II METHOD OF DREAM INTERPRETATION
THE ANALYSIS OF A SAMPLE DREAM
The title which I have given my treatise indicates the tradition which I wish to make the starting-point in my discussion of dreams. I have made it my task to show that dreams are capable of interpretation, and contributions to the solution of the dream problems that have just been treated can only be yielded as possible by-products of the settlement of my own particular problem. With the hypothesis that dreams are interpretable, I at once come into contradiction with the prevailing dream science, in fact with all dream theories except that of Scherner, for to “interpret a dream” means to declare its meaning, to replace it by something which takes its place in the concatenation of our psychic activities as a link of full importance and value. But, as we have learnt, the scientific theories of the dream leave no room for a problem of dream interpretation, for, in the first place, according to these, the dream is no psychic action, but a somatic process which makes itself known to the psychic apparatus by means of signs. The opinion of the masses has always been quite different. It asserts its privilege of proceeding illogically, and although it admits the dream to be incomprehensible and absurd, it cannot summon the resolution to deny the dream all significance. Led by a dim intuition, it seems rather to assume that the dream has a meaning, albeit a hidden one; that it is intended as a substitute for some other thought process, and that it is only a question of revealing this substitute correctly in order to reach the hidden signification of the dream.
The laity has, therefore, always endeavoured to “interpret” the dream, and in doing so has tried two essentially different methods. The first of these procedures regards the dream content as a whole and seeks to replace it by another content which is intelligible and in certain respects analogous. This is symbolic dream interpretation; it naturally goes to pieces at the outset in the case of those dreams which appear not only unintelligible but confused. The construction which the biblical Joseph places upon the dream of Pharaoh furnishes an example of its procedure. The seven fat kine, after which came seven lean ones which devour the former, furnish a symbolic substitute for a prediction of seven years of famine in the land of Egypt, which will consume all the excess which seven fruitful years have created. Most of the artificial dreams contrived by poets are intended for such symbolic interpretation, for they reproduce the thought conceived by the poet in a disguise found to be in accordance with the characteristics of our dreaming, as we know these from experience.[Q] The idea that the dream concerns itself chiefly with future events whose course it surmises in advance—a relic of the prophetic significance with which dreams were once credited—now becomes the motive for transplanting the meaning of the dream, found by means of symbolic interpretation, into the future by means of an “it shall.”
A demonstration of the way in which such symbolic interpretation is arrived at cannot, of course, be given. Success remains a matter of ingenious conjecture, of direct intuition, and for this reason dream interpretation has naturally been elevated to an art, which seems to depend upon extraordinary gifts.[R] The other of the two popular methods of dream interpretation entirely abandons such claims. It might be designated as the “cipher method,” since it treats the dream as a kind of secret code, in which every sign is translated into another sign of known meaning, according to an established key. For example, I have dreamt of a letter, and also of a funeral or the like; I consult a “dream book,” and find that “letter” is to be translated by “vexation,” and “funeral” by “marriage, engagement.” It now remains to establish a connection, which I again am to assume pertains to the future, by means of the rigmarole which I have deciphered. An interesting variation of this cipher procedure, a variation by which its character of purely mechanical transference is to a certain extent corrected, is presented in the work on dream interpretation by Artemidoros of Daldis.[2] Here not only the dream content, but also the personality and station in life of the dreamer, are taken into consideration, so that the same dream content has a significance for the rich man, the married man, or the orator, which is different from that for the poor man, the unmarried man, or, say, the merchant. The essential point, then, in this procedure is that the work of interpretation is not directed to the entirety of the dream, but to each portion of the dream content by itself, as though the dream were a conglomeration, in which each fragment demands a particular disposal. Incoherent and confused dreams are certainly the ones responsible for the invention of the cipher method.[S]
The worthlessness of both these popular interpretation procedures for the scientific treatment of the subject cannot be questioned for a moment. The symbolic method is limited in its application and is capable of no general demonstration. In the cipher method everything depends upon whether the key, the dream book, is reliable, and for that all guarantees are lacking. One might be tempted to grant the contention of the philosophers and psychiatrists and to dismiss the problem of dream interpretation as a fanciful one.
