How One Woman Became Insane
( Originally Published 1920 )
Psychoanalysts seldom have the opportunity of treating any of the "great psychoses." The patient who has lost all insight into his mental condition is generally confined in an institution and few insane asylums have analysts on their medical staff. [an error occurred while processing this directive]
One case treated by Dr. Kempf at St. Elizabeth Hospital, Washington, D. C., offers good evidence that many apparently "desperate" cases could be cured by the psychoanalytic technique.
If an abstract of that case is presented to the reader, it is not merely owing to the success which crowned Dr. Kempf's efforts, but because it offers, besides, a striking and grewsome picture of the process by which people are at times "driven to insanity."
It shows how well-meaning associates, lacking in sympathy and understanding, beset with many prejudices and affected by complexes of their own, may gradually make reality so unbearable for a weaker individual that he unconsciously seeks to escape it by the door which leads to an insane asylum.
The various relapses which Kempf's patient suffered before she regained her normal balance illustrate perhaps more impressively than any other detail of the ease that process of abnormal escape from unpleasant situations.
The influence which education may have in determining the content of psychopathic fancies was made very clear by the analysis of Kempf's patient.
The patient was a young woman of twenty-four, married and the mother of a child. She was the youngest of several children.
Her father was an engineer, a hard-worker, saving to the point of being stingy and obsessed by the fear of being destitute in his old age. He loved his children but tended to conflict with them owing to his prudishness. All sexual topics were taboo in his home. He berated his daughters when they sat with their legs crossed, he objected to their wearing kimonos. He owned some houses in a distant city which were for a time, through no fault of his own, converted into brothels..
In his later years he depended upon his oldest daughter to manage his affairs and persistently inclined to treat the youngest as a child. At the time of the patient's illness, he was about seventy years old and suffering from chronic gastritis.
The mother was a "nervous," kind, home loving woman, tall and heavy, and extremely fond of eating. She, like her husband, encouraged her oldest daughter to be self-reliant and, on the other hand, trained her youngest daughter to depend upon her in every way, introducing her to visitors as the baby. She never allowed the "baby" to have any initiative and imposed her will upon her in all matters, telling her what style and material to select for her clothes, what to wear for the day, how to act, to whom to talk, etc.
Like her husband, she also excluded from her conversation all matters pertaining to sex and never tolerated any intimate confidence on the part of her children. The patient was whipped at the age of eleven for asking her mother about the meaning of a word she read in a toilet and for relating to her her fancies in connection with that word.
The patient's oldest sister was mentally and_ physically very like the mother and she, too, demanded constant submission to her decisions and opinions on the part of the patient.
In other words the patient's training had unfitted her for self-reliance and efficiency in real life. She was perfectly satisfied with that arrangement and even was inclined to treat her own inefficiency and irresponsibility as a joke. She was a lazy and rather obese type of girl. Her education was never planned systematically and she missed many school days on whimsical pretexts.
Her early curiosity in regard to sexual problems only met with rebuke and on several occasions with punishment.
Her parents' prudishness only increased her interest in all things pertaining to reproduction. She watched excitedly cats, dogs, chickens, horses and derived much secret enjoyment from her observation of their sexual behaviour. On the other hand she would be morbidly embarrassed by the sight of a woman nursing a child.
Her father considered it indecent for her to sit on his lap. When her sister began to menstruate and she tried to secure information as to that phenomenon, her mother scolded her and sent her to her room. She felt then that she lived on a plane beneath her mother and her sister and she developed a distinct feeling of inferiority.
She trained herself never to ask questions because they might expose her thoughts and she would have remained in absolute ignorance of sexual facts but for the romantic stories told her by a coloured maid who had been employed once in a house of prostitution. Those stories simply set her imagination on fire and far from enlightening her, caused her to derive sexual suggestions from almost everything in her environment, the behaviour of her father and mother, the sight of attractive women, etc.
At twenty-one, she married a young man whose family was in almost every respect quite the opposite of her own.
His father was also an engineer, but younger than the patient's father, a free spender and fond of gay parties.
The patient's mother-in-law was a handsome woman with a girlish figure, small feet and ankles, well dressed, who had travelled a good deal and had a wide range of interests. She was proud of her youthful appearance and dieted in order to keep herself attractive looking.
