superimposed upon this real stimulus. It follows without doubt that in dealing with the psychical forces which arose in connection with the X-ray examination the patient was gravely impeded in mental adaptability by a high degree of 'complex' sensitivity which had developed from the experiences described. It is in this group therefore that we can recognise the immediate exciting causes of the neurosis. The persistence latently, at fifteen years, of the unduly developed anal-erotic instinct-factor was meanwhile confirmed by a peculiar memory. The patient tells that he could not easily bring himself to defaecate in the open, although it was the everyday custom in the circles to which he belonged. In addition to repressed exhibitionism, one can see clearly in this recollection the reaction against his passive homosexuality.[1] Furthermore, the fact of onanism having been transiently practised and smoothly given up during puberty, speaks in favour of other instinctive tendencies having remained prominent at this time, and consequently in childhood.
Let us summarise the results of the analysis up to this point. They lead to the inevitable conclusion that the X-ray episode materially disturbed the equilibrium of the patient's libidinous tendencies. So far the state of affairs would seem completely explained. In regard to two questions, however, which arise directly therefrom, satisfactory answers are still to a large extent outstanding. In connection with the first of these, namely the wish-phantasy made active by the neurosis, many indications strengthen the idea that it has to do with an hallucinated (hysterical) pregnancy, with associated representation of parturition in the attack. As to the second, we suspect with some justice, and particularly on account of insight into the patient's character, that anal-erotic tendencies play a part. It was these, then, that constituted the form of the neurosis, i.e. determined the wish-phantasy. Decisive conclusions on these two subjects, which are continually interrelated and supplementary, can be reached only by searching through the conditions of infant life. The material relevant to this was, as in all analyses, not obtained suddenly at a certain stage, but rather was accumulated at various times by eliciting facts, sometimes spontaneously, sometimes requiring careful re-interpretation. The essential achievement of the analysis is involved in
- ↑ Boys often amuse themselves by stepping unnoticed behind their playfellow's back for fun to startle him. (Related by the patient.)
