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STUDY OF A SEVERE CASE OF OBSESSIONAL
BY JAMES YOUNG.
THE patient came to me eight months ago complaining of obsessions of such severity that his life was a misery to him. He had often thought of suicide and had given up all hope of cure. He is aged thirty-three. He is the son of a Yorkshire manufacturer-a self-made man. Until the age of nine he was at a ladies' school. He was rather delicate and was a good deal at home due to illness. Later at a grammar school he took very badly to the more robust methods of both boys and masters.
To continue in his own words:
"At the age of thirteen I left school and gradually became interested in my father's business. I used to be with him a large portion of my time. A clothier's shop was opened for my brother who unfortunately did not give it the attention he might have done. So here I used to spend hours with father, often on Saturdays until ten and eleven o'clock. He thought a great deal of me and I of him. This state of affairs was continued for a few years."
There is a history of a well-marked desire for exhibitionism about the age of puberty, gratified on two or three occasions. Masturbation also began about this period. Later developed the obsessive desire to micturate when about to engage in any activity which called for resolution or determination. This was specially liable to occur if this undertaking were something a little outside of the ordinary routine. At the age of nineteen he fell in love with a girl who accepted him as her fiancé. At this period obsessive emotions developed. If she lent him a book and he returned it, he always doubted whether he had returned it. He sometimes actually had to write the question "Have I returned so-and-so," and she had to write the reply "Yes." Verbal assurance was not enough. The patient destroyed not long ago a large sheaf of written questions and answers belonging to that period. The girl apparently was long-suffering, but after three years the association was broken off. The following summer he suffered from hay fever and has done so every summer since. This summer, however, it has troubled him much less than usual, whether due to vaccine treatment or in consequence of the
general psychological improvement I am unable to say. The range of the obsessions gradually increased. He had to refer the settling of the most trivial details to his parents. He could with the greatest difficulty leave home even for a holiday, and his life became restricted to the narrowest of circles.
At length came the war. He was exempted from military service many times on the ground of neurasthenia. Finally he was accepted and served in Mesopotamia and India for eighteen months, when he was invalided---utterly broken down by the force of his obsessions. A typical one which occurred in India was as follows. Although there was a strict rule that topees should be worn on all occasions, once or twice he had run out of his tent without putting on his topee. The fear was that if anyone should die from sunstroke through not wearing a topee it would be due to his example.
The most striking feature in the above history is the obsessive desire to pass water at all sorts of inconvenient times. It was this for which he chiefly sought relief, because it restricted his wanderings to within a few miles of his home. It is notable that the desire did not have compulsive force if the patient felt free to gratify it at any moment. But in practically any circumstances where there was not easy or immediate access to a urinal, the compulsion would occur. The usual places were theatres, church services, clubs and railway compartments. Before going to keep an appointment he also always found it necessary to empty the bladder. Always in his mind he had the idea that he must be a success, that he must come up to his conscious estimate of himself as an intelligent and really rather an important man. If he could have felt indifferent, no compulsion would have occurred. He was always orientated by the idea of success-the philosophy of his father. It was as if he carried the competitive spirit of his business life into all the other relations of life. There was always the desire to be adequate or to dominate the situation. If at a meeting he spoke freely and successfully all compulsive desire to micturate vanished. He had been adequate in that situation.
If on entering a railway carriage he met with people with whom he could 'chat'-to use his own term-freely and as he might do at home or in his own circle of friends, there was no compulsion.
If, however, he could establish no rapport and so was left to his own resources, the compulsive desire to pass water occurred. If it were a corridor train with the usual toilet accommodation it mattered little, but if it were a closed compartment, the desire to micturate gradually
changed itself into the sensation of approaching orgasm and on many such occasions the actual ejaculatio seminis occurred. On no occasion, however, was the bladder actually emptied incontinently. This failure to establish a rapport resulting in compulsion of such enormous and incapacitating force would appear to be regarded by the ego as a menace to its supremacy. The fact that the patient is ignored or does not obtain an immediate reward for his infantile feelings calls forth an immediate protest. By the rules of ordinary behaviour he cannot force people to speak. But something must happen and so the libido spills over or regresses to the organic and power may be said to be expressed by the desire to micturate. Now, urination as an expression of power is a feature of primitive human conduct. Little boys perhaps first show the spirit of rivalry in seeing who can make his urinary stream go furthest or last longest. Men who are going to sit for an examination, or pass some other test, notoriously have frequency of micturition. It is as if power were called upon too soon and were side-tracked from the psychological into the organic. We have seen that the patient as it were anticipated events. It might be said that when a situation was to be met the libido was summoned too soon. It could hardly deal with a situation which had not developed and so perforce it regressed to the organic, and an emission either threatened or occurred.
In my opinion, this psychological hurry is another aspect of the will to dominate every situation. As the history shows it usually frustrated itself. The following dream is quoted as an unconscious picture of this functional tendency.