I have come, however, to think differently. I have been forced to admit that here once more we have one of those not infrequent cases where an ancient and stubbornly retained popular belief seems to have come nearer to the truth of the matter than the judgment of the science which prevails to-day. I must insist that the dream actually has significance, and that a scientific procedure in dream interpretation is possible. I have come upon the knowledge of this procedure in the following manner:—
For several years I have been occupied with the solution of certain psychopathological structures in hysterical phobias, compulsive ideas, and the like, for therapeutic purposes. I have been so occupied since becoming familiar with an important report of Joseph Breuer to the effect that in those structures, regarded as morbid symptoms, solution and treatment go hand in hand.[T] Where it has been possible to trace such a pathological idea back to the elements in the psychic life of the patient to which it owes its origin, this idea has crumbled away, and the patient has been relieved of it. In view of the failure of our other therapeutic efforts, and in the face of the mysteriousness of these conditions, it seems to me tempting, in spite of all difficulties, to press forward on the path taken by Breuer until the subject has been fully understood. We shall have elsewhere to make a detailed report upon the form which the technique of this procedure has finally assumed, and the results of the efforts which have been made. In the course of these psychoanalytical studies, I happened upon dream interpretation. My patients, after I had obliged them to inform me of all the ideas and thoughts which came to them in connection with the given theme, related their dreams, and thus taught me that a dream may be linked into the psychic concatenation which must be followed backwards into the memory from the pathological idea as a starting-point. The next step was to treat the dream as a symptom, and to apply to it the method of interpretation which had been worked out for such symptoms.
For this a certain psychic preparation of the patient is necessary. The double effort is made with him, to stimulate his attention for his psychic perceptions and to eliminate the critique with which he is ordinarily in the habit of viewing the thoughts which come to the surface in him. For the purpose of self-observation with concentrated attention, it is advantageous that the patient occupy a restful position and close his eyes; he must be explicitly commanded to resign the critique of the thought-formations which he perceives. He must be told further that the success of the psychoanalysis depends upon his noticing and telling everything that passes through his mind, and that he must not allow himself to suppress one idea because it seems to him unimportant or irrelevant to the subject, or another because it seems nonsensical. He must maintain impartiality towards his ideas; for it would be owing to just this critique if he were unsuccessful in finding the desired solution of the dream, the obsession, or the like.
I have noticed in the course of my psychoanalytic work that the state of mind of a man in contemplation is entirely different from that of a man who is observing his psychic processes. In contemplation there is a greater play of psychic action than in the most attentive self-observation; this is also shown by the tense attitude and wrinkled brow of contemplation, in contrast with the restful features of self-observation. In both cases, there must be concentration of attention, but, besides this, in contemplation one exercises a critique, in consequence of which he rejects some of the ideas which he has perceived, and cuts short others, so that he does not follow the trains of thought which they would open; toward still other thoughts he may act in such a manner that they do not become conscious at all—that is to say, they are suppressed before they are perceived. In self-observation, on the other hand, one has only the task of suppressing the critique; if he succeeds in this, an unlimited number of ideas, which otherwise would have been impossible for him to grasp, come to his consciousness. With the aid of this material, newly secured for the purpose of self-observation, the interpretation of pathological ideas, as well as of dream images, can be accomplished. As may be seen, the point is to bring about a psychic state to some extent analogous as regards the apportionment of psychic energy (transferable attention) to the state prior to falling asleep (and indeed also to the hypnotic state). In falling asleep, the “undesired ideas” come into prominence on account of the slackening of a certain arbitrary (and certainly also critical) action, which we allow to exert an influence upon the trend of our ideas; we are accustomed to assign “fatigue” as the reason for this slackening; the emerging undesired ideas as the reason are changed into visual and acoustic images. (_Cf._ the remarks of Schleiermacher[61] and others, p. 40.) In the condition which is used for the analysis of dreams and pathological ideas, this activity is purposely and arbitrarily dispensed with, and the psychic energy thus saved, or a part of it, is used for the attentive following of the undesired thoughts now coming to the surface, which retain their identity as ideas (this is the difference from the condition of falling asleep). “Undesired ideas” are thus changed into “desired” ones.
The suspension thus required of the critique for these apparently “freely rising” ideas, which is here demanded and which is usually exercised on them, is not easy for some persons. The “undesired ideas” are in the habit of starting the most violent resistance, which seeks to prevent them from coming to the surface. But if we may credit our great poet-philosopher Friedrich Schiller, a very similar tolerance must be the condition of poetic production. At a point in his correspondence with Koerner, for the noting of which we are indebted to Mr. Otto Rank, Schiller answers a friend who complains of his lack of creativeness in the following words: “The reason for your complaint lies, it seems to me, in the constraint which your intelligence imposes upon your imagination. I must here make an observation and illustrate it by an allegory. It does not seem beneficial, and it is harmful for the creative work of the mind, if the intelligence inspects too closely the ideas already pouring in, as it were, at the gates. Regarded by itself, an idea may be very trifling and very adventurous, but it perhaps becomes important on account of one which follows it; perhaps in a certain connection with others, which may seem equally absurd, it is capable of forming a very useful construction. The intelligence cannot judge all these things if it does not hold them steadily long enough to see them in connection with the others. In the case of a creative mind, however, the intelligence has withdrawn its watchers from the gates, the ideas rush in pell-mell, and it is only then that the great heap is looked over and critically examined. Messrs. Critics, or whatever else you may call yourselves, you are ashamed or afraid of the momentary and transitory madness which is found in all creators, and whose longer or shorter duration distinguishes the thinking artist from the dreamer. Hence your complaints about barrenness, for you reject too soon and discriminate too severely” (Letter of December 1, 1788).
