*This is Freud's interpretation of his dream about Irma one his
patients, feel free to skip*
Dream of July 23-24, 1895
A great hall - a number of guests, whom we are receiving - among them Irma,
whom I immediately take aside, as though to answer her letter, and
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 have now in the throat, stomach, and abdomen - I am
choked by them." I am startled, and look at her. She looks pale and
puffy. I think that after all I must be overlooking some organic affection. I
take her to the window and look into her throat. She offers some
resistance to this, like a woman who has a set of false teeth. I think, surely,
she doesn't need them. - The mouth then opens wide, and I find a large
white spot on the right, and elsewhere I see extensive grayish-white scabs
adhering to curiously curled formations, which are evidently shaped
like the turbinal bones of the nose. - I quickly call Dr. M, who repeats the
examination and confirms it.... Dr. M looks quite unlike his usual self;
he is very pale, he limps, and his chin is clean-shaven.... Now my friend Otto,
too, is standing beside her, and my friend Leopold percusses her
covered chest, and says "She has a dullness below, on the left," and also calls
attention to an infiltrated portion of skin on the left shoulder (which
I can feel, in spite of the dress).... M says: "There's no doubt that it's an
infection, but it doesn't matter; dysentery will follow and the poison will
be eliminated." ... We know, too, precisely how the infection originated. My
friend Otto, not long ago, gave her, when she was feeling unwell, an
injection of a preparation of propyl... propyls... propionic acid... trimethylamin
(the formula of which I see before me, printed in heavy type)....
One doesn't give such injections so rashly.... Probably, too, the syringe was
not clean.
This dream has an advantage over many others. It is at once obvious to what
events of the preceding day it is related, and of what subject it treats.
The preliminary statement explains these matters. The news of Irma's health
which I had received from Otto, and the clinical history, which I was
writing late into the night, had occupied my psychic activities even during
sleep. Nevertheless, no one who had read the preliminary report, and
had knowledge of the content of the dream, could guess what the dream
signified. Nor do I myself know. I am puzzled by the morbid symptoms
of which Irma complains in the dream, for they are not the symptoms for
which I treated her. I smile at the nonsensical idea of an injection of
propionic acid, and at Dr. M's attempt at consolation. Towards the end the
dream seems more obscure and quicker in tempo than at the beginning.
In order to learn the significance of all these details I resolve to undertake an
exhaustive analysis.
Analysis
The hall - a number of guests, whom we are receiving. We were living that
summer at Bellevue, an isolated house on one of the hills adjoining
the Kahlenberg. This house was originally built as a place of entertainment,
and therefore has unusually lofty, hall-like rooms. The dream was
dreamed in Bellevue, a few days before my wife's birthday. During the day my
wife had mentioned that she expected several friends, and among
them Irma, to come to us as guests for her birthday. My dream, then,
anticipates this situation: It is my wife's birthday, and we are receiving a
number of people, among them Irma, as guests in the large hall of Bellevue.
I reproach Irma for not having accepted the "solution." I say, "If you still have
pains, it is really your own fault." I might even have said this while
awake; I may have actually said it. At that time I was of the opinion
(recognized 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 grateful to this error, which, fortunately, has
now been overcome, since it made life easier for me at a time when,
with all my unavoidable ignorance, I was expected to effect successful cures.
But I note that, in the speech which I make to Irma in the dream, I
am above all anxious that I shall not be blamed for the pains which she still
suffers. 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 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 examinations, 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 arrierepensees
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 diphtheritic membrane. The person of Dr. M and the
membrane 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 nor
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.[10] 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.[11]
What I see in the throat: a white spot and scabby turbinal bones. The white
spot recalls diphtheria, and thus Irma'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.
