THE PHENOMENON OF TRANSFERENCE IN A CASE OF PHOBIA (ANXIETY HYSTERIA) By Frrrz Wires, M.D. OF NEW YORK, N.Y. The psychological phenomenon called transference is one of the main pillars of psychoanalysis and psychoanalytic therapy. This phenomenon seems difficult to comprehend and a number of misunderstandings have arisen among people not altogether familiar with the mechanism, such misunderstandings being not infrequently used for an assault against psychoanalytic therapy. We sometimes hear the more or less sneering statement that the psychoanalyst insists upon his patient falling in love with him and that unless this occurs the patient cannot be cured. Thus, the analyst is presented to the public as a conceited ass and his work changed into a questionable farce. Freud discovered the dynamism of transference when he perceived that his patients related their recollections not only in words but, as though driven by an inner and unconscious power, re-experienced them, re-enacted them while they worked with him. The analyst is made father, mother, brother, sister, lover, benefactor, malefactor, thus becom- ing the target for the patient’s behavior which at first appears nonsensi- cal, unjustified, exaggerated, out of joint, until we discern that in this “transference” resides an enforced new edition of experiences which had a particularly important bearing on the patient's life long ago. Transference is an expression of an obscure law in our psychology: the repetition compulsion. What was, must again be; what is, must cease to be, so that it may become again what it was. This is not the place to ponder and solve conondrums of a theoretical and general psychological nature. On the other hand, physicians are naturally interested to see how a scientific phenomenon looks in practice and how it is employed thera- peutically. The following case is a twenty-six year old man who came to me for treatment because of his anxiety states—. George, recommended to me by his family physician, introduced himself in a manner which shows the phenomenon of transference unmistakably independent of any suggestion on the part of the psychoanalyst. Transference in this case started even before the patient and I had met. As I opened the door to the waiting room, a long, lanky young fellow sneaked in, nodded his head, said: “Just a minute,” and ran out before I could say a word. A few minutes afterwards, he reappeared with an elderly lady, his mother, (x2]TRANSFERENCE IN A CASE OF PHOBIA 13 who immediately tried to explain his behavior. He suffered from anxiety she said, could never be without her and she had to accompany him every- where. Even when she was in the bathroom he took his stand in front of the locked door, sometimes knocking at it and asking why it took her so long. He was afraid of new acquaintances and asked her to wait in the lobby downstairs, while he went up to inspect me so that he could make up his mind whether or not I could be trusted. This account left certain facts inexplicable. If, as she claimed, he could not be without her even for a moment because of his fears, how did he dare enter the lion’s den alone? That he should wish first to sec his doctor before committing himself to treatment is nothing to wonder at. We are accustomed to having patients come only once and not come back because they don’t want to be treated by us. But the manner in which he fulfills his wish is certainly unusual. His furtive entrance, the nod, the running away, all contained a compulsive momentum which did not jibe with what his mother had told me. My patient’s father, a well-known physician in a small city of Serbia, was divorced from George’s mother. ‘The children, George and his two sisters, lived with the mother. The father had remarried and had children from his second wife. In former days he had been very affectionate toward his only son but his attitude changed considerably after the divorce. He paid alimony but under pressure and saw his son only when he came for money at which times George found his father cold and indifferent. ‘The mother made no secret of her bitter feelings towards her ex-husband. She was filled with an excess of tenderness for her son and admitted to me that she was afraid that her over-affectionate attitude might be responsible for her son’s nervous disorders. Later, analysis proved that George—contrary to his mother’s belief— admired his father beyond measure despite the fact, or perhaps because he was strong enough to forsake the mother and build up a new happiness for himself. Behind George’s overwhelming love for his mother we discovered violent antagonism; he blamed her for not having made his father happy. Father was wrong but for only one reason: he had not taken his son with him. His unconscious desire was to abandon his mother and go to his father, a wish doubly unfulfillable. He could not do such a thing to his mother who lived only for him; and his father obviously had no use for him. Had I been aware of all this when he first introduced himself to me, his peculiar behavior would have been clearer. He left his mother downstairs and transferred on me his desire to go to his father. As is so frequent in compulsion he accomplished this in two opposing motions: first, he runs into my office—I am going to my father. Then he runs out—I must stay with mother. Finally, he brings us both together. This transference mechanism is rationalized with the fear: he does not know whether I am the right man (iather) for him or not. Although I could not interpret the hidden meaning underlying George's14 FRITZ WITTELS behavior when he first came, soon there was no longer any doubt that he had transferred his father, or, as we prefer to say it, his father-imago on me. His first free idea on the analytical couch was that my chandelier was exactly like the one in his father’s office, a statement which could hardly be true inasmuch as my chandelier had been made accordingly to my individual specifications. But objective truth does not matter here. A short time after- wards, he said that he felt that someone was eavesdropping behind the door. When I asked him who he suspected this to be, he said, after some hesitation: “Your wife.” I opened the door and he convinced himself that his fear was groundless. He then told me that whenever he went to see his father, he received the impression that his father’s second wife was hiding behind the door. He had never seen this woman, carefully avoided meeting her, an almost impossible achievement in a small city, considering that his father’s relations to this woman dated back many years. He related however, that among other plans of revenge against his father, he had toyed with the idea of seducing his wife. In reality he is full of anxiety, in dreams and fantasies he is a hero, Shortly before he left his home-town, he met a woman em- ployed as a maid in his father’s house. She was an elderly unattractive wo- man. A strong desire to seduce her came over him, simultaneously feelings of anxiety. Even when he mentioned the incident to me, he felt anxiety George had an tinusually strong tendency to transfer. His father’s second wife was of humble origin and my patient's mother never tired of reminding her