And yet, “such a withdrawal of the watchers from the gates of intelligence,” as Schiller calls it, such a shifting into the condition of uncritical self-observation, is in no way difficult.
Most of my patients accomplish it after the first instructions; I myself can do it very perfectly, if I assist the operation by writing down my notions. The amount, in terms of psychic energy, by which the critical activity is in this manner reduced, and by which the intensity of the self-observation may be increased, varies widely according to the subject matter upon which the attention is to be fixed.
The first step in the application of this procedure now teaches us that not the dream as a whole, but only the parts of its contents separately, may be made the object of our attention. If I ask a patient who is as yet unpractised: “What occurs to you in connection with this dream?” as a rule he is unable to fix upon anything in his psychic field of vision. I must present the dream to him piece by piece, then for every fragment he gives me a series of notions, which may be designated as the “background thoughts” of this part of the dream. In this first and important condition, then, the method of dream interpretation which I employ avoids the popular, traditional method of interpretation by symbolism famous in the legends, and approaches the second, the “cipher method.” Like this one it is an interpretation in detail, not _en masse_; like this it treats the dream from the beginning as something put together—as a conglomeration of psychic images.
In the course of my psychoanalysis of neurotics, I have indeed already subjected many thousand dreams to interpretation, but I do not now wish to use this material in the introduction to the technique and theory of dream interpretation. Quite apart from the consideration that I should expose myself to the objection that these are dreams of neuropathic subjects, the conclusions drawn from which would not admit of reapplication to the dreams of healthy persons, another reason forces me to reject them. The theme which is naturally always the subject of these dreams, is the history of the disease which is responsible for the neurosis. For this purpose there would be required a very long introduction and an investigation into the nature and logical conditions of psychoneuroses, things which are in themselves novel and unfamiliar in the highest degree, and which would thus distract attention from the dream problem. My purpose lies much more in the direction of preparing the ground for a solution of difficult problems in the psychology of the neuroses by means of the solution of dreams. But if I eliminate the dreams of neurotics, I must not treat the remainder too discriminatingly. Only those dreams still remain which have been occasionally related to me by healthy persons of my acquaintance, or which I find as examples in the literature of dream life. Unfortunately in all these dreams the analysis is lacking, without which I cannot find the meaning of the dream. My procedure is, of course, not as easy as that of the popular cipher method, which translates the given dream content according to an established key; I am much more prepared to find that the same dream may cover a different meaning in the case of different persons, and in a different connection I must then resort to my own dreams, as an abundant and convenient material, furnished by a person who is about normal, and having reference to many incidents of everyday life. I shall certainly be with doubts as to the trustworthiness of these “self-analyses.” Arbitrariness is here in no way avoided. In my opinion, conditions are more likely to be favourable in self-observation than in the observation of others; in any case, it is permissible to see how much can be accomplished by means of self-analysis. I must overcome further difficulties arising from inner self. One has a readily understood aversion to exposing so many intimate things from one’s own psychic life, and one does not feel safe from the misinterpretation of strangers. But one must be able to put one’s self beyond this. “Toute psychologiste,” writes Delbœuf,[26] “est obligé de faire l’aveu même de ses faiblesses s’il croit par là jeter du jour sur quelque problème obscure.” And I may assume that in the case of the reader, the immediate interest in the indiscretions which I must commit will very soon give way to exclusive engrossment in the psychological problems which are illuminated by them.
I shall, therefore, select one of my own dreams and use it to elucidate my method of interpretation. Every such dream necessitates a preliminary statement. I must now beg the reader to make my interests his own for a considerable time, and to become absorbed with me in the most trifling details of my life, for an interest in the hidden significance of dreams imperatively demands such transference.
