Deep in thoughts of this kind, I came to my patient of over ninety; I must have been well on the way to grasp the universal character of the Œdipus fable as the correlation of the fate which the oracle pronounces, for I made a blunder in reference to or on the old woman. Here, again, the mistake was harmless; of the two possible errors, taking the morphine solution for the eye, or the eye lotion for the injection, I chose the one by far the least harmful. The question still remains open whether in mistakes in handling things which may cause serious harm we can assume an unconscious intention as in the cases here discussed.
The following case from Brill’s experience corroborates the assumption that even serious mistakes are determined by unconscious intentions: “A physician received a telegram informing him that his aged uncle was very sick. In spite of important family affairs at home he at once repaired to that distant town because his uncle was really his father, who had cared for him since he was one and a half years old, when his own father had died. On reaching there he found his uncle suffering from pneumonia, and, as the old man was an octogenarian, the doctors held out no hope for his recovery. ‘It was simply a question of a day or two,’ was the local doctor’s verdict. Although a prominent physician in a big city, he refused to co-operate in the treatment, as he found that the case was properly managed by the local doctor, and he could not suggest anything to improve matters.
“Since death was daily expected, he decided to remain to the end. He waited a few days, but the sick man struggled hard, and although there was no question of any recovery, because of the many new complications which had arisen, death seemed to be deferred for a while. One night before retiring he went into the sick-room and took his uncle’s pulse. As it was quite weak, he decided not to wait for the doctor, and administered a hypodermic injection. The patient grew rapidly worse and died within a few hours. There was something strange in the last symptoms, and on later attempting to replace the tube of hypodermic tablets into the case, he found to his consternation that he had taken out the wrong tube, and instead of a small dose of digitalis he had given a large dose of hyoscine.
“This case was related to me by the doctor after he read my paper on the Œdipus Complex.[49] We agreed that this mistake was determined not only by his impatience to get home to his sick child, but also by an old resentment and unconscious hostility toward his uncle (father).”
It is known that in the more serious cases of psychoneuroses one sometimes finds self-mutilations as symptoms of the disease. That the psychic conflict may end in suicide can never be excluded in these cases. Thus I know from experience, which some day I shall support with convincing examples, that many apparently accidental injuries happening to such patients are really self-inflicted. This is brought about by the fact that there is a constantly lurking tendency to self-punishment, usually expressing itself in self-reproach, or contributing to the formation of a symptom, which skilfully makes use of an external situation. The required external situation may accidentally present itself or the punishment tendency may assist it until the way is open for the desired injurious effect.
Such occurrences are by no means rare even in cases of moderate severity, and they betray the portion of unconscious intention through a series of special features—for example, through the striking presence of mind which the patients show in the pretended accidents.[50]
I will report exhaustively one in place of many such examples from my professional experience. A young woman broke her leg below the knee in a carriage accident so that she was bedridden for weeks. The striking part of it was the lack of any manifestation of pain and the calmness with which she bore her misfortune. This calamity ushered in a long and serious neurotic illness, from which she was finally cured by psychotherapy. During the treatment I discovered the circumstances surrounding the accident, as well as certain impressions which preceded it. The young woman with her jealous husband spent some time on the farm of her married sister, in company with her numerous other brothers and sisters with their wives and husbands. One evening she gave an exhibition of one of her talents before this intimate circle; she danced artistically the “cancan,” to the great delight of her relatives, but to the great annoyance of her husband, who afterward whispered to her, “Again you have behaved like a prostitute.” The words took effect; we will leave it undecided whether it was just on account of the dance. That night she was restless in her sleep, and the next forenoon she decided to go out driving. She chose the horses herself, refusing one team and demanding another. Her youngest sister wished to have her baby with its nurse accompany her, but she opposed this vehemently. During the drive she was nervous; she reminded the coachman that the horses were getting skittish, and as the fidgety animals really produced a momentary difficulty she jumped from the carriage in fright and broke her leg, while those remaining in the carriage were uninjured. Although after the disclosure of these details we can hardly doubt that this accident was really contrived, we cannot fail to admire the skill which forced the accident to mete out a punishment so suitable to the crime. For as it happened “cancan” dancing with her became impossible for a long time.
Concerning self-inflicted injuries of my own experience, I cannot report anything in calm times, but under extraordinary conditions I do not believe myself incapable of such acts. When a member of my family complains that he or she has bitten his tongue, bruised her finger, and so on, instead of the expected sympathy I put the question, “Why did you do that?” But I have most painfully squeezed my thumb, after a youthful patient acquainted me during the treatment with his intention (naturally not to be taken seriously) of marrying my eldest daughter, while I knew that she was then in a private hospital in extreme danger of losing her life.
One of my boys, whose vivacious temperament was wont to put difficulties in the management of nursing him in his illness, had a fit of anger one morning because he was ordered to remain in bed during the forenoon, and threatened to kill himself: a way out suggested to him by the newspapers. In the evening he showed me a swelling on the side of his chest which was the result of bumping against the door knob. To my ironical question why he did it, and what he meant by it, the eleven-year-old child explained, “That was my attempt at suicide which I threatened this morning.” However, I do not believe that my views on self-inflicted wounds were accessible to my children at that time.
Whoever believes in the occurrence of semi-intentional self-inflicted injury—if this awkward expression be permitted—will become prepared to accept through it the fact that aside from conscious intentional suicide there also exists semi-intentional annihilation—with unconscious intention—which is capable of aptly utilizing a threat against life and masking it as a casual mishap. Such mechanism is by no means rare. For the tendency to self-destruction exists to a certain degree in many more persons than in those who bring it to completion. Self-inflicted injuries are, as a rule, a compromise between this impulse and the forces working against it, and even where it really comes to suicide the inclination has existed for a long time with less strength or as an unconscious and repressed tendency.