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 examination. It reminds me of
a sad medical experience. By continually prescribing a drug
(sulphonal), which at that time was still considered harmless, I was once
responsible for a condition of acute poisoning in the case of a woman
patient, and hastily turned for assistance to my older and more experienced
colleague. The fact that I really had this case in mind is confirmed by
a subsidiary circumstance. The patient, who succumbed to the toxic effects
of the drug, bore the same name as my eldest daughter. I had never
thought of this until now; but now it seems to me almost like a retribution of
fate - as though the substitution of persons had to be continued 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 for a lack of medical conscientiousness.
Dr. M is pale; his chin is shaven, and he limps. Of this so much is correct, that
his unhealthy appearance often arouses the concern of his friends.
The other two characteristics must belong to another person. An elder
brother living abroad occurs to me, for he, too, shaves his chin, and if I
remember him rightly, the M of the dream bears on the whole a certain
resemblance to him. And some days previously the news arrived that he
was limping on account of an arthritic affection of the hip. There must be
some reason why I fuse the two persons into one in my dream. I
remember that, in fact, I was on bad terms with both of them for similar
reasons. Both had rejected a certain proposal which I had recently made
them.
My friend Otto is now standing next to the patient, and my friend Leopold
examines her and calls attention to a dulness low down on the left side.
My friend Leopold also is a physician, and a relative of Otto's. Since the two
practice the same specialty, fate has made them competitors, so that
they are constantly being compared with one another. Both of them assisted
me for years, while I was still directing a public clinic for neurotic
children. There, scenes like that reproduced in my dream had often taken
place. While I would be discussing the diagnosis of a case with Otto,
Leopold would examine the child anew and make an unexpected contribution
towards our decision. There was a difference of character between
the two men like that between Inspector Brasig and his friend Karl. Otto was
remarkably prompt and alert; Leopold was slow and thoughtful, but
thorough. If I contrast Otto and the cautious Leopold in the dream I do so,
apparently, in order to extol Leopold. The comparison is like that made
above between the disobedient patient Irma and her friend, who was believed
to be more sensible. I now become aware of one of the tracks along
which the association of ideas in the dream proceeds: from the sick child to
the children's clinic. Concerning the dulness low on the left side, I
have the impression that it corresponds with a certain case of which all the
details were similar, a case in which Leopold impressed me by his
thoroughness. I thought vaguely, too, of something like a metastatic
affection, but it might also be a reference to the patient whom I should have
liked to have in Irma's place. For this lady, as far as I can gather, exhibited
symptoms which imitated tuberculosis.
An infiltrated portion of skin on the left shoulder. I know at once that this is
my own rheumatism of the shoulder, which I always feel if I lie
awake long at night. The very phrasing of the dream sounds ambiguous:
Something which I can feel, as he does, in spite of the dress. "Feel on my
own body" is intended. Further, it occurs to me how unusual the phrase
infiltrated portion of skin sounds. We are accustomed to the phrase: "an
infiltration of the upper posterior left"; this would refer to the lungs, and thus,
once more, to tuberculosis.
In spite of the dress. This, to be sure, is only an interpolation. At the clinic the
children were, of course, examined undressed; here we have some
contrast to the manner in which adult female patients have to be examined.
The story used to be told of an eminent physician that he always
examined his patients through their clothes. The rest is obscure to me; I
have, frankly, no inclination to follow the matter further.
Dr. M says: "It's an infection, but it doesn't matter; dysentery will follow, and
the poison will be eliminated." This, at first, seems to me
ridiculous; nevertheless, like everything else, it must be carefully analysed;
more closely observed it seems after all to have a sort of meaning.
What I had found in the patient was a local diphtheritis. I remember the
discussion about diphtheritis and diphtheria at the time of my daughter's
illness. Diphtheria is the general infection which proceeds from local
diphtheritis. Leopold demonstrates the existence of such a general infection
by the dulness, which also suggests a metastatic focus. I believe, however,
that just this kind of metastasis does not occur in the case of diphtheria.
It reminds me rather of pyaemia.
