea and it’s possible associations. The idea represents a wish and a fear. “At the very same moment as the idea, the ‘sanction’ also appears, i.e., the parrying measure that must be adopted to prevent such a fantasy from being realized.” Here the word “guess” is translated differently by Mahony. He had access to Freud’s notes and was able to find translation problems. Here the guess should be translated from the German erraten  meaning a correct guess. The Father being the earlier idea than the lady, Freud guesses that the father is included in this torture. “…the rat punishment should be carried out on the lady. Now he is forced to admit that at the same time there surfaced another idea, that the punishment should also be applied to his father.” This also brings up the theory that Lanzer wants to punish objects of desire for not being supportive of his goals for them, but he suppresses them when in presence of those people. “He admitted, incidentally, that from time to time he experiences quite explicit impulses to do some harm to the lady he adores. These impulses are generally subdued in her presence and come to the fore only in her absence.”

Obsessive rituals

Lanzer’s obsession escalated when his replacement pince-nez glasses were delivered to him by the sadistic Captain with the message that a Lieutenant A. paid for the charges and that he should be paid back. The demand from the torture loving captain triggered his wish to pay the money back and to not pay the money back. “ You must not pay back the money, or it will happen (i.e. the rat fantasy would be realized on his father and the lady). And straight away, in accordance with a familiar pattern, there arose a command to combat this sanction, as a vow: ‘ You must pay back the 3.80 crowns to Lieutenant A.’,  words that he found himself speaking half out loud…Two days later the military exercises came to an end. He filled up the intervening time with efforts to pay back the small sum of money to Lieutenant A. …At first he attempted to make the payment through another officer who was going to the post but was [not] very pleased when this man brought the money back and explained that he had not bumped into Lieutenant A. at the post office, as this manner of keeping his vow did not satisfy him since it did not meet the form of words: ‘You must pay back the money to Lieutenant A.’ Finally he met the man A. who refused to take the money, however, remarking that he had not paid anything on his behalf, and did not deal with the post at all, it was Lieutenant B. who did so. It caused him some consternation to realize that he could not keep his vow because it was based on a false premiss and he dreamed up the most bizarre solutions to his problem: he would go to the post office with both A. and B., where A. would give 3.80 crowns to the girl who dealt with the post and the girl would give his money back to B. so that he could pay A. back the 3.80 crowns according to the strict wording of his vow.” Even after all that, the exasperated Freud was able to learn that Lanzer already knew who paid for the delivery charges. It was the post-office woman herself. She met with an officer and asked about Lanzer. She told him that she would pay for the charges herself so he could get his glasses sooner. The officer overheard Lanzer’s name and told him what happened. When the sadistic captain gave him the wrong instructions, Lanzer knew they were wrong, but his compulsions sowed doubt and he followed his pathological vows anyways.

When obsessive rituals take hold they are emotionally invested and must be carried out to gain relief. Ambivalence is increased when opposite choices are available and worries of punishment lie on both sides. If Lanzer pays the money he worries that rat torture will happen to Gisela and his Father. If he doesn’t repay the money then he’ll be guilty of bad character. Ernst remembered a war story from his father where he had gambling debts to repay but it never happened because he couldn’t find the person he owed. Ernst identified with his father and associated repayment with being better than his father was. All these worries clouded the simple answer of just going to the post office lady and paying her directly. It’s hard to imagine a pathology like this when you are just a reader. One has to imagine vividly so that the emotions well up partially inside oneself to feel the bind an obsessive person is in. Their emotions override facts and carry them away. The way that people stayed in Lanzer’s mind, including his father that had already passed away, was as imaginary figures watching over him. Intrusive thoughts. Those figures influenced him emotionally and he communicated with them. “…For a long time he could not take in the fact of this father’s death; again and again it came about that when he heard a good joke he would say to himself: ‘I must tell my father that.’ His imagination played on the idea of his father, moreover, so that when there was a knock at the door he would often think: ‘That will be my father’, and would expect to see his father when he walked into a room; and although he was never able to forget the fact that he was dead, the expectation that his ghost would appear held no terror but was something for which he felt a deep longing.”

