Now even if the mother’s death were logically, by a train of fortuitous circumstances, the patient’s fault, why did an otherwise intelligent woman lay so much stress upon an irresponsible child’s behavior? The child after all behaved no differently from other children. People do not consciously blame themselves in after life for the ultimate consequences of childhood’s heedlessness. According to common experience such self-reproaches do not last into adult life without some continuously acting factor.
A search in this case into the unconscious brought to light a persisting idea that when events in her life happened unfortunately it was due to her fault. It had cropped out again and again in connection with inconsequential as well as consequential matters. She had, for instance, been really unable on many occasions to leave home on pleasure trips for fear lest some accident might happen within the home and consequently it would be due to her fault; and if away she was in constant dread of something happening for which she would be to blame. It was not a fear of what might happen—an accident to the children, for example—but that it would be her fault. I have heard her, when some matter of apparently little concern had gone wrong, suddenly exclaim, “Was it my fault?” her voice and features manifesting a degree of emotion almost amounting to terror. When her brother died (still earlier, before her mother’s death) she had blamed herself for that death, as later with her mother, on the same religious grounds. This self-reproach for happenings, fancied as due to her fault, has frequently appeared in her dreams. It would take us too far afield to trace the origin and psychogenesis of this idea. Suffice to say, it can be followed back to early childhood when she was five or six years of age. She was a lonely, unhappy child. She thought herself ugly and unattractive and disliked and that so it always would be through life, and it was all her fault because she was ugly, as she thought.[[186]] The instinct of self-abasement (McDougall[[187]]) or negative self-feeling (Ribot) dominated the personality as the most insistent instinct and from its intensity within the self-regarding sentiment (McDougall) formed a sentiment of self-depreciation. She wanted to be liked and believed it to be her own fault that, as she fancied, she was not and never would be, and reproached herself accordingly. This sentiment of self depreciation with its impulse to render self-reproach has persisted, as with many people, all her life and has been fostered by unwise and thoughtless domestic criticism. The persistence to the present day of this impulse to self-reproach is shown in the following observation:
Quite recently this subject began to suffer from general fatigue, insomnia, distressing dreams, hysterical crying, indefinable anxiety and pseudo twilight states or extreme states of abstraction. In these states she became oblivious of her environment, did not hear the conversation going on about her, nor answer when directly spoken to. This became so noticeable that she became the jest of her companions. In these states her mind was always occupied with reveries (not fantasies), though mostly pleasant, regarding a very near relative who had died about six months previously. Her distressing dreams also concerned this relative. It appeared, therefore, probable, on the face of the symptoms that they were in some way related to this relative’s death.
Now it transpired, as I already knew, that the relative had died under somewhat tragic circumstances and that our subject’s experience during the last illness was unusually distressing and sorrowful. This experience, she asserted, she could not bear to speak or even think about and over and over again had refused to do so and put it out of her mind. She further asserted that her reason for this attitude was the distressing nature of the scenes in which she took part.
Now I did not believe that this was the true reason, although given in good faith. It was improbable on its face. To say that a grown woman, forty years of age, could not do what every woman can do, tolerate sorrowful memories simply because they were sorrowful, and must perforce put them out of her mind, is sheer nonsense. There must be some other reason.
On examining a dream it was found to be peculiar in one respect: It was not an imaginative or fantastic composition, but a detailed and precise living over again of the scenes at the death bed: that is to say, it was a sort of somnambulistic state. In recalling this dream[[188]] she could not for some time recover the ending. Finally it “broke through,” as she expressed it. The dream was as follows: First came many details of the vigil of the last night of the illness; then she went to her room and to bed to snatch a few moments’ sleep; she was waked up by the husband of the dying relative appearing in her room. He sat on the edge of her bed and said to her, “All is over.” Up to this point the facts of the dream were actual representations in great detail of the actual facts as they had occurred, but at this moment the dream presented a fact which had not occurred in the real scene; she suddenly, in the dream, sat up in bed and exclaimed, “My God! then I ought to have sent for the doctor!”
Here was the key to the intolerance for memories of the illness of the relative and the death-bed scene. What had happened was this: The question had arisen early in the illness whether or not a doctor should be sent for from London in consultation. The expense, owing to the distance, would have been considerable. The whole responsibility and decision rested upon the subject. Against the opinion of other relatives she had decided that it was inadvisable. After the fatal ending the question had arisen again whether or not she ought to have sent for the consultant and she had been tormented by the doubt as to whether she did right; was the fatal result her fault? Although she had reasoned with herself that her decision was good judgment and right still there had always lurked a doubt in her mind. She was also somewhat disturbed by the thought of what the husband’s opinion might be.
The real reason why she could not tolerate the memories of the last illness of this relative, and the psychogenesis of the symptoms now were plain: they were not grief but self-reproach with its instinct of self-abasement. The memories brought to her mind that the fault was her’s and with the thought came self-reproach. This self-reproach she was afraid of and unwilling to face. This fact she recognized and frankly confessed after the disclosures of the analysis.
Now follows the therapeutic sequel. The relative’s illness at the beginning was in no way of a dangerous nature and the proposed consultation had nothing to do with the question of danger to life. The death was due to purely an accidental factor and could not have been foreseen. When I assured her in hypnosis, with full explanation, that her decision had been medically sound, as it was, the change in her mental attitude was delightful to look upon. “Wasn’t it my fault! Wasn’t it my fault!” she exclaimed in excitement. Anxiety, dread, and depression gave way to exhilaration and joyousness. Thereupon she woke up completely relieved in mind, and retained the same feeling of joy, but without knowing the reason thereof. The explanation was repeated to her in the waking state and she then fully realized (as she did also in hypnosis) that her previous view was a pure subterfuge and fully appreciated the truth of the discovered reason for her inability to face her painful memories. The twilight states, the insomnia, and the distressing dreams, the anxiety, and other symptoms ceased at once.
Returning to the phobia for bells, in the light of all these facts, the patient’s belief that her mother’s death was her fault and the consequent self-reproach were obviously only a particular concrete example of a lifelong emotional tendency originating in the experiences of childhood to blame herself; and this tendency was the striving to express itself of the instinct of self-abasement (with the emotion of self-subjection) which, incorporated within “the self-regarding sentiment” (McDougall), was so intensely cultivated and had played so large a part in her life. Indeed this instinct had almost dominated her self-regarding sentiment and had given rise time and again to self-reproach for accidental happenings. It now specifically determined her attitude of mind toward the series of events which led up to the fatal climax and determined her judgment of self-condemnation and self-reproach. These last most probably received increased emotional force from the large number of roots in painful associations of antecedent experiences (particularly of childhood) in which the self-regarding sentiment, self-debasement, and self-reproaches were incorporated.[[189]] Nevertheless the fear was of a particular concrete self-reproach. The general tendency was of practical consequence only so far as it explained the particular point of view and might induce other self-reproaches.