Preliminary statement: In the summer of 1895 I had psychoanalytically treated a young lady who stood in close friendship to me and those near to me. It is to be understood that such a complication of relations may be the source of manifold feelings for the physician, especially for the psychotherapist. The personal interest of the physician is greater, his authority is less. A failure threatens to undermine the friendship with the relatives of the patient. The cure ended with partial success, the patient got rid of her hysterical fear, but not of all her somatic symptoms. I was at that time not yet sure of the criteria marking the final settlement of a hysterical case, and expected her to accept a solution which did not seem acceptable to her. In this disagreement, we cut short the treatment on account of the summer season. One day a younger colleague, one of my best friends, who had visited the patient—Irma—and her family in their country resort, came to see me. I asked him how he found her, and received the answer: “She is better, but not altogether well.” I realise that those words of my friend Otto, or the tone of voice in which they were spoken, made me angry. I thought I heard a reproach in the words, perhaps to the effect that I had promised the patient too much, and rightly or wrongly I traced Otto’s supposed siding against me to the influence of the relatives of the patient, who, I assume, had never approved of my treatment. Moreover, my disagreeable impression did not become clear to me, nor did I give it expression. The very same evening, I wrote down the history of Irma’s case, in order to hand it, as though for my justification, to Dr. M., a mutual friend, who was at that time a leading figure in our circle. During the night following this evening (perhaps rather in the morning) I had the following dream, which was registered immediately after waking:—
DREAM OF JULY 23–24, 1895
_A great hall—many guests whom we are receiving—among them Irma, whom I immediately take aside, as though to answer her letter, to reproach her for not yet accepting the “solution.” I say to her: “If you still have pains, it is really only your own fault.” She answers: “If you only knew what pains I now have in the neck, stomach, and abdomen; I am drawn together.” I am frightened and look at her. She looks pale and bloated; I think that after all I must be overlooking some organic affection. I take her to the window and look into her throat. She shows some resistance to this, like a woman who has a false set of teeth. I think anyway she does not need them. The mouth then really opens without difficulty and I find a large white spot to the right, and at another place I see extended grayish-white scabs attached to curious curling formations, which have obviously been formed like the turbinated bone—I quickly call Dr. M., who repeats the examination and confirms it.... Dr. M.’s looks are altogether unusual; he is very pale, limps, and has no beard on his chin.... My friend Otto is now also standing next to her, and my friend Leopold percusses her small body and says: “She has some dulness on the left below,” and also calls attention to an infiltrated portion of the skin on the left shoulder (something which I feel as he does, in spite of the dress).... M. says: “No doubt it is an infection, but it does not matter; dysentery will develop too, and the poison will be excreted.... We also have immediate knowledge of the origin of the infection. My friend Otto has recently given her an injection with a propyl preparation when she felt ill, propyls.... Propionic acid ... Trimethylamine (the formula of which I see printed before me in heavy type).... Such injections are not made so rashly.... Probably also the syringe was not clean.”_
This dream has an advantage over many others. It is at once clear with what events of the preceding day it is connected, and what subject it treats. The preliminary statement gives information on these points. The news about Irma’s health which I have received from Otto, the history of the illness upon which I have written until late at night, have occupied my psychic activity even during sleep. In spite of all this, no one, who has read the preliminary report and has knowledge of the content of the dream, has been able to guess what the dream signifies. Nor do I myself know. I wonder about the morbid symptoms, of which Irma complains in the dream, for they are not the same ones for which I have treated her. I smile about the consultation with Dr. M. I smile at the nonsensical idea of an injection with propionic acid, and at the consolation attempted by Dr. M. Towards the end the dream seems more obscure and more terse than at the beginning. In order to learn the significance of all this, I am compelled to undertake a thorough analysis.
ANALYSIS
_The hall—many guests, whom we are receiving._
We were living this summer at the Bellevue, in an isolated house on one of the hills which lie close to the Kahlenberg. This house was once intended as a place of amusement, and on this account has unusually high, hall-like rooms. The dream also occurred at the Bellevue, a few days before the birthday of my wife. During the day, my wife had expressed the expectation that several friends, among them Irma, would come to us as guests for her birthday. My dream, then, anticipates this situation: It is the birthday of my wife, and many people, among them Irma, are received by us as guests in the great hall of the Bellevue.
_I reproach Irma for not having accepted the solution. I say: “If you still have pains, it is your own fault.”_
I might have said this also, or did say it, while awake. At that time I had the opinion (recognised later to be incorrect) that my task was limited to informing patients of the hidden meaning of their symptoms. Whether they then accepted or did not accept the solution upon which success depended—for that I was not responsible. I am thankful to this error, which fortunately has now been overcome, for making life easier for me at a time when, with all my unavoidable ignorance, I was to produce successful cures. But I see in the speech which I make to Irma in the dream, that above all things I do not want to be to blame for the pains which she still feels. If it is Irma’s own fault, it cannot be mine. Should the purpose of the dream be looked for in this quarter?
_Irma’s complaints; pains in the neck, abdomen, and stomach; she is drawn together._
Pains in the stomach belonged to the symptom-complex of my patient, but they were not very prominent; she complained rather of sensations of nausea and disgust. Pains in the neck and abdomen and constriction of the throat hardly played a part in her case. I wonder why I decided upon this choice of symptoms, nor can I for the moment find the reason.
_She looks pale and bloated._
My patient was always ruddy. I suspect that another person is here being substituted for her.
_I am frightened at the thought that I must have overlooked some organic affection._
This, as the reader will readily believe, is a constant fear with the specialist, who sees neurotics almost exclusively, and who is accustomed to ascribe so many manifestations, which other physicians treat as organic, to hysteria. On the other hand, I am haunted by a faint doubt—I know not whence it comes—as to whether my fear is altogether honest. If Irma’s pains are indeed of organic origin, I am not bound to cure them. My treatment, of course, removes only hysterical pains. It seems to me, in fact, that I wish to find an error in the diagnosis; in that case the reproach of being unsuccessful would be removed.