Displacement and repression

Here Freud shows how badly linked complexes behave. It means with distorted logic, or displacement, distorted emotions follow. “The idea-content that we know about has arrived here by means of inaccurate linking. We are not used to sensing strong emotions in ourselves without idea-content, and so in the absence of a content we take a different one, which seems more or less to fit, as a surrogate, much as our police, if they cannot catch the real murderer, will arrest the wrong person in his place. The fact that inaccurate links are made also accounts in itself for the impotence of logic in combating the tormenting idea.” Part of the healing process is to investigate the distorted logic to find out what underlies them. Freud goes onto use an archaeological metaphor of Pompeii for unearthing what is unconscious. Lanzer was worried that “one person might behave in such a way as to overcome the [self-blame], but another might not,” which Freud replied that “it is in the nature of things that the emotion is always overcome, usually while the work is still in progress.” This gave him hope that he could reintegrate his personality and achieve more in his life. Paralleling Carl Jung’s understanding of one-sidedness in people, and the need to develop skills to channel unconscious undeveloped impulses in a good direction, Freud suggested that “all that he need do is weld his new opposition, between the moral person and the wicked one, together with the one we had discussed earlier, the opposition between the conscious and the unconscious. The moral person was the conscious part, the wicked one the unconscious part. – He can remember that, although he regards himself as a moral person, he certainly did things in his childhood that had come from the other person. – I observe that he has discovered, incidentally as it were, one of the main characteristics of the unconscious, namely its relationship to the  infantile.  The unconscious is the infantile part, that bit of the personality that cut itself off back in infancy, did not continue to develop alongside the rest of the personality and was thus  repressed.”

“You interfered with my pleasure!”

In a Freudian sense, neurosis comes from having frustrated goals or wishes. The unconscious mind can roil in short-term destructive goals that scare the conscious mind which represses it. When people see frustrated goals, the lack of skill in dealing with problems shows itself in vengeful thoughts and actions that hurt oneself and society. One can see this acted out in soap operas and pulpy dramas. Impulses without the accompanying skill lead to these kind of dramas in the mind. Lanzer recounted a childhood story that had that unskilled reaction when he was slighted by a girl who was not as affectionate towards him as he wanted her to be. The desire to want to change people is a form of self-created stress. To try and change her mind he imagined that “…the death of his father…as one such possibility” as a way to garner sympathy from her. He had a similar thought towards the Gisela. “He was already in love with the lady he had mentioned, but was prevented by material considerations from contemplating a closer connection. Then the idea came: his father’s death would perhaps make him rich enough to be able to marry her. ” With a clarity, Freud reminded Lanzer of the constant self-imposed obstacles he would create for himself if he continued to find pleasure in the wrong solutions. “I remark that it is well known that those who are ill derive a certain satisfaction from their suffering, so that they all in fact strive only partially to get well. He must not lose sight of the fact that a treatment of the kind we were undertaking would inevitably be accompanied by constant resistance ; I should be reminding him of this fact over and over again.” Fortunately the psychoanalytical process takes advantage of the repeated resistance. “One arrives at such a solution…by examining when an individual compulsive idea first appeared and under what external circumstances it tends to be repeated.” In this case, the desire to annihilate obstacles to wishes, scares the patient by showing him what violence he is capable of dreaming up. For a lot of people in analysis, it can be a recording of a list of grudges and desires for revenge against those who interfered with their pleasure.

“Here the connection between this compulsive idea and our patient’s life is contained in the opening remarks of the account. His lady was absent while he was studying strenuously for an examination that would make union with her a more realistic possibility. While studying he was overtaken by longing for his absent love and the thought of the reason for her absence. And then there came something that in a normal person might have been a stirring of ill-feeling towards the grandmother: ‘Did the old woman really have to fall ill now, when I feel such dreadful yearning for  her? ‘ We must suppose something similar but far more intense to have taken place in our patient, an unconscious attack of rage that, together with his yearning, might have been couched in the exclamation: ‘Oh, I should like to go there and kill the old woman who is keeping my beloved from me!’ There follows the command: ‘Kill yourself as a punishment for such murderous, angry cravings’ and, accompanied by such vehement emotion, the whole process enters the consciousness of our compulsive patient  in reverse order – the punitive command at the beginning, the reference to the punishable cravings at the end.”

