I still recollect very well a case which greatly interested me at the time.
A young woman had been admitted to the hospital, suffering from “melancholia.”
The examination was conducted with the usual care: anamnesis, tests, physical check-ups, and so on.
The diagnosis was schizophrenia, or “dementia praecox,” in the phrase of those days.
The prognosis: poor.
This woman happened to be in my section.
At first I did not dare to question die diagnosis.
I was still a young man then, a beginner, and would not have had the temerity to suggest another one.
And yet the case struck me as strange.
I had the feeling that it was not a matter of schizophrenia but of ordinary depression, and resolved to apply my own method.
At the time I was much occupied with diagnostic association studies, and so I undertook an association experiment with the patient.
In addition, I discussed her dreams with her.
In this way I succeeded in uncovering her past, which the anamnesis had not clarified.
I obtained information directly from the unconscious, and this information revealed a dark and tragic story.
Before the woman married she had known a man, the son of a wealthy industrialist, in whom all the girls of the neighborhood were interested.
Since she was very pretty, she thought her chances of catching him were fairly good.
But apparently he did not care for her, and so she married another man.
Five years later an old friend visited her.
They were talking over old times, and he said to her, “When you got married it was quite a shock to someone your Mr. X” (the wealthy industrialist’s
son). That was the moment!
Her depression dated from this period, and several weeks later led to a catastrophe.
She was bathing her children, first her four-year-old girl and then her two-year-old son.
She lived in a country where the water supply was not perfectly hygienic; there was pure spring water for drinking, and tainted water from the river for bathing and washing.
While she was bathing the little girl, she saw the child sucking at the sponge, but did not stop her.
She even gave her little son a glass of the impure water to drink.
Naturally, she did this unconsciously, or only half consciously, for her mind was already under the shadow of the incipient depression.
A short time later, after the incubation period had passed ,the girl came down with typhoid fever and died.
The girl had been her favorite. The boy was not infected.
At that moment the depression reached its acute stage, and the woman was sent to the institution.
From the association test I had seen that she was a murderess, and I had learned many of the details of her secret.
It was at once apparent that this was a sufficient reason for her depression.
Essentially it was a psychogenic disturbance and not a case of schizophrenia.
Now what could be done in the way of therapy?
Up to then the woman had been given narcotics to combat her insomnia and had been under guard to prevent attempts at suicide. But otherwise nothing had been done.
Physically, she was in good condition.
I was confronted with the problem: Should I speak openly with her or not? Should I undertake the major operation?
I was faced with a conflict of duties altogether without precedent in my experience.
I had a difficult question of conscience to answer, and had to settle the matter with myself alone.
If I had asked my colleagues, they would probably have *warned me, “For heaven’s sake, don’t tell the woman any such thing.
That will only make her still crazier.”
To my mind, the effect might well be the reverse.
In general it may be said that unequivocal rules scarcely exist in psychology, A question can be answered one way or another, depending on whether or not we take the unconscious factors into account.
Of course I knew very well the personal risk I was running: if the patient got worse, I would be in the soup too!
Nevertheless, I decided to take a chance on a therapy whose outcome was uncertain.
I told her everything I had discovered through the association test.
It can easily be imagined how difficult it was for me to do this.
To accuse a person point-blank of murder is no small matter.
And it was tragic for the patient to have to listen to it and accept it.
But the result was that in two weeks it proved possible to discharge her, and she was never again institutionalized.
There were other reasons that caused me to say nothing to my colleagues about this case.
I was afraid of their discussing it and possibly raising legal questions.
Nothing could be proved against the patient, of course, and yet such a discussion might have had disastrous consequences for her.
Fate had punished her enough!
It seemed to me more meaningful that she should return to life in order to atone in life for her crime.
When she was discharged, she departed bearing her heavy burden.
She had to bear this burden.
The loss of the child had been frightful for her, and her expiation had already begun with the depression and her confinement to the institution.
In many cases in psychiatry, the patient who comes to us has a story that is not told, and which as a rule no one knows of.
To my mind, therapy only really begins after the investigation of that wholly personal story.
It is the patient’s secret, the rock against which he is shattered.
If I know his secret story, I have a key to the treatment. The doctor’s task is to find out how to gain that knowledge.
In most cases exploration of the conscious material is insufficient
Sometimes an association test can open the way; so can the interpretation of dreams, or long and patient human contact with the individual.
In therapy the problem is always the whole person, never the symptom alone.
We must ask questions which challenge the whole personality. ~Carl Jung, Memories Dreams and Reflections, Pages 115-117