The analysis was rich in such dreams, in which I had to recognise very typical projections of his anal-erotic phantasies. These by themselves allowed a certain view to be taken of the diagnosis, and this was more and more confirmed, finding secure support from the actual memories.
I will now attempt a brief survey of the case. At the beginning of analytic treatment, the case appeared one of hysteria due to shock. Gradually it became evident that not the actual accident, but an unimportant experience in hospital treatment (X-ray episode), the significance of which had been reinforced by important experiences in childhood and puberty, undoubtedly counted as the immediate determining motive of the illness. It was the business of the symptom that arose from this to indulge a passive homosexual wish-phantasy, and at the same time the neurosis mobilised a multitude of anal-erotic memory-traces wich took the lead in giving shape to the symptom. A memory became operative in the attack, namely that of the childbirth observed in childhood, which, ranking as an outstanding experience, had already in its time led to powerful repression of allied memory-traces (his own mother's frequent childbirths) of even earlier years. These actual infantile experiences were closely bound up with the predominant activity of one of the component instincts. The immense contribution of anal erotism to the patient's sexual constitution was discovered, and by ascertaining piecemeal its former and current derivatives, the libidinous fixations and their transmutations into character traits, we eventually obtained access on the one hand to the elementary sources from which the neurosis derived its energy, and on the other achieved the gradual dissolution of the repressions that had been pathogenic. Although the dispositional factor of the libido had remained sufficiently prominent to contend against normal sexual development, the other symptoms of the disease had become so unbearable that they compelled him to show the necessary patience and endurance to put the analytic treatment through to its end, and this made a satisfactory result possible. The peculiar psychical material that came to light must stand as evidence of the degree of thoroughness with which I treated the case.
