As an example I give a fragment of a Frankian analysis of a case of
FEAR NEUROSIS (ANGST-NEUROSE)
Y. B., born 1883, a law clerk. Patient comes on the third of December, 1908, to Frank's consultation hour; he complains of periods of short breath; during these he feels as if his heart were ceasing to beat, especially when he is just going to bed. He feels then as if something heavy were striking him on the chest, great restlessness, and a feeling of faintness comes over him. After taking a glass of wine the condition is aggravated and becomes insupportable. These attacks come once or twice a day, mostly in the evenings. At times they keep off for eight or ten days. He lives continually in an excited state, he suffers from palpitations of the heart, from pain in the left thigh, pain in the left side, and at night cannot get to sleep.
Patient attributes this condition to an automobile accident which happened to him on June 2, 1908. Even before this accident he had been a trifle nervous on account of overwork. In the automobile accident he had been thrown out, and had been thrown a distance of ten or fifteen yards. The automobile, which was at high speed, had also plunged down the decline, but luckily the patient was not caught directly under the machine. He did not lose consciousness, and escaped with some scratches and a bad fright; it was a marvel that he and the chauffeur escaped with their lives. He plainly recalls thinking, during the fall, that his last hour had come, and even yet is amazed how extremely untroubled he had been by that thought. The days following the accident he felt as if his face were burning, and he was inwardly agitated whenever he thought of an automobile. On June 30, 1908, he was obliged to take a business journey. While seated in the station restaurant it suddenly grew dark before his eyes. He could breathe only with difficulty, his heartbeats were irregular and he had a strange sensation of fear. This condition lasted the whole day. On the return journey his train ran into an automobile truck. The patient was thrown to the floor of the coupe by the shock. This incident made a great impression upon him; nevertheless, for eight days he was free from the uneasiness already described. After that an attack of fear again set in, continuing at intervals, with periods of greater or lesser violence, until the present.
December 7, 1908. A first attempt to induce hypnosis was successful.
December 8, 1908. Patient goes to sleep immediately, becomes frightened and gives frequent signs of terror. When awakened, he mentioned that he had had a feeling as if he were falling into a hole, that had given him a very strange sensation. The patient speaks while he sleeps; his super-consciousness therefore remains awake and is able to take notice directly of the scene taking place. After some minutes he sees in the hypnosis a locomotive approaching. He cries out, "There it comes out of the tunnel." He is afraid of being run over, and is terrified. Two years previously he had been through this scene. He was standing on the track when a train approached, and he was afraid of being run over. In his sleep, the patient communicates the details and sees everything clearly. After a short interval of complete rest, he begins to breathe heavily, his pulse quickens, then he cries out in fright and excitement and dread, "Now it's coming, now the auto's coming, it's turning over, we're under it, there it's riding over us!" Gradually he quiets down again, and after a quarter of an hour, awakes. He says he now feels something lifted from his chest, that he has slept well, and feels better. He recalls everything. The train came out of the tunnel with gleaming lights; this scene took place in the evening. The automobile scene was reproduced precisely as he had taken part in it, no detail escaped him; his breathing is unobstructed now, and he has no more heart palpitations.
On the day appointed for the seance I was unexpectedly obliged to go away. When I wished to resume the treatment, January 9, the patient wrote me that his condition was strikingly improved, the heart palpitations and feelings of anxiety had not reappeared. His pleasure in life and work had returned once more, his night's rest left nothing to be desired, his appetite was excellent, therefore he thought that further treatment was not necessary for the present. To a later inquiry, February 12, 1910, a year afterwards, I obtained this answer: "Without exaggeration I am able to write you that in my whole life I have never felt so well as now. There has been no question of any nervous attacks or feelings of dread. My weight, which had gone down to fifty-eight kilos during my nervous sickness, has gone up to seventy kilos."
When Frank shuts himself up with his patients in a room, from which all outer noises are excluded as much as possible, by means of double windows and doors, although he—by means of electric light signals visible to him alone—keeps in touch with the servant outside, he has the patient recline as comfortably as possible upon a low sofa. He kneels on a cushion at the head, bends down over the patient and has the latter look upwards directly into his eyes. Meanwhile he lets his left hand rest upon the patient's forehead and gently presses the latter's eyelids with his thumb and forefinger. As soon as the patient shows signs of weariness, he carefully gets up, takes a seat next to the patient and continues carefully observant of the latter's behavior and expression of countenance. He makes note of everything that shows itself and rouses the patient after about a quarter of an hour, unless the latter awakes spontaneously. Now he talks over with him the material which has been procured and then has the patient go into a renewed hypnosis, until the end of an hour. Sometimes the seances are protracted when important scenes come up, and in the interest of the treatment it might be lengthened to two or even three hours.
Bezzola makes use of a small, light, black silk mask, which he puts on the eyes of the patient. He induces hypnosis, and for the rest follows Frank's technique already described.
While analysts who avail themselves of hypnosis as a means of help have all their patients take a reclining position, those who have given up hypnotism in their treatment, have also given up this reclining position. Freud continues to prefer having the patient assume a reclining position, and takes his position with his back to the patient, behind the head of the sofa. He considers that this manner of treatment induces the greatest calmness in the patient and makes it easier for him to express himself and to confess. He keeps as quiet as possible, listens with undivided attention, does not take any notes during the seance, not wishing to give rise to the suspicion that all the confession will be written down and perhaps seen by other eyes.