Compulsion to understand

Like with Hysteria, Freud isn’t just talking about Obsessive Compulsive Personality Disorder, but a conglomeration of symptoms under the heading of obsession. This obsession was like that of a stalker that must always know the whereabouts of the target and everything the target says is interpreted with this lens of control and suspicion. “Before the summer, when he took his leave of her in Vienna, he interpreted something she said as meaning that she did not wish to be associated with him in present company, and this made him very unhappy. In the summer they found the opportunity to bring the matter out into the open and the lady was able to prove to him that her words, which he had taken the wrong way, had in fact been intended to protect him from ridicule of others. Now he was again very happy. The clearest reference to this incident is contained in his compulsion to understand , the form of which is as if he had said to himself: ‘After this experience you must never again misunderstand anyone if you want to spare yourself unnecessary torment.’ But his resolution has not only been generalized from that single occasion but has also – perhaps because of his beloved’s absence – been displaced from her esteemed person on to every other poor wretch…Compulsive activity of this kind with two consecutive time-signatures, where the rhythm of the first cancels out the second, is a typical feature of obsessive-compulsive neurosis. It is of course misunderstood in the conscious thought processes of the patient and given a secondary motivation – i.e. rationalized.  Its true meaning lies in its depiction of the conflict between two more or less equally strong opposing impulses, opposites which, in my experience to date, are always those of love and hate.”

Rationalization

This intermixing of desire with harm is described by Freud when Lanzer tells the story of removing a rock from being in the way of his lady’s carriage, and then putting it back showing the ambivalence he has for his love. He also displayed these ambivalent behaviours with his other intimate relationships. “It was a matter of conscience to him not to hand anyone dirty paper notes; they carried bacteria of the most dangerous sort, which might harm the recipient. At that time I already had some faint sense of the connection between the neuroses and sexuality and so on another occasion I took the risk of asking my patient how he felt about this matter. ‘Oh, everything’s fine in that department’, he answered lightly, ‘I don’t go short. There’s more than a few good families where I play the kindly old uncle and now and again I take the opportunity to invite a young girl on an outing to the country. Then I arrange things so that we miss the train and have to spend the night in the country. I do things very handsomely; I always take two rooms, but when the girl is in bed I go in to hers and masturbate her.’ – ‘Are you afraid of doing her some harm when you use your dirty hand to work on her?’ – At this he exploded, however: ‘Harm? What do you mean, harm? I didn’t do any of them any harm, and they all liked it. Some of them are married already and it didn’t do them any harm.'” Freud viewed the excuses as a rationalization which allowed Ernst to let go of some of his scruples towards cleanliness so he could gain more pleasure than if he was more principled.

The apple doesn’t fall far from the tree

Freud returned back to Ernst’s father and this conflict between love and hate and how it affected his relationship decisions. His mother had arranged a marriage to a daughter of a cousin of hers when Lanzer finished his studies. Mahony identifies this family as “wealthy Saborsky relatives.” This would open up prospects for him from her side of the family. This scenario would be similar to what happened to his father before he married Ernst’s mother. Should he follow his heart and marry his admired lady or marry for prospects like his father? “He resolved this conflict, which was actually the conflict between his love and the continuing effect of his father’s will, by means of illness, or more precisely: he used his illness to escape the task of resolving it in reality…The principle outcome of the illness was a persistent inability to work, which caused him to defer conclusion of his studies for years…The conflict underlying the illness was essentially the clash between the continuing effect of his father’s will and his own inclinations as a lover.” To prove that his father’s decisions were working in Ernst’s unconscious, Freud used the patient’s transference, where a patient projects characteristics of authority figures in their life onto a new authority figure. He did this to Freud by elevating “a young girl whom he had once met on the steps of my house to the status of my daughter. He was attracted to her and started to imagine that I was only being so kind and unbelievably patient with him because I wanted him for a son-in-law; and that through this marriage he would enhance his wealth and refinement of my house to a level that would correspond to his own aspirations. Inside him, however, this temptation battled with his inextinguishable love for his mistress. After we had overcome instance after instance of the most powerful resistance and the most bitter insults, he could not escape the persuasive effects of the complete analogy between transference fantasy and past reality. I give as an example one of his dreams from this period as a sample of the representation style: he sees my daughter standing in front of him, but instead of eyes she has two filthy splodges. Anyone who understands the language of dreams will have no difficulty in translating this: he is marrying my daughter not for her lovely eyes, but for her money …He found himself in a situation that he knew or supposed to be the same as the one confronting his father before his own marriage, and was able to identify with his father.” We can also see here a sense of alienation that people go through, Eg. By not being able to satisfy a wish, one can create omnipotent thoughts that force the situation in one’s mind to a fantasy satisfaction and conclusion. Unfortunately if reality doesn’t change, the mind simply goes back to a depressed position. It’s a form of self-torture. This is also a clue to how people use proximity and grab what is available in the environment, and in memory, to solve problems. His father’s experience, for example, is a strategy to satisfy wishes and because Ernst is aware of it he can explore it. This constant vacillation between different objects of love is a way to see how people are constantly looking for the most accessible forms of pleasure that are available. The Pleasure Principle.