_I take her to the window in order to look into her throat. She resists a little, like a woman who has false teeth. I think she does not need them anyway._
I had never had occasion to inspect Irma’s aural cavity. The incident in the dream reminds me of an examination, made some time before, of a governess who at first gave an impression of youthful beauty, but who upon opening her mouth took certain measures for concealing her teeth. Other memories of medical examinations and of little secrets which are discovered by them, unpleasantly for both examiner and examined, connect themselves with this case. “She does not need them anyway,” is at first perhaps a compliment for Irma; but I suspect a different meaning. In careful analysis one feels whether or not the “background thoughts” which are to be expected have been exhausted. The way in which Irma stands at the window suddenly reminds me of another experience. Irma possesses an intimate woman friend, of whom I think very highly. One evening on paying her a visit I found her in the position at the window reproduced in the dream, and her physician, the same Dr. M., declared that she had a diphtheritic membrane. The person of Dr. M. and the membrane return in the course of the dream. Now it occurs to me that during the last few months, I have been given every reason to suppose that this lady is also hysterical. Yes, Irma herself has betrayed this to me. But what do I know about her condition? Only the one thing, that like Irma she suffers from hysterical choking in dreams. Thus in the dream I have replaced my patient by her friend. Now I remember that I have often trifled with the expectation that this lady might likewise engage me to relieve her of her symptoms. But even at the time I thought it improbable, for she is of a very shy nature. _She resists_, as the dream shows. Another explanation might be that _she does not need it_; in fact, until now she has shown herself strong enough to master her condition without outside help. Now only a few features remain, which I can assign neither to Irma nor to her friend: _Pale, bloated, false teeth_. The false teeth lead me to the governess; I now feel inclined to be satisfied with bad teeth. Then another person, to whom these features may allude, occurs to me. She is not my patient, and I do not wish her to be my patient, for I have noticed that she is not at her ease with me, and I do not consider her a docile patient. She is generally pale, and once, when she had a particularly good spell, she was bloated.[U] I have thus compared my patient Irma with two others, who would likewise resist treatment. What can it mean that I have exchanged her for her friend in the dream? Perhaps that I wish to exchange her; either the other one arouses in me stronger sympathies or I have a higher opinion of her intelligence. For I consider Irma foolish because she does not accept my solution. The other one would be more sensible, and would thus be more likely to yield. _The mouth then really opens without difficulty_; she would tell more than Irma.[V]
_What I see in the throat; a white spot and scabby nostrils._
The white spot recalls diphtheria, and thus Irma’s friend, but besides this it recalls the grave illness of my eldest daughter two years before and all the anxiety of that unfortunate time. The scab on the nostrils reminds me of a concern about my own health. At that time I often used cocaine in order to suppress annoying swellings in the nose, and had heard a few days before that a lady patient who did likewise had contracted an extensive necrosis of the nasal mucous membrane. The recommendation of cocaine, which I had made in 1885, had also brought grave reproaches upon me. A dear friend, already dead in 1895, had hastened his end through the misuse of this remedy.
_I quickly call Dr. M., who repeats the examination._
This would simply correspond to the position which M. occupied among us. But the word “quickly” is striking enough to demand a special explanation. It reminds me of a sad medical experience. By the continued prescription of a remedy (sulfonal) which was still at that time considered harmless, I had once caused the severe intoxication of a woman patient, and I had turned in great haste to an older, more experienced colleague for assistance. The fact that I really had this case in mind is confirmed by an accessory circumstance. The patient, who succumbed to the intoxication, bore the same name as my eldest daughter. I had never thought of this until now; now it seems to me almost like a retribution of fate—as though I ought to continue the replacement of the persons here in another sense; this Matilda for that Matilda; an eye for an eye, a tooth for a tooth. It is as though I were seeking every opportunity to reproach myself with lack of medical conscientiousness.
_Dr. M. is pale, without a beard on his chin, and he limps._
Of this so much is correct, that his unhealthy appearance often awakens the concern of his friends. The other two characteristics must belong to another person. A brother living abroad occurs to me, who wears his chin clean-shaven, and to whom, if I remember aright, M. of the dream on the whole bears some resemblance. About him the news arrived some days before that he was lame on account of an arthritic disease in the hip. There must be a reason why I fuse the two persons into one in the dream. I remember that in fact I was on bad terms with both of them for similar reasons. Both of them had rejected a certain proposal which I had recently made to them.