It doesn't 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 patient's
sufferings are the result of a serious organic affection. I begin to suspect
that by this I am only trying to shift the blame from myself. Psychic
treatment cannot be held responsible for the continued presence of a
diphtheritic affection. Now, indeed, I am distressed by the thought of having
invented such a serious illness for Irma, for the sole purpose of exculpating
myself. It seems so cruel. Accordingly, I need the assurance that the
outcome will be benign, and it seems to me that I made a good choice when I
put the words that consoled me into the mouth of Dr. M. But here I
am placing myself in a position of superiority to the dream; a fact which
needs explanation.
But why is this consolation so nonsensical?
Dysentery. Some sort of far-fetched theoretical notion that the toxins of
disease might be eliminated through the intestines. Am I thereby trying to
make fun of Dr. M's remarkable store of far-fetched explanations, his habit of
conceiving curious pathological relations? Dysentery suggests
something else. A few months ago I had in my care a young man who was
suffering from remarkable intestinal troubles; a case which had been
treated by other colleagues as one of "anaemia with malnutrition." I realized
that it was a case of hysteria; I was unwilling to use my psychotherapy on
him, and sent him off on a sea-voyage. Now a few days previously I had
received a despairing letter from him; he wrote from Egypt,
saying that he had had a fresh attack, which the doctor had declared to be
dysentery. I suspect that the diagnosis is merely an error on the part of
an ignorant colleague, who is allowing himself to be fooled by the hysteria;
yet I cannot help reproaching myself for putting the invalid in a
position where he might contract some organic affection of the bowels in
addition to his hysteria. Furthermore, dysentery sounds not unlike
diphtheria, a word which does not occur in the dream.
Yes, it must be the case that with the consoling prognosis, Dysentery will
develop, etc., I am making fun of Dr. M, for I recollect that years ago
he once jestingly told a very similar story of a colleague. He had been called
in to consult with him in the case of a woman who was very
seriously ill, and he felt obliged to confront his colleague, who seemed very
hopeful, with the fact that he found albumen in the patient's urine.
His colleague, however, did not allow this to worry him, but answered calmly:
"That does not matter, my dear sir; the albumen will soon be
excreted!" Thus I can no longer doubt that this part of the dream expresses
derision for those of my colleagues who are ignorant of hysteria. And,
as though in confirmation, the thought enters my mind: "Does Dr. M know
that the appearances in Irma's friend, his patient, which gave him
reason to fear tuberculosis, are likewise due to hysteria? Has he recognized
this hysteria, or has he allowed himself to be fooled?"
But what can be my motive in treating this friend so badly? That is simple
enough: Dr. M agrees with my solution as little as does Irma herself.
Thus, in this dream I have already revenged myself 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 know precisely how the infection originated. This precise knowledge in
the dream is remarkable. Only a moment before this we did not yet
know of the infection, since it was first demonstrated by Leopold.
My friend Otto gave her an injection not long ago, when she was feeling
unwell. Otto had actually related during his short visit to Irma's family
that he had been called in to a neighbouring hotel in order to give an injection
to someone who had been suddenly taken ill. Injections remind me
once more of the unfortunate friend who poisoned himself with cocaine. I
had recommended the remedy for internal use only during the
withdrawal of morphia; but he immediately gave himself injections of
cocaine.
With a preparation of propyl... propyls... propionic acid. How on earth did this
occur to me? On the evening of the day after I had written the
clinical history and dreamed about the case, my wife opened a bottle of
liqueur labelled "Ananas,"[12] which was a present from our friend Otto.