The Pleasure Principle: https://rumble.com/v1gurqv-the-pleasure-principle-sigmund-freud.html

Father as a ghostly presence

Going back into Lanzer’s infantile sexual development Freud inquired about his masturbation habits and if they were different from “typical behaviour….Our patient’s attitude to masturbation was a striking one: he did not practice masturbation in puberty…The urge to masturbatory activity manifested itself, on the other hand, in his twenty-first year, a short time after his father’s death . Each time, having achieved satisfaction, he was deeply ashamed and soon vowed to give up the habit. From then on he masturbated only rarely and for somewhat surprising reasons. He could be moved to do so when he experienced a particularly beautiful moment or read a particularly beautiful passage in a book.” Lanzer also masturbated when he experienced people flouting authority in real life and in books. “We may place in the same context his strange behaviour at a time when he was studying for an examination and was playing with a fantasy that he had become very partial to, namely that his father was still alive and might come back at any moment. At the same time he arranged his day so that his study was undertaken in the small hours of the night. He would break off his studies between midnight and 1 o’clock and open the front door of the apartment as if his father might be standing there; then, after he had come back in, he would unfasten his trousers and gaze at his penis in the hall mirror. It is easier to understand such antics if we assume that he was behaving as if he expected his father to visit him at the witching hour. When his father was alive he had been a somewhat lazy student, a fact that his father had often lamented. Now, if he returned as a ghost he should find him at his studies and be pleased with him. His father was most unlikely to take pleasure in the other aspect of his behaviour, however; in this way he defied him and gave simultaneous expression, by means of a compulsive action that he did not understand, to the two sides of his relationship with his father, just as he did to the lady he loved in his later compulsive action over the stone on the road.”

Psycho-archaeology

Delving deeper into Pompeii , as Freud alluded earlier, the flouting of authority went back to a childhood, possibly connecting with his earlier masturbation practices. Like with most early memories, they are covered up not just by unconscious repressions but also from parents who want avoid embarrassment. Freud explored “…the possibility that as a child of 6 he had committed some sexual misdemeanour relating to masturbation and received a painful beating from his father. While his punishment had put an end to the masturbation it had left him, on the other hand, with a grudge against his father and fixed him for all time in the role of an intruder upon sexual pleasure. To my great astonishment the patient now told me that his mother had recounted such an incident from his early childhood on many occasions, and that it had obviously not been forgotten because it had such remarkable associations. He, on the other hand, had retained no trace of it in his own memory. However the story was as follows: when he was still very young – it would be possible to determine the exact point in time because it coincided with the fatal illness of one of his older sisters – he was supposed to have done something awful for which he received a beating from his father. The little chap apparently got into a fearful rage and abused his father even as he was being beaten. Since he was not yet familiar with any terms of abuse, however, he called him by the names of all the objects which came into his mind, such as ‘You lamp, you towel, you plate’, etc. Shaken by this elemental outburst his father paused in mid-blow and remarked: ‘This boy will either be a great man one day, or a great criminal!’ He thought this scene had had a permanent impact on both himself and on his father. His father had never beaten him again; he himself attributes some part of the change in his character to this experience. From then on, terrified by the magnitude of his rage, he had become a coward. His whole life long, moreover, he had had a terrible fear of being beaten and would creep away, horrified and outraged, whenever one of his brothers or sisters was being caned…When he questioned his mother again she provided both confirmation of his narrative and also the information that he was aged between 3 and 4 at the time and had been punished because he had bitten someone. Even his mother could not remember any more; she thought – though with considerable uncertainty – that the person to whom the boy had caused injury might have been the children’s nurse; nothing she said suggested that the offense might have been sexual in nature.”

The most difficult part of psychoanalysis is to get at early memories, or to find evidence that proves an incident actually happened. Mahony says that, “…this one traumatic event was never…ratified in the treatment, for the most Dr. Lanzer could do was to report a tale that was repeated in the family but the events of which he had forgotten…As to the fact that the mother’s account contained no explicitly sexual element, Freud offered two explanations: either her censorship effaced the sexual material or there was no erotic meaning in the misdeed at all.” To get to possible other reasons for a quitting of masturbation, psychoanalysis has to delve into infantile sexual development.

