The Compulsion Neuroses

CHAPTER IV THE COMPULSION NEUROSES (OBSESSIONS, DOUBTS, PHOBIAS) Their Relation to the Sadistic Component and the Psychology of Love and Hatred During the spring of 1909, the patient R., twenty-three years old, born in New York City, of Hebrew parentage, married, driver by occupation, applied for treatment in the neurological department of the Vanderbilt clinic. He was examined by Dr. C. Beling,who, after discussing the case with me, made the diagnosis "compulsion neurosis, probably paranoid," and referred the patient to the department of psychiatry to be treated by me. R. was in excellent physical condition. There was nothing to attract one's attention to him anthropologically; his features were well formed and symmetrical, mentally he was alert and intelligent, answering questionsreadily and relevantly and his judgment and reasoning corresponded to his type—a bright, thoroughly Americanized young man of Russian-Jewish extraction. According to the patient there was nothing to note about his family history. He was the only child and as far as he could judge there were no mental or nervous diseases in the family. His own life was not marked by any special events. He attended thepublic school up to the
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age of fourteen years and was a good student. After leaving school he worked and then peddled, first with his father and then alone in the neighboring farming districts. His present position he had obtained two years before. I will add here that upon entering somewhat deeper into my patient's symptom-complex I soon became convincedthat I dealt with a case of compulsion neurosis and that there was nothing paranoid in it. By compulsion neurosis in the Freudian sense we understand those cases which present obsessions, doubts and phobias and which are commonly called psychasthenias. The patient sought treatment because for four years he had been annoyed by the thought that all the Jews would be killed by the Christians. To usehis own words: " I have the idea that all Jews will be killed by Christians. I know the idea is foolish, but I cannot shake it off. It is always with me and at times is so strong that I almost believe it. I think that I will be killed because all Jews will be killed. I argue with myself about the impossibility of this idea, but I always come to the conclusion that although it is absurd it mighthappen and this naturally depresses me. I begin to worry and feel sorry for my poor father and I often cry over it." What the patient himself thought strange was the fact that he had absolutely no reason for such thoughts. He never had any trouble with any Christian. On the contrary he could number many Christians among his friends. He had been employed by a Christian firm and was highly regarded andthe one person with whom he had some differences was the only other Jew who was employed by the same firm. To my question he answered

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that on a few occasions he had thought of committing suicide. It came to him as a sort of a command: "You must die." But he argued that it would be useless to do it as the Christians would then cut up his body. He stated that the ideacame on suddenly one day about four years before. It at first surprised and seemed strange to him, but he soon found that he could not rid himself of it. He had to think of it or of something referring to it. When asked to explain he said that he was always spinning fancies around it. He elaborated upon all sorts of abstruse questions in reference to it, e.g., what kind of a world would it be afterall the Jews were killed; what would Mrs. X. do; suppose Mr. Z. escapes, etc. As a result of all this he was very depressed, had no ambition and could take no interest in anything. Besides these obsessions he complained of headaches and a peculiar "dull feeling" which came on from time to time and during which he could not think. He also stated that he was very often suspicious. He feared that...