He had, as a matter of fact, a habit of making presents on every possible
occasion; I hope he will some day be cured of this by a wife.[13] This
liqueur smelt so strongly of fusel oil that I refused to drink it. My wife
suggested: "We will give the bottle to the servants," and I, more prudent,
objected, with the philanthropic remark: "They shan't be poisoned either." The
smell of fusel oil (amyl...) has now apparently awakened my
memory of the whole series: propyl, methyl, etc., which furnished the
preparation of propyl mentioned in the dream. Here, indeed, I have effected
a substitution: I dreamt of propyl after smelling amyl; but substitutions of this
kind are perhaps permissible, especially in organic chemistry. -
Trimethylamin. In the dream I see the chemical formula of this substance -
which at all events is evidence of a great effort on the part of my
memory - and the formula is even printed in heavy type, as though to
distinguish it from the context as something of particular importance. And
where does trimethylamin, thus forced on my attention, lead me? To a
conversation with another friend, who for years has been familiar with all
my germinating ideas, and I with his. At that time he had just informed me of
certain ideas concerning a sexual chemistry, and had mentioned,
among others, that he thought he had found in trimethylamin one of the
products of sexual metabolism. This substance thus leads me to sexuality,
the factor to which I attribute the greatest significance in respect of the origin
of these nervous affections which I am trying to cure. My patient
Irma is a young widow; if I am required to excuse my failure to cure her, I
shall perhaps do best to refer to this condition, which her admirers
would be glad to terminate. But in what a singular fashion such a dream is
fitted together! The friend who in my dream becomes my patient in
Irma's place is likewise a young widow.
I surmise why it is that the formula of trimethylamin is so insistent in the
dream. So many important things are centered about this one word:
trimethylamin is an allusion, not merely to the all-important factor of
sexuality, but also to a friend whose sympathy I remember with satisfaction
whenever I feel isolated in my opinions. And this friend, who plays such a
large part in my life: will he not appear yet again in the concatenation
of ideas peculiar to this dream? Of course; he has a special knowledge of the
results of affections of the nose and the sinuses, and has revealed to
science several highly remarkable relations between the turbinal bones and
the female sexual organs. (The three curly formations in Irma's throat.)
I got him to examine Irma, in order to determine whether her gastric pains
were of nasal origin. But he himself suffers from suppurative rhinitis,
which gives me concern, and to this perhaps there is an allusion in pyaemia,
which hovers before me in the metastasis of the dream.
One doesn't give such injections so rashly. Here the reproach of rashness is
hurled directly at my friend Otto. I believe I had some such thought in
the afternoon, when he seemed to indicate, by word and look, that he had
taken sides against me. It was, perhaps: "How easily he is influenced;
how irresponsibly he pronounces judgment." Further, the above sentence
points once more to my deceased friend, who so irresponsibly resorted
to cocaine injections. As I have said, I had not intended that injections of the
drug should be taken. I note that in reproaching Otto I once more
touch upon the story of the unfortunate Matilda, which was the pretext for
the same reproach against me. Here, obviously, I am collecting
examples of my conscientiousness, and also of the reverse.
Probably too the syringe was not clean. Another reproach directed at Otto,
but originating elsewhere. On the previous day I happened to meet the
son of an old lady of eighty-two, to whom I am obliged to give two injections
of morphia daily. At present she is in the country, and I have heard
that she is suffering from phlebitis. I immediately thought that this might be
a case of infiltration caused by a dirty syringe. It is my pride that in
two years I have not given her a single infiltration; I am always careful, of
course, to see that the syringe is perfectly clean. For I am
conscientious. From the phlebitis I return to my wife, who once suffered from
thrombosis during a period of pregnancy, and now three related
situations come to the surface in my memory, involving my wife, Irma, and
the dead Matilda, whose identity has apparently justified my putting
these three persons in one another's places.