If you remember from my early study of Freud’s sexual theories, the anal phase includes childhood reactions where the child holds back their stool and after staying too long on the pot it leads to parents chastising them. The punished child will often associate the pleasure of feces moving in and out of the anal sphincter with the messiness that is to be avoided in life and create a reaction formation by being “anal” and doing the opposite of messiness: Orderliness. The Phallic period is one where genital confidence is developed, but can revert back to anal behaviours. Here Freud didn’t elaborate much on this with Ernst Lanzer. Mahony tries to use contemporaneous events to see how this could happen. Lanzer’s sister Camilla died “when the little boy was three and a half – yet the consequential prolongation of the [forgotten] period was left unexplained. A greater lack-though understandable for the early state of psychoanalysis at the time – is that Freud did not yet see the essential relationship between anality and obsessional neurosis.” He quotes Gedo and Goldberg: “‘Freud explained the neurosis as a whole on the basis of repression of Oedipial hatred of the father as well as of the rejecting woman, followed by a dual regression: that of the libido from phallic aims to anal sadistic ones, and that of action to the sphere of eroticized thought.’ In the case at hand, he simply acknowledged the importance of anal eroticism in Ernst’s childhood, manifest in his early [playing with feces] and olfactory hypersensitivity as well as in the stimulation caused by rectal worms he had over a period of years. It is equally noteworthy that Freud made only sparing use of the concept of regression and did not express any understanding of the patient’s anal eroticism in that sense. Freud pointed out the unusual fact that Lanzer remembered his governess not by her first name but by her last, masculine-sounding name (Rudolf), an early indication of the part played by a homosexual object-sexual choice in the patient’s life. Freud’s comments to the Vienna Psychoanalytic Society indicate that he may have considered the Rat Man’s homosexuality as fully emerging only in the latency period [the period before puberty]: ‘The basic conflict in this case lies, roughly speaking, in the patient’s struggle between his drive toward man and that toward woman (his drive toward man is stronger)….The patient already at such an early age clearly showed heterosexual inclinations and…his later homosexuality is in sharp contrast with these.'”

Mahony says that “since the Rat Man was obsessed with anal penetration, we might expect that the terminal parts of his utterances would be hyperinvested; and in reality, such was the case. It is as if his utterances at times were symbolic extensions of his corporeal schema where an investment was defensively displaced from the front to the anal region. The oath ‘May God protect him/her.’ A not would suddenly emerge from the Rat Man’s unconscious and turn the sentence into its opposite. As opposed to English, however, in German the negative  Nicht is appended to the end of the sentence so that it penetrates the formula just as the rats did the anus.”

Sexuality Pt. 2 – Sigmund Freud: https://rumble.com/v1gtort-sexuality-pt-2-infantile-sexuality-sigmund-freud.html

An important influence that Freud didn’t explore was that of Ernst’s mother and sisters. Mahony describes how those early influences affected his heterosexual inclinations. “Ernst maintained that he loved his lady but had no sensual desire for her, a defensive maneuver further subjected to doubt and alternate periods of his loving her intensely and being indifferent to her. Not exploring the oedipal significance of the relationship, Freud kept Mrs. Lanzer and Gisela apart…In Ernst’s dreams ‘his sexual desires for his mother and sister and his sisters’s premature death were linked up with the young hero’s chastisement at his father’s hand.’ Apart from this passage, Freud was content to subsume his patient’s mother into a few oedipal statements. Nor did Freud [express] any oedipal conclusions from back-to-back associations that at the age of six the little Ernst complained about erections to his mother and felt that his desires to see girls naked were liable to cause his father’s death…One may want to argue that Freud had to be discreet and consequently filtered out many allusions to Mrs. Lanzer, who functioned as a controller of the purse strings and thus as a participant in the analysis. Yet as sound as that objection may be, it is surely not sufficient in itself. But if we seek elsewhere, a supplementary reason comes quickly into view to resolve our puzzlement. The relatively pallid picture of the Rat Man’s mother and the full-bodied picture of his father fit the lopsided pattern in Freud’s descriptions of both Dora’s and little Hans’s parents…Marcus’s incisive comment: the relative exclusion of the mother in Freud’s case histories ‘was characteristic of his culture as well, and one of the more strongly marked features of both the major novels and major autobiographies of nineteenth-century culture is the consistency with which they place the relation of father and child (particularly, of course, father and son) at the center of the human universe of development, passion and choice, and how relatively infrequently the relation of mother and child (with a few notable exceptions) occupies that paramount position. One can say that one of the themes of nineteenth-century literary culture has to do with the conflict surrounding this tendency to a suppression of the mother.'” Mrs. Lanzer was also an interferer in Ernst’s desires, like with his choice of a marriage partner. “…Mrs. Lanzer did not fail to criticize Gisela’s family as ‘futile persons’ and even forbade Ernst from going to the funeral of Gisela’s grandmother. If it is only probable that Mrs. Lanzer controlled her family’s financial affairs, it is certain that she was the strict administrator of Ernst’s inheritance. As the distributor of the analytic fees, did she force…ending of the treatment?”