"I am with the army. We are marching and the leading section persists in going too quickly. Eventually they are much ahead of the remainder of the column."
In this and in other similar dreams the idea of hurry is clearly indicated. It is as if he attempted to keep his hand on the throttle of the future and so dominate the event by anticipating it. Now, when there is interference with the cortical system nervous energy is driven into the reflex autonomic system. Similarly, when energy is expressed in the inferior unadapted way which has been described, it must be either because there is no potentiality of a higher path, and so of more adapted functioning, or because the higher path is not sufficiently canalized. That is to say, it is undifferentiated. It offers obstruction to the nervous impulse and so the latter chooses the line of least resistance along a lower path. An example of this lack of differentiation is seen in the case of the child who in its early efforts to climb a rope in the
gymnasium, experiences, during the intensity of muscular exertion, sexual excitement and sometimes orgasm. It is as if the neuro-muscular system were not sufficiently canalized or differentiated to allow the full influx of energy. Again there are people who see colours when they hear sounds. This phenomenon is called coloured audition. It is often regarded, specially by those who experience it, as being something rather remarkable, as evidence of high development or of artistic potentiality. But it is really due to lack of differentiation. The two functions of sight and hearing are still to some extent fused. They have not become discrete, clear-cut functions. They are not self-determined. They are not differentiated. Now if we view this case of obsessional neurosis in the light of the above remarks we shall see that when a situation was to be met, the energy available used often to express itself through the organic channel in urinary or seminal discharge. This means that there was an absence or limitation of canalization, in higher purely psychological paths, so that the libido of the patient was shortcircuited and his expression was inadequate. A part of his psychology remained as it were in the mass-undifferentiated. This is what Jung calls the undifferentiated co-function in the unconscious. It is unconscious because it is undifferentiated. It is potential. I shall call it the inferior function. In this case I think it is feeling which is the inferior function.
It may be asked why does the inferior function remain inferior? The reply is that his family life in which he is so bound up does not tend to develop his feeling. His father's philosophy is exceedingly hard and materialistic. His life has been exclusively devoted to the acquirement of wealth. His religious beliefs were of a crude fire and brimstone order, which made life for his sensitive son bristle with taboos and prohibitions. It is easy to understand that feeling with the patient under these influences is at a discount. But feeling, and that of a very finely graduated kind, is demanded in the various relationships of life outside the family. It is in the feeling relationship that the patient invariably fails. He states that he assumes a pleasant manner to everyone but rarely feels it. Certainly his uniformly pleasant manner is abnormal-almost irritating. In matters of conduct he always represses his feelings. He asks himself "Is this right or wrong?" rather than "What do I feel?" He distrusts feelings. They are irrational. They might compromise him. This distrust is understandable when one thinks how crude and undifferentiated his feeling has shown itself to be in the course of analysis.
For these reasons, then, we say that feeling is the inferior function. In so far as the patient calculates rather than feels his way into life he tries to adapt by means of thought, with distressing results as we have seen. This attempt at adaptation is always with a view to the preservation of his own integrity. He is therefore still identified with the infantile pleasure principle. He has not accepted the pain principle. He has not left his parents either geographically or psychologically. That would certainly mean sacrifice and suffering, which he regards as one aspect of the irrational. Through his father's influence the idea has been ingrained in him that by taking thought, by being prudent, one can secure oneself against the chances of life. This prudent rationalism is backed by all the instinctive energy which has not been freed from the parents as object. In this instinctive energy is included his sexuality in an infantile or primitive form. The force which motivates his rationalism is therefore immensely powerful. The power system is directed by the whole of the instinctive energy which strives, not to lose itself in the scheme of things as they are, but to confine itself in the mould of the infantile pleasure principle. This seeks to maintain that security from the chances and changes of life-the immutable integrity of the ego-which is associated with abnormally prolonged dependence on parental love. It might be said that the onward movement of life is denied and resisted by all the force of that power which should affirm it--that is, sexuality. This is auto-eroticism. It includes the activities usually associated with the term masturbation, but it transcends the ordinarily accepted bounds of the term, because it is developed into a well-organized, if limited, intellectual system. It has become a “Will to Power." I shall call this the superior function. To be identified with it results in a condition which Jung has called God-Almightiness. The rationalistic power system is compensatory for the inferiority of the unconscious feeling. At no time in the analysis has the material shown anything that would indicate an organic inferiority or insufficiency in the sense in which Adler uses the term. In my experience the question of organic inferiority plays a minor part in the great majority of neurotics.
We must now turn to the question of how the inferior function is to be differentiated and made a conscious adapted function-in other words how the mass is to be canalized. During the first two months of rather irregular analysis, the patient became aware that the possibilities of his life had been restricted in no small degree by his fixation to the family. At the same time an orientation about sexuality was obtained. This delivered him from a feeling of isolation and insecurity with regard