The patient's husband was a slender man who at thirty had the figure of a wiry, active boy of twenty. He also was an engineer, ambitious, earnest, spoiled by his mother, and at times irritable and impulsive.
During their engagement, the patient never allowed her fiancÚ to kiss her or to put his arm around her. She was terribly upset and almost gave him up when he confessed to her that he had had a hard struggle with his desire to masturbate and had consorted with other girls. She never communicated her wish to desert him to any one then but later in her psychose felt sure that their marriage was not legal.
At that time she finally demanded that her mother enlighten her as to the origin of children and she felt extremely shocked by her mother's explanation and always hated her in later life for having deceived her so long.
After the novelty of their relation and the excitement attendant upon the first months of married life had worn away, her husband began to be disturbed by what he called "asinine thoughts." He could not understand why dainty feet, hairless limbs, small firm breasts and a small abdomen (his mother's characteristics) should prove so attractive to him and why large soft breasts, a large abdomen, heavy feet and ankles and hairy limbs (his wife's characteristics) should prove sexually depressing.
He was undoubtedly conscious of his mother-fixation and in his more or less conscious endeavour to escape incest had selected for his mate the opposite type of a woman. His mother-fixation was clearly revealed by incestuous dreams which pursued him even after his marriage.
He was greatly relieved later when told of the simple biological significance of such dreams. Realizing obscurely to what causes his growing sexual indifference to his wife was due, he tried to induce her to diet, to exercise (in order to reduce her abdomen and breasts) and to remove the hair from her ankles. After a while she gave up those practices which would have made her a little more similar to the mother-image and became careless about her appearance.
The two families did not harmonize at all. Her family appeared too coarse and bigoted to her husband's family which in turn was scorned by her family for its freer views and extravagance. The two families naturally made the unfortunate young woman their common battle ground because she was weak and unsophisticated.
Her husband caused her much distress by threatening to leave her if she lost her beauty, if she did not take better care of her appearance, or did not write to him daily when he was away.
Her sexual life was naturally very unsatisfactory and she masturbated during her pregnancy, after which she was overwhelmed with shame. To make matters worse, her sister told her that masturbation was a symptom of insanity. She was obsessed by the fear that her child might inherit her bad habits. When the child was born and her husband showed a good deal of indifference to it, his threats to leave her caused her more and more anxiety.
Both families resumed their strife over the child. Her mother-in-law insisted upon plenty of fresh air for the infant and her own mother protested that they were freezing it. The patient's mother finally assumed complete charge of the child and treated it like her own.
When her husband was away, his mother berated her for not travelling with him; her mother objected to this because she would neglect the baby by going to meet her husband out of town.
She was made to regard herself as a failure, both as a wife and as a mother. Her husband, thoroughly frightened but well-meaning, decided then to educate her. For that purpose he gave her an absurd book on "sexology" filled with moralizing platitudes on masturbation and perversions. The only conclusion she drew from reading that drivel was that she was a pervert and a degenerate, absolutely unfit to raise her child, and that her child was doomed to become abnormal.
She had fits of crying and depression and often told her family she wished she, her husband and baby were dead. She spoke of her husband remarrying and asked her sister to take care of the baby when she married her husband, She indulged more and more in masturbation and began to speak of it openly. Delusions appeared. She thought people sneered at her "as if she was passing disgusting odours." She insisted that she was not her father's daughter but a prostitute in a house kept by her father; she thought she saw a picture of herself in tights in the Police Gazette; she was afraid medicines might contain poison. Finally she drank tincture of iodine in an attempt to kill herself and thereupon was taken to a sanatorium.
In that institution which she, in her delusions, considered as a house of prostitution, some stupid nurses yielded to the temptation of playing upon her sexual fears and told her many weird sadistic stories of immorality. Pursued by erotic fancies she tried hard to resist her cravings and adopted no end of devices to save herself from masturbation. She experienced a profound sense of her sinfulness and her letters to her husband contained many references to her worthlessness, to the fact that she had ruined her baby, etc.
She was then removed from the sanatorium to St. Elizabeth Hospital.