_My friend Otto is now standing next to the sick woman, and my friend Leopold examines her and calls attention to a dulness on the left below._
My friend Leopold is also a physician, a relative of Otto. Since the two practise the same specialty, fate has made them competitors, who are continually being compared with each other. Both of them assisted me for years, while I was still directing a public dispensary for nervous children. Scenes like the one reproduced in the dream have often taken place there. While I was debating with Otto about the diagnosis of a case, Leopold had examined the child anew and had made an unexpected contribution towards the decision. For there was a difference of character between the two similar to that between Inspector Brassig and his friend Charles. The one was distinguished for his brightness, the other was slow, thoughtful, but thorough. If I contrast Otto and the careful Leopold in the dream, I do it, apparently, in order to extol Leopold. It is a comparison similar to the one above between the disobedient patient Irma and her friend who is thought to be more sensible. I now become aware of one of the tracks along which the thought association of the dream progresses; from the sick child to the children’s asylum. The dulness to the left, below, recalls a certain case corresponding to it, in every detail in which Leopold astonished me by his thoroughness. Besides this, I have a notion of something like a metastatic affection, but it might rather be a reference to the lady patient whom I should like to have instead of Irma. For this lady, as far as I can gather, resembles a woman suffering from tuberculosis.
_An infiltrated portion of skin on the left shoulder._
I see at once that this is my own rheumatism of the shoulder, which I always feel when I have remained awake until late at night. The turn of phrase in the dream also sounds ambiguous; something which I feel ... in spite of the dress. “Feel on my own body” is intended. Moreover, I am struck with the unusual sound of the term “infiltrated portion of skin.” “An infiltration behind on the upper left” is what we are accustomed to; this would refer to the lung, and thus again to tuberculosis patients.
_In spite of the dress._
This, to be sure, is only an interpolation. We, of course, examine the children in the clinic undressed; it is some sort of contradiction to the manner in which grown-up female patients must be examined. The story used to be told of a prominent clinician that he always examined his patients physically only through the clothes. The rest is obscure to me; I have, frankly, no inclination to follow the matter further.
_Dr. M. says: “It is an infection, but it does not matter. Dysentery will develop, and the poison will he excreted._”
This at first seems ridiculous to me; still it must be carefully analysed like everything else. Observed more closely, it seems, however, to have a kind of meaning. What I had found in the patient was local diphtheritis. I remember the discussion about diphtheritis and diphtheria at the time of my daughter’s illness. The latter is the general infection which proceeds from local diphtheritis. Leopold proves the existence of such general infection by means of the dulness, which thus suggests a metastatic lesion. I believe, however, that just this kind of metastasis does not occur in the case of diphtheria. It rather recalls pyæmia.
_It does not matter_, is a consolation. I believe it fits in as follows: The last part of the dream has yielded a content to the effect that the pains of the patient are the result of a serious organic affection. I begin to suspect that with this I am only trying to shift the blame from myself. Psychic treatment cannot be held responsible for the continued presence of diphtheritic affection. But now, in turn, I am disturbed at inventing such serious suffering for Irma for the sole purpose of exculpating myself. It seems cruel. I need (accordingly) the assurance that the result will be happy, and it does not seem ill-advised that I should put the words of consolation into the mouth of Dr. M. But here I consider myself superior to the dream, a fact which needs explanation.
But why is this consolation so nonsensical?
_Dysentery_:
Some sort of far-fetched theoretical notion that pathological material may be removed through the intestines. Am I in this way trying to make fun of Dr. M.’s great store of far-fetched explanations, his habit of finding curious pathological relationships? Dysentery suggests something else. A few months ago I had in charge a young man suffering from remarkable pains during evacuation of the bowels, a case which colleagues had treated as “anæmia with malnutrition.” I realised that it was a question of hysteria; I was unwilling to use my psychotherapy on him, and sent him off on a sea voyage. Now a few days before I had received a despairing letter from him from Egypt, saying that while there he had suffered a new attack, which the physician had declared to be dysentery. I suspect, indeed, that the diagnosis was only an error of my ignorant colleague, who allows hysteria to make a fool of him; but still I cannot avoid reproaching myself for putting the invalid in a position where he might contract an organic affection of the bowels in addition to his hysteria. Furthermore, dysentery sounds like diphtheria, a word which does not occur in the dream.
Indeed it must be that, with the consoling prognosis: “Dysentery will develop, &c.,” I am making fun of Dr. M., for I recollect that years ago he once jokingly told a very similar story of another colleague. He had been called to consult with this colleague in the case of a woman who was very seriously ill and had felt obliged to confront the other physician, who seemed very hopeful, with the fact that he found albumen in the patient’s urine. The colleague, however, did not let this worry him, but answered calmly: “That does not matter, doctor; the albumen will without doubt be excreted.” Thus I can no longer doubt that derision for those colleagues who are ignorant of hysteria is contained in this part of the dream. As though in confirmation, this question now arises in my mind: “Does Dr. M. know that the symptoms of his patient, of our friend Irma, which give cause for fearing tuberculosis, are also based on hysteria? Has he recognised this hysteria, or has he stupidly ignored it?”
But what can be my motive in treating this friend so badly? This is very simple: Dr. M. agrees with my solution as little as Irma herself. I have thus already in this dream taken revenge on two persons, on Irma in the words, “If you still have pains, it is your own fault,” and on Dr. M. in the wording of the nonsensical consolation which has been put into his mouth.