“Already on the basis of the first several weeks of clinical material presented by Freud to the Vienna Psychoanalytic Society, Rank opined that ‘all factors clearly point to the patient’s love for his mother, even though there has not yet been any direct reference to this in the analytic material’ …Freud replied that ‘Rank will probably prove to be right in his assumption that incestuous wishes for the mother play a  role, though the relationship is complicated by the presence of four sisters…The extant evidence allows us to draw a mixed picture of the interaction between Ernst and his mother. Her controlling nature, entrenched miserliness, ambivalent attitude toward neatness, and lack of the outbursts so characteristic of her husband and son indicate an obsessional personality with restrictive traits. If she was family-conscious, concerned about the comfort of her house, and even protective of her son against her violent husband, she could yet be critical, controlling, and dangerously seductive and phallic.”

Like in the ‘Little Hans’ case, the birth of new siblings creates a lot of emotional turmoil. Mahony says that, “…when he was living through the phase of gender consolidation, his privileged position as the only son in a family of daughters was undermined by the birth of a rival brother; when Ernst neared three, another sister was born; and nine months later, Camilla died. In general, Mrs. Lanzer hardly appears to be a preoedipal or oedipal mother who functioned as a consistent developmental stabilizer or as one who maintained an open dialogue with her son that would have constantly promoted and solidified ego functioning. She did not suffice for her son to deal with his unresolved distress, frustration, and rage; he turned then to other family members for gratifying solace and sustenance. We attain a clear idea of the oedipal constellation if we understand that Ernst’s sisters became substitute objects more approachable than his mother.” 

Case Studies: ‘Little Hans’ – Sigmund Freud: https://rumble.com/v1gu93b-case-studies-little-hans-sigmund-freud.html

Mahony found that much of what bothered Ernst in later life could be explained by his experiences with his sisters in the process notes. “Ernst’s first perception of sexual difference dating from his observation of Camilla on the pot; her declaration to him, ‘If you die I shall kill myself’; remembered scenes of her illness and death and the distressed reactions of himself and his parents; his fear that his own masturbation might have caused her death; and last, his experience of her death as a relief over a rival being eliminated, as [a warning] sign of what might happen to him if he continued to masturbate, and as the origin of his omnipotent belief that by giving or retaining love he could control life…Being a focus of Camilla’s oedipal strivings obviously intensified Ernst’s choice of her as his incestuous heterosexual object. If the one reported event of Ernst’s early biting is seen phasically, we might understand that to ward off the painful affects of anxiety and helplessness connected with Camilla’s impending loss, he regressed to the conflicts of the anal stage and the oral-sadistic rage he had brought into it. Occurring during the height of his oedipal phase, the catastrophic loss of the mother surrogate traumatically shaped his infantile neurosis.”

Mahony also describes the behaviour of making substitutes. “When Camilla died, the nine month old Olga might have been the object of Ernst’s deflected libido. We are on surer grounds when we postulate that at least during adulthood, Olga was his incestuously preferred sister and a choice object of sadistic-anal fantasies. The finicky brother brought himself to tell her, ‘Nothing about you would be disgusting to me’, a total acceptance no other woman in the case history receives. After the death of their father (the ‘interferer’), Ernst repeatedly attacked Olga and once ‘assaulted’ her; he even had to make a vow to keep away from her. Once he dreamed of copulating with her and of then being fearful for having broken his vow; upon waking and recognizing that he had only been dreaming, he was so delighted that he ‘went into her bedroom and smacked her bottom under the bedclothes’. Servants thought that Ernst and Olga kissed not like siblings but like lovers. Even her eventual husband became jealous to the point that Ernst said to him, ‘If Olga has a baby in 9 months’ time, you needn’t think I am its father; I am innocent.'”