Her husband was deeply affected by his wife's mental derangement and was conscious of his responsibility for her depression and anxiety. His first visits were very cautiously conducted and he always sought advice as to what to say to her. She reacted in a gratifying way to his kind attitude.
She gradually accorded Dr. Kempf her confidence and learned to depend upon him for assurance and encouragement. She became adjusted to a higher level of interest.
Suddenly, however, she began to regress, reverting to her prostitution fancies. The cause was not far to seek.
One day her husband, losing his patience, had in the course of a visit threatened again to leave her if she did not get well. She learnt also that he had been drinking.
Some time afterward she had another regression which was traced again to some stupid statements made by her husband. Her mother had died and willed all her property to the patient's father which necessitated the signature of all the heirs, including the patient. Her husband had carried the will in his pocket for several days trying to decide whether or not he would sign it. He brought up the whole family conflict again and told the patient that her mother must have been insane when she made that will. They were together at the patient's dance when it occurred and she changed in a few minutes from a state of hopefulness and promise to one of serious confusion and inaccessibility.
This lasted nearly two weeks and then she became more cheerful.
Then the family difficulties were once more depressed upon her by her husband, sister and father and this time she regressed almost completely to a prenatal attitude. She was afraid of being smothered in boxes, of being passed into the toilet with feces, she had all sorts of terrifying hallucinations.
Her dreams, however, showed affective trends which suggested that a reconstruction was possible. She developed more and more interest in her environment, her child, her husband. She gathered much insight into her condition and could analyse her delusions very skilfully.
About the twenty-third week she had rallied so far that a nurse took her out to visit her people. Then the old family quarrel about spending money flared up again. The patient wished to change the arrangement of the furniture and her sister, as domineering as ever, prevented her from asserting herself even during her brief stay at home. She returned to the hospital angry and worried.
She had too much insight by that time, owing to the psychoanalytic treatment she had been undergoing, to regress very far. She recovered and was finally discharged.
Two months afterward, a crisis confronted her again. She was pregnant and some members of her family were urging her to resort to an abortion. She managed to assert herself, however, and bore the child.
When she was discharged from the hospital, she seemed to be uncomfortable about two things, her inability to find a religion which was free from dogma and hypocrisy and a feeling that her education was not ample. Kempf gave her a rather indefinite reply on the subject of religion but accorded more serious consideration to her feelings of inferiority about her education.
Her education had been badly supervised and her conception of her fitness as a woman was not commensurate with the magnificent affections of a practical nature which were natural to her. She had become more of a woman in her sympathies and insight than the average social light. She had a keen insight into the affective mechanism of people surrounding her.
In order to free herself from her feeling of inferiority she read, upon Kempf's advice, biographies of famous women and gradually came to the conclusion that much of her suffering had been due to her repression of her affections. She determined to join the movement for woman's emancipation.
Her husband had to be educated too. Attentive and kind to her, he was still too completely enthralled by his mother-fixation to cooperate with Kempf very faithfully. He could not restrain his tendency to criticize his wife and to show displeasure over her diet, her careless way of dressing, etc. Kempf told him explicitly that he should not suppress, among other things, her interest in feminism, but frankly support it. He agreed to do so but was not quite able to keep his word.
The patient, however, in spite of all the pressure which both families tried again to bring to bear upon her, asserted herself.
She met their arguments with the statements that she must use her own judgment "because her physician had insisted upon it," and that she did not care what they had to say. She could not please everybody and no matter what happened she knew her physician respected her personal integrity and sincerity.
The way in which she managed her second pregnancy and the rearrangement of her household were very encouraging. The only distressing note was a statement she made that if any hopeless family estrangement should arise she would kill herself.
Therein lurked the possibility of a fateful regression to the lowest possible level, the fatal level, for the committing of suicide is a regression to the eternal mother, an effort to return to the ancient state of intrauterine peace, comfort and dependence.
Now, four years after her discharge from the hospital, she is in excellent mental condition, working out most of her plans to her heart's desire and taking good care of her two children.
Intelligent, sympathetic re-education, reducing her feeling of inferiority; the reliance she could place in a well known psychiatrist understanding her better than any member of her family and whose opinions had naturally more weight than that of any one else in her environment have enabled her to become herself at last.
