Irma's complaints - pains in the neck, abdomen, and stomach; she is choked by them. Pains in the stomach belonged to the symptom-complex of my patient, but they were not very prominent; she complained rather of qualms and a feeling of nausea. Pains in the neck and abdomen and constriction of the throat played hardly any part in her case. I wonder why I have decided upon this choice of symptoms in the dream; for the moment I cannot discover the reason.
She looks pale and puffy. My patient had always a rosy complexion. I suspect that here another person is being substituted for her.
I am startled at the idea that I may 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 to hysteria so many manifestations which other physicians treat as organic. On the other hand, I am haunted by a faint doubt - I do not know whence it comes - whether my alarm is altogether honest. If Irma's pains are indeed of organic origin, it is not my duty 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; for then I could not be reproached with failure to effect a cure.
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 to myself, she does not need them. I had never had occasion to inspect Irma's oral cavity. The incident in the dream reminds me of an examination, made some time before, of a governess who at first produced an impression of youthful beauty, but who, upon opening her mouth, took certain measures to conceal her denture. Other memories of medical examination, and of petty secrets revealed by them, to the embarrassment of both physician and patient, associate themselves with this case. - 'She surely does not need them', is perhaps in the first place a compliment to Irma: but I suspect yet another meaning. In a careful analysis one is able to feel whether or not the arrière-pensées which are to be expected have all been exhausted. The way in which Irma stands at the window suddenly reminds me of another experience. Irma has an intimate woman friend of whom I think very highly. One evening, on paying her a visit, I found her at the window in the position reproduced in the dream, and her physician, the same Dr M., declared that she had a diphtheric membrane. The person of Dr M. and the membrance return, indeed, in the course of the dream. Now it occurs to me that during the past few months I have had every reason to suppose that this lady too is hysterical. Yes, Irma herself betrayed the fact to me. But what do I know of her condition? Only the one thing, that like Irma in the dream she suffers from hysterical choking. Thus, in the dream I have replaced my patient by her friend, Now I remember that I have often played with the supposition that this lady, too, might ask me to relieve her of her symptoms But even at the time I thought it improbable since she is extremely reserved. 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 not to her friend; pale, puffy, false teeth, The false teeth led me to the governess; I now feel inclined to be satisfied with bad teeth, Here 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 not felt particularly well, she was puffy. I have thus compared my patient Irma with two others, who would likewise resist treatment. What is the meaning of the fact that I have exchanged her for her friend in the dream? Perhaps that I wish to exchange her; either her friend arouses in me stronger sympathies, or I have a higher regard for her intelligence. For I consider Irma foolish because she does not accept my solution. The other woman would be more sensible, and would thus be more likely to yield. The mouth then opens readily; she would tell more than Irma.
What I see in the throat: a white spot and scabby turbinal bones. The white spot recalls diphtheria, and thus Ir,a's friend, but it also recalls the grave illness of my eldest daughter two years earlier, and all the anxiety of that unhappy time. The scab on the turbinal bones reminds me of my anxiety concerning my own health. At that time I frequently used cocaine in order to suppress distressing swellings in the nose, and I had heard a few days previously that a lady patient who did likewise had contracted an extensive necrosis of the nasal mucous membrane. In 1885 it was I who had recommended the use of cocaine, and I had been gravely reproached in consequence. A dear friend, who had died before the date of this dream, had hastened his end by the misuse of this remedy.
To be continued...
saving score / loading statistics ...