Core complex of neuroses

Freud describes what is experienced by every child, which is a series of thwarted attempts at pleasure and why. He called it the “core complex of the neuroses.” As the layers of resentments pile up, resistance in the patient starts to be taken out on the analyst, Freud in this case, which is an expected hazard of being a therapist. “I will merely say that as a result of [the childhood scene] re-emergence he started to falter for the first time in his refusal to believe in feelings of rage against his beloved father, acquired prehistorically and subsequently lying dormant. I had expected the scene to have a more powerful effect, if anything, since he had been told of his event so often, by his father as well, that there was no doubt as to its reality. With a capacity to flout logic that is always particularly disconcerting in highly intelligent patients suffering from a compulsive disorder, he denied the value of the scene as evidence, protesting over and over again that he himself could not remember a thing about it. He was obliged therefore to come by the conviction that his relationship to his father did indeed need to be amplified by material from the unconscious by the painful route of transference. It soon came about that in dreams, daytime fantasies and arbitrary notions he would insult me and mine in the most coarse and offensive manner, yet at the same time he never intentionally showed me anything but the greatest respect. His behaviour when relating these insults to me was that of a desperate man. ‘Most honoured Professor, how can you allow yourself to be insulted in this way by filthy scum like me? You ought to throw me out; I don’t deserve any better.’ He would get up from the couch and walk around the room as he spoke, claiming at first that this was motivated by tact: he could not bear to say such terrible things while lying there in comfort. Soon he himself hit upon the more convincing explanation, however, that he was putting himself at arm’s length for fear that I would strike him. If he remained seated, he would conduct himself like a man seeking to protect himself in desperate anxiety from an intemperate beating: he would bury his face in his hands, cover his face with his arm, or run away suddenly, his features distorted with pain, etc. He recalled how his father would fall into sudden rages and in the violence of his feelings would no longer have any sense of how far he could go. In this school of suffering he gradually gained the conviction he had been lacking…” By bringing all those old memories up, including the actions of the father, mother, siblings, and the resentments they caused, the emotions over those incidents could be mourned by Lanzer.

Rat associations

Once rat associations could be connected with a painful complex it became clear how the obsessions could colour other concepts. Freud was able to connect the game of Spielratte , or “Gambling rat” to a game where his father lost money and couldn’t repay the debt. The rats burrowing in the victim’s anus could trigger associations of punishment related to pleasure holding back defecation and the sensations of worms that he had in childhood. The penetration could be associated with the penis. The penis can spread disease just like a rat can. Penetrating an anus can be associated with sewage where rats live and feed on excrement. When discussing Ibsen’s Little Eyolf , in analysis, the Rat-Wife commands rats, which could also be associated with children, like in the story of the Pied Piper , and Ernst’s desire to have children. “And now he provided a piece of information that he had withheld from its proper context for long enough, but which fully explained his interest in children. As a result of a gynaecological operation, the removal of both ovaries, the lady whose admirer he had been for so many years and yet could not bring himself to marry was condemned to childlessness; this was indeed the principal reason for his hesitation, since he was extraordinarily fond of children.” So many associations to rats created a symbol in him “designated to grate, on the complex of his feelings.”

Even if this appears far-fetched for some, more obvious examples of triggers can be references to sex, sexual orientation, race, bodily ugliness, mental illness and any references to low status that can trigger defense mechanisms. Lanzer was triggered by embarrassing desires and sources of shame with his family. Being mindful, you can catch yourself seeing words when you scan a text, and how it triggers a sore spot on your self-esteem. Sometimes you may see words that aren’t even there because your concern about a troubling subject matter related to yourself esteem is so consuming that the brain fills in the blanks. Notice how when the economy is good, people feel less sensitive, but when the economy crashes and people are struggling, it’s hard to find anything funny. You may have made fun of lots of people, but your circumstances have changed so much that now you are the target of jokes. Notice how hard it is to move beyond those negative labels that stigmatize and create a flurry of stressful thinking, suicidal thoughts, inhibition and inaction that prevents full development of yourself. Seeing it in your own life helps you to see how it is everywhere. Defense mechanisms can be masochistic and self-attacking, or sadistic where people redress slights with insults and violence externally. Being able to laugh at oneself and accept imperfections for as many wounds as you have, and to be less reactive to slights people give to you, cures the need to launch pre-emptive strikes on people, and cures the need for you to shrink away and avoid achieving your goals. As an adult you can’t change the past. You can only make new choices. In a modern environment people are sensitive to feeling insignificant or ridiculed because there are more signals in media and advertising displaying our inferiority. Understanding your impulses helps you to be able to control them. Then you can mourn past decisions and forgive your younger self for not knowing what you know now.