A perusal of this remarkable case furnishes the reader with concrete applications of various statements contained in the chapters on the Love Life and the Sexual Enlightenment of Children.
The puritanical father and mother who in their fear of facts allowed their daughters to remain in ignorance of the sexual truth until a former inmate of a house of prostitution brought them the most spurious and romantic form of enlightenment are familiar figures. The baneful influence of a prudish father continually throwing obscene suggestions into the minds of his children by his very efforts to instil "modesty" into them is graphically illustrated.
This case also offers us a demonstration of the effects which a man's mother-fixation can have upon that man's sexual partner, causing her to experience a sense of physical inferiority because to his complex-beset mind, the mother type only can rep-resent feminine attraction and arouse his desire.
The striking change which the crisis brought about in the patient's personality and in her attitude to life, makes good food for thought. It is difficult to avoid the conclusions that AFTER BEING INSANE and recovering she was better fitted for life, and had become a more interesting human type than before the onset of her neurosis.
To one who realizes that recovery from a severe neurosis means the acquisition of an enormous amount of insight into, not only one's own thinking functions and motives, but into the psychology of one's associates as well, it will be evident that many persons who lived through such a terrible experience may have developed a more robust mentality than they ever had.
Unfortunately that view is not held by many people and the individual who was unfortunate enough to require treatment in an institution for the insane comes back to his former environment bearing an undefinable stigma. People are afraid of him and expect him to "go crazy" again at some time or other. And their fears are, if not justified, at least often realized. The insane man who made a recovery sometimes becomes insane again because he has been discouraged in his fight for reality by the very same people who once drove him into insanity.
Kempf's patient having it dinned constantly in her ears by two absolutely dissimilar groups of people that she was crazy finally followed the line of least resistance and yielded to their absurd pronouncement. The pressure of such environmental forces together with the fact that the patient was actually insane once and may have a few lingering doubts about his complete recovery, may succeed in sending him back to the institution from which he was discharged.
As Kempf writes, "The thoughtless attitude of the people is to be changed by educating them to have as much confidence in those who have recovered from mental diseases as they have in those who recover from other diseases, in order to help the patient to be less fearful of being distrusted and disrespected. Both sides of this procedure have essentially a therapeutic value in that they are conducive to an easier and more durable recovery for the patient as well as exerting a humanizing influence on the people. Hence the procedure should be an important part of the therapeutic method, a permanent, outstanding feature of the hospital life of the patient and the means of maintaining social contact between the hospital and the community."
Finally the method employed by Kempf in restoring his patient to a normal condition exposes the absurdity of herding the insane by the thou-sands in institutions where nature is mainly relied upon to bring about a cure. Let the average man, Kempf writes, imagine what distress he would suffer and what changes of character he would undergo if he were confined indefinitely in a hospital ward, his judgment discredited, and forced to associate constantly with twenty to fifty other worrying, unhappy people, many of whom had lost control of themselves and become sexually perverse either overtly or in fancy. The universal answer would be that the experience would soon become unendurable to the sane man or woman and cause nothing less than prolonged misery and suffering.
The hospital for mental diseases, he concludes, should be a first class vocational university for the practical re-education and rehabilitation of the people who have become abnormal and unable to adapt themselves to their social obligations and the social laws, due to their incompatible cravings and previous unsuitable education and training.
Such a plan would require for its realization a considerable increase in the number of physicians, nurses, attendants, and vocational and athletic trainers. This would at first appear very expensive, but, as Kempf remarks, owing to the great reduction in the duration of the average patient's illness, and the increase in recoveries, the annual cost would be greatly reduced after a few years.
Eighty per cent. of the mentally diseased, he thinks, could be cured if properly treated. This applies, of course, to cases in which there is no destruction of nervous tissues.
Furthermore, the asylum would lose its depressing, ominous stigma and many patients in the incipient stage would be influenced to come and seek treatment before their condition had become chronic or incurable. What with the many who would not become insane owing to preventive measures, and the many insane who could be helped to
regain their mental balance, the population of insane asylums would be greatly reduced by adopting Kempf's suggestions.