I have now completed the interpretation of the dream.[14] In the course of
this interpretation I have taken great pains to avoid all those notions
which must have been suggested by a comparison of the dream-content with
the dream-thoughts hidden behind this content. Meanwhile the
meaning of the dream has dawned upon me. I have noted an intention which
is realized through the dream, and which must have been my motive
in dreaming. The dream fulfills several wishes, which were awakened within
me by the events of the previous evening (Otto's news, and the
writing of the clinical history). For the result of the dream is that it is not I
who am to blame for the pain which Irma is still suffering, but that
Otto is to blame for it. Now Otto has annoyed me by his remark about Irma's
imperfect cure; the dream avenges me upon him, in that it turns the
reproach upon himself. The dream acquits me of responsibility for Irma's
condition, as it refers this condition to other causes (which do, indeed,
furnish quite a number of explanations). The dream represents a certain
state of affairs, such as I might wish to exist; 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 other details of the dream
become intelligible when regarded from the standpoint of wishfulfilment. I
take my revenge on Otto, not merely for too readily taking sides against me.
in that I accuse him of careless medical treatment (the
injection), but I revenge myself also for the bad liqueur which smells of fusel
oil, and I find an expression in the dream which unites both these
reproaches: the injection of a preparation of propyl. Still I am not satisfied,
but continue to avenge myself by comparing him with his more
reliable colleague. Thereby I seem to say: "I like him better than you." But Otto
is not the only person who must be made to feel the weight of my
anger. I take my revenge on the disobedient patient, by exchanging her for a
more sensible and more docile one. Nor do I pass over Dr. M's
contradiction; for I express, in an obvious allusion, my opinion of him: namely,
that his attitude in this case is that of an ignoramus (Dysentery
will develop, etc.). Indeed, it seems as though I were appealing from him to
someone better informed (my friend, who told me about
trimethylamin), just as I have turned from Irma to her friend, and from Otto to
Leopold. It is as though I were to say: Rid me of these three
persons, replace them by three others of my own choice, and I shall be rid of
the reproaches which I am not willing to admit that I deserve! In my
dream the unreasonableness of these reproaches is demonstrated for me in
the most elaborate manner. Irma's pains are not attributable to me,
since she herself is to blame for them, in that she refuses to accept my
solution. They do not concern me, for being as they are of an organic
nature, they cannot possibly be cured by psychic treatment. Irma's sufferings
are satisfactorily explained by her widowhood (trimethylamin!); a
state which I cannot alter. Irma's illness has been caused by an incautious
injection administered by Otto, an injection of an unsuitable drug, such
as I should never have administered. Irma's complaint is the result of an
injection made with an unclean syringe, like the phlebitis of my old lady
patient, whereas my injections have never caused any ill effects. I am aware
that these explanations of Irma's illness, which unite in acquitting me,
do not agree with one another; that they even exclude one another. The whole
plea - for this dream is nothing else - recalls vividly the defence
offered by a man who was accused by his neighbour of having returned a
kettle in a damaged condition. In the first place, he had returned the
kettle undamaged; in the second place it already had holes in it when he
borrowed it; and in the third place, he had never borrowed it at all. A
complicated defence, but so much the better; if only one of these three lines
of defence is recognized as valid, the man must be acquitted.
Still other themes play a part in the dream, and their relation to my nonresponsibility
for Irma's illness is not so apparent: my daughter's illness,
and that of a patient with the same name; the harmfulness of cocaine; the
affection of my patient, who was traveling in Egypt; concern about the
health of my wife; my brother, and Dr. M; my own physical troubles, and
anxiety concerning my 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, which might be labelled: Concern for the health of
myself and others; professional conscientiousness. I recall a vaguely
disagreeable feeling when Otto gave me the news of Irma's condition. Lastly,
I am inclined, after the event, to find an expression of this fleeting sensation
in the train of thoughts which forms part of the dream. It is as though
Otto had said to me: "You do not take your medical duties seriously enough;
you are not conscientious; you do not perform what you promise."
Thereupon this train of thought placed itself at my service, in order that I
might give proof of my extreme conscientiousness, of my intimate
concern about the health of my relatives, friends and patients. Curiously
enough, there are also some painful memories in this material, which
confirm the blame attached to Otto rather than my own exculpation. The
material is apparently impartial, but the connection between this broader
material, on which the dream is based, and the more limited theme from
which emerges the wish to be innocent of Irma's illness, is, nevertheless,
unmistakable.