Sublimated revenge

After this review you can now go out into the world and understand its hostility much better. Lanzer took pleasure in thinking about obstacles meeting with an untimely end, but these fantasies have to brought to consciousness or they will look for other avenues. The typical way people discharge their frustrations if they can’t get revenge, is to resort to entertainment and addictions to numb the pain instead. For example, most people enjoy movies and TV shows that depict revenge that people can’t have in real life. The neuroscientist Vittorio Gallese, references René Girard. “[René] argues that actors on stage are symbolically sacrificed. In that way, society discharges its ever-present propensity for violence without doing harm.” To bring these unconscious intentions into consciousness allows us to predict how we will feel in competitive, insulting environments, and make better choices. One can spend more time with people who aren’t constantly triggering you. One can love and accept oneself with the understanding that most other people are the same and have one thing or another that causes them to feel shame. To see the toxic method of discharge, all you have to do is look at politics. Notice how many people actually direct attention to the weaknesses of others to bolster their own self-esteem.

Humor – Sigmund Freud: https://rumble.com/v1gtm13-humour-sigmund-freud.html

Sublimation – Sigmund Freud: https://rumble.com/v1gv2fr-sublimation-sigmund-freud.html

Stalking: https://rumble.com/v1gvhk1-stalking-world-narcissistic-abuse-awareness-day.html

The Joker Trailer: https://www.youtube.com/watch?v=zAGVQLHvwOY

Parasite Trailer: https://www.youtube.com/watch?v=isOGD_7hNIY

Once upon a time in Hollywood Trailer: https://www.youtube.com/watch?v=ELeMaP8EPAA

‘Ratman’ to just Man

Whether Lanzer’s mother ended the sessions, or whether he was too busy to continue them, he behaved more assertively and returned to his studies. He became a lawyer, found employment and married Gisela. This was despite attending only a brief analysis with Freud. Questions still remained of how cured he really was. Certainly by marrying for love, instead of for money, the ghost of his father, and his mother’s influence, weakened. Of course there would have to be confirmation that he wasn’t marrying the woman, who could not bear children, to deprive his father of the continuation of his line. If that was the case then his father’s pathological presence would still be there. How he viewed Gisela based on his experience with his mother and sisters is too murky to have definite conclusions. Many parents use their power of inheritance to force matches. Marrying Gisela could be a way to defy his mother or she may have had similar characteristics to his sisters that he found attractive. The healthy choice would be to choose based on love that exists day in and day out for a person, and not on getting attention from authority figures. This way the marriage partner wouldn’t be treated as a means to an end. Ernst also had a tendency to idealize and devalue Gisela. People are more of a mix rather than an angel or devil. It’s not known if Lanzer could see beyond that dichotomy. There were also self-esteem issues. If Lanzer felt that people could read his mind, and know his thoughts, I wonder myself if a feeling of inferiority was involved in this magical thinking that people have these abilities that he doesn’t have. Are authority figures given too much reverence? An independent mind would be rid of that habit. Finally, Freud’s use of the primal scene, where children watch their parents have sex and develop theories of conception, was such an important part of his study of the ‘Wolfman’, but was actually more applicable to Lanzer’s case study. Sleeping in the same bed with his parents would be “over-stimulation”, and early introductions to male and female savouring of sexual pleasure could have introduced conflict on which form of savouring would be better to imitate. Any shame for homosexual impulses could create self-reproaches and be triggered by reminders of anal penetration, including triggers from the story about the rat torture. Unfortunately, very soon it was the breakout of WWI, and Ernst was enlisted. He was captured by the Russians on November 21, 1914 and died on November 25th. Freud himself was still in his early phase of his theories and around this time was finding challenges from within his own circle, notably Carl Jung and Alfred Adler who offered their own treatment methods and moved onto creating their own schools. Naturally Freud’s view of WWI would change a lot of his theories and advance them to include more darkness and depth that humanity displayed during that war.

The Wolfman and other cases – Sigmund Freud: https://www.isbns.net/isbn/9780142437452/

Freud and the Rat Man – Patrick J. Mahony: https://www.isbns.net/isbn/9780300036947/

Freud and the Culture of Psychoanalysis – Steven Marcus: https://www.isbns.net/isbn/9781138993136/

The Violence and the Sacred – René Girard: https://rumble.com/v1gsnwv-the-origin-of-envy-and-narcissism-ren-girard.html

We Are All Stardust – Klein, Stefan: https://www.isbns.net/isbn/9781615190591/

Psychology: https://psychreviews.org/category/psychology01/