_We have immediate knowledge of the origin of the infection._
This immediate knowledge in the dream is very remarkable. Just before we did not know it, since the infection was first demonstrated by Leopold.
_My friend Otto has recently given her an injection when she felt ill._
Otto had actually related that in the short time of his visit to Irma’s family, he had been called to a neighbouring hotel in order to give an injection to some one who fell suddenly ill. Injections again recall the unfortunate friend who has poisoned himself with cocaine. I had recommended the remedy to him merely for internal use during the withdrawal of morphine, but he once gave himself injections of cocaine.
_With a propyl preparation ... propyls ... propionic acid._ How did this ever occur to me? On the same evening on which I had written part of the history of the disease before having the dream, my wife opened a bottle of cordial labelled “Ananas,”[W] (which was a present from our friend Otto. For he had a habit of making presents on every possible occasion; I hope he will some day be cured of this by a wife).[X] Such a smell of fusel oil arose from this cordial that I refused to taste it. My wife observed: “We will give this bottle to the servants,” and I, still more prudent, forbade it, with the philanthropic remark: “They mustn’t be poisoned either.” The smell of fusel oil (amyl ...) has now apparently awakened in my memory the whole series, propyl, methyl, &c., which has furnished the propyl preparation of the dream. In this, it is true, I have employed a substitution; I have dreamt of propyl, after smelling amyl, but substitutions of this kind are perhaps permissible, especially in organic chemistry.
_Trimethylamin._ I see the chemical formula of this substance in the dream, a fact which probably gives evidence of a great effort on the part of my memory, and, moreover, the formula is printed in heavy type, as if to lay special stress upon something of particular importance, as distinguished from the context. To what does this trimethylamin lead, which has been so forcibly called to my attention? It leads to a conversation with another friend who for years has known all my germinating activities, as I have his. At that time he had just informed me of some of his ideas about sexual chemistry, and had mentioned, among others, that he thought he recognised in trimethylamin one of the products of sexual metabolism. This substance thus leads me to sexuality, to that factor which I credit with the greatest significance for the origin of the nervous affections which I attempt to cure. My patient Irma is a young widow; if I am anxious to excuse the failure of her cure, I suppose I shall best do so by referring to this condition, which her admirers would be glad to change. How remarkably, too, such a dream is fashioned! The other woman, whom I take as my patient in the dream instead of Irma, is also a young widow.
I suspect why the formula of trimethylamin has made itself so prominent in the dream. So many important things are gathered up in this one word: Trimethylamin is not only an allusion to the overpowering factor of sexuality, but also to a person whose sympathy I remember with satisfaction when I feel myself forsaken in my opinions. Should not this friend, who plays such a large part in my life, occur again in the chain of thoughts of the dream? Of course, he must; he is particularly acquainted with the results which proceed from affections of the nose and its adjacent cavities, and has revealed to science several highly remarkable relations of the turbinated bones to the female sexual organs (the three curly formations in Irma’s throat). I have had Irma examined by him to see whether the pains in her stomach might be of nasal origin. But he himself suffers from suppurative rhinitis, which worries him, and to this perhaps there is an allusion in pyæmia, which hovers before me in the metastases of the dream.
_Such injections are not made so rashly._ Here the reproach of carelessness is hurled directly at my friend Otto. I am under the impression that I had some thought of this sort in the afternoon, when he seemed to indicate his siding against me by word and look. It was perhaps: “How easily he can be influenced; how carelessly he pronounces judgment.” Furthermore, the above sentence again points to my deceased friend, who so lightly took refuge in cocaine injections. As I have said, I had not intended injections of the remedy at all. I see that in reproaching Otto I again touch upon the story of the unfortunate Matilda, from which arises the same reproach against me. Obviously I am here collecting examples of my own conscientiousness, but also of the opposite.
_Probably also the syringe was not clean._ Another reproach directed at Otto, but originating elsewhere. The day before I happened to meet the son of a lady eighty-two years of age whom I am obliged to give daily two injections of morphine. At present she is in the country, and I have heard that she is suffering from an inflammation of the veins. I immediately thought that it was a case of infection due to contamination from the syringe. It is my pride that in two years I have not given her a single infection; I am constantly concerned, of course, to see that the syringe is perfectly clean. For I am conscientious. From the inflammation of the veins, I return to my wife, who had suffered from emboli during a period of pregnancy, and now three related situations come to the surface in my memory, involving my wife, Irma, and the deceased Matilda, the identity of which three persons plainly justifies my putting them in one another’s place.
I have now completed the interpretation of the dream.[Y] In the course of this interpretation I have taken great pains to get possession of all the notions to which a comparison between the dream content and the dream thoughts hidden behind it must have given rise. Meanwhile, the “meaning” of the dream has dawned upon me. I have become conscious of a purpose which is realised by means of the dream, and which must have been the motive for dreaming. The dream fulfils several wishes, which have been actuated in me by the events of the preceding evening (Otto’s news, and the writing down of the history of the disease). For the result of the dream is that I am not to blame for the suffering which Irma still has, and that Otto is to blame for it. Now Otto has made me angry by his remark about Irma’s imperfect cure; the dream avenges me upon him by turning the reproach back upon himself. The dream acquits me of responsibility for Irma’s condition by referring it to other causes, which indeed furnish a great number of explanations. The dream represents a certain condition of affairs as I should wish it to be; _the content of the dream is thus the fulfilment of a wish; its motive is a wish_.
This much is apparent at first sight. But many things in the details of the dream become intelligible when regarded from the point of view of wish-fulfilment. I take revenge on Otto, not only for hastily taking part against me, in that I accuse him of a careless medical operation (the injection), but I am also avenged on him for the bad cordial which smells like fusel oil, and I find an expression in the dream which unites both reproaches; the injection with a preparation of propyl. Still I am not satisfied, but continue my revenge by comparing him to his more reliable competitor. I seem to say by this: “I like him better than you.” But Otto is not the only one who must feel the force of my anger. I take revenge on the disobedient patient by exchanging her for a more sensible, more docile one. Nor do I leave the contradiction of Dr. M. unnoticed, but express my opinion of him in an obvious allusion, to the effect that his relation to the question is that of _an ignoramus_ (“_dysentery will develop_,” _&c._).
It seems to me, indeed, as though I were appealing from him to some one better informed (my friend, who has told me about trimethylamin); just as I have turned from Irma to her friend, I turn from Otto to Leopold. Rid me of these three persons, replace them by three others of my own choice, and I shall be released from the reproaches which I do not wish to have deserved! The unreasonableness itself of these reproaches is proved to me in the dream in the most elaborate way. Irma’s pains are not charged to me, because she herself is to blame for them, in that she refuses to accept my solution. Irma’s pains are none of my business, for they are of an organic nature, quite impossible to be healed by a psychic cure. Irma’s sufferings are satisfactorily explained by her widowhood (trimethylamin!); a fact which, of course, I cannot alter. Irma’s illness has been caused by an incautious injection on the part of Otto, with an ill-suited substance—in a way I should never have made an injection. Irma’s suffering is the result of an injection made with an unclean syringe, just like the inflammation of the veins in my old lady, while I never do any such mischief with my injections. I am aware, indeed, that these explanations of Irma’s illness, which unite in acquitting me, do not agree with one another; they even exclude one another. The whole pleading—this dream is nothing else—recalls vividly the defensive argument of a man who was accused by his neighbour of having returned a kettle to him in a damaged condition. In the first place, he said, he had returned the kettle undamaged; in the second, it already had holes in it when he borrowed it; and thirdly, he had never borrowed the kettle from his neighbour at all. But so much the better; if even one of these three methods of defence is recognised as valid, the man must be acquitted.
Still other subjects mingle in the dream, whose relation to my release from responsibility for Irma’s illness is not so transparent: the illness of my daughter and that of a patient of the same name, the harmfulness of cocaine, the illness of my patient travelling in Egypt, concern about the health of my wife, my brother, of Dr. M., my own bodily troubles, and concern about the absent friend who is suffering from suppurative rhinitis. But if I keep all these things in view, they combine into a single train of thought, labelled perhaps: Concern for the health of myself and others—professional conscientiousness. I recall an undefined disagreeable sensation as Otto brought me the news of Irma’s condition. I should like to note finally the expression of this fleeting sensation, which is part of the train of thought that is mingled into the dream. It is as though Otto had said to me: “You do not take your physician’s duties seriously enough, you are not conscientious, do not keep your promises.” Thereupon this train of thought placed itself at my service in order that I might exhibit proof of the high degree in which I am conscientious, how intimately I am concerned with the health of my relatives, friends, and patients. Curiously enough, there are also in this thought material some painful memories, which correspond rather to the blame attributed to Otto than to the accusation against me. The material has the appearance of being impartial, but the connection between this broader material, upon which the dream depends, and the more limited theme of the dream which gives rise to the wish to be innocent of Irma’s illness, is nevertheless unmistakable.
I do not wish to claim that I have revealed the meaning of the dream entirely, or that the interpretation is flawless.
I could still spend much time upon it; I could draw further explanations from it, and bring up new problems which it bids us consider. I even know the points from which further thought associations might be traced; but such considerations as are connected with every dream of one’s own restrain me from the work of interpretation. Whoever is ready to condemn such reserve, may himself try to be more straightforward than I. I am content with the discovery which has been just made. If the method of dream interpretation here indicated is followed, it will be found that the dream really has meaning, and is by no means the expression of fragmentary brain activity, which the authors would have us believe. _When the work of interpretation has been completed the dream may be recognised as the fulfilment of a wish._