children of this fact: a maid, an ordinary maid, to whom she had to surrender her rights. T have disordered the chronology in this case and must now go back to the beginning. When I saw mother and son sitting together in front of me, to my mind came the psychoanalytic rule that if a patient cannot exist without a certain other person who has the power to allay his anxiety, this very person is the kernel of the neurosis. We have already spoken about the repressed antagonism of the patient towards his mother, seemingly so in- dispensable to him, Because of the mechanism of ambivalence his antagonism resided side by side with his love. Because of the continuous close contact of this adult son with his mother, incestuous tendencies which in turn produce anxiety feelings also vexed him. T suggested to the mother that she return home and leave her son with me for treatment, The lady declared this to be impossible. In point of fact, she would not only have to remain with him but even go with him cach time he came to my office, because—as she had tried to make clear to me—not a step would he take without her. Much to his mother’s surprise, however, George demurred, saying that he thought he would be able to come alone. We again see in this change and first therapeutic result the magic of transference. If there is a father who invites him to come to him, he can, no, he must go without mother. The departure of the mother how- ever, was delayed for about one month. The patient was only partly toTRANSFERENCE IN 4A CASE OF PHOBIA i5 blame for this delay, for his mother, something of which she was uncon- scious, did not want her son to become completely free of her. She wanted him to stop suffering because she suffered with him. But she wished to re- main all-important to him, because he was the one thing in her life worth living for. This ambivalent attitude on the part of parents, sisters, wives, is typical and well-known to psychotherapists. About two months after the treatment had started, T was obliged to leave the city for ten days. Considerable improvement had been made by that time, his mother was gone and he was enjoying himself in the city of Vienna. When I apprised him of my approaching departure, however, his anxiety states recurred. He might jump out of the window, he said, and I certainly had no right to leave him in such a condition! At that time he as well as T understood that I was his father-imago: he saw faithlessness in my forsaking bim. | acted like his father. It then occurred to me that a wo- man analyst would be a good substitute: I wanted him to have a mother- surrogate for a father-surrogate. So I told him that he very likely would get along quite well without me for these days, but should an emergency arise, he could go to a certain woman analyst I recommended. ‘Truc to his pattern, he said that he would have to see her before I left. He saw her, liked her and worked with her all during my absence. To her he told a number of things which he had carefully withheld from me: naturally, one cannot say to a father what one may say to a mother. What I knew was that he had taken up the study of law but was unable to finish his studies and that for years before he had endeavored to become a painter but also with no success. Occasionally, he wrote poems. Above everything, however, he told me that he was an ardent communist and had attended secret meetings, a very dangerous thing to do in his country. His father, a conservative man, was aware that his son ran about in bad company and censured him bitterly for it. The relation between father and son went from bad to worse because the young man was always sick, a loafer, a ne’er-do-well. It was easy to see that George’s behavior was his unconscious revenge on his father. ‘This interpretation became clear to George after he had told my woman- substitute that he was no communist, did not believe in it, never had been a member of the party and loathed all those men, who—as he put it—understood nothing of life and were given to fu strong man adhere to these chimeras. With the woman-analyst he played the role of the conservative father himself. He also informed her of an ugly deed he had committed, an incident I knew nothing about. His friends had entrusted him with a secret letter written in invisible ink. He was to smuggle this letter over the border and hand it to a comrade in Vienna, all of which he promised to faithfully carry out. Although, as he himself said, there was no real danger connected with the execution of this mission inasmuch as there was more or less negligible examination at the Austrian border in those Gays, he tore the letter up and threw it away. He could not tell this story ideals. Never, he said, would a really16 FRITZ WITTELS to me, his father-imago, for with me he had to play the role of a rebel. In this form of transference, George gradually reached an insight into the nature of his neurotic reaction-formation. When he had sufficiently improved to permit himself a certain amount of sex life, he encountered girls on the streets and in restaurants, and in- variably fell intensely in love with them. He repeatedly came to me with the revelation that he was going to get married, I usually quickly succeeded in making him realize that all this hysterical acting aimed at frightening and punishing me in transference; that he and he alone would have to suffer such self-inflicted punishment because I was not his father, and even his father, while he would probably be annoyed at his son’s foolishness, would be much less hurt by it than George, himself, to whom it would mean the ruination of his whole future Most strikingly did he experience his unconscious relation to his father in the form of transference on me, when we had a discussion about paying for the analysis. He had been paying weekly and altogether punctually, when he suddenly began to squander the allowance his mother sent him regularly and was compelled to ask me to have patience. Here T perhaps erred in not telling him what this dissipation with simultaneously becoming indebted to me meant. He wished again to punish his father, forcing him to be good to him at the same time, to treat him for love and not for moncy. T told him nothing of the kind and agreed. Finally, not only did he not pay but did not even apologize and this went on for three weeks. So T had to bring the matter up because it had clearly become material to be discussed in his analysis. He was feeling particularly well at this time, almost free of anxiety. He answered my question calmly and correctly, but after the week- end he returned full of complaints. For two days he had been again tortured by anxiety. I asked him: “Could it be that you were angry at me?” He replied: “I was so angry at you, that I felt like going back and giving you a piece of my mind, But then I thought that you were right and I was wrong in not having mentioned the money matter.” The meaning of all this was that we had obtained a so-called transference success which broke down when the patient was compelled to realize that I was not his father, at least not the loving father who was good to his child. For he had two father- imagos: a good one and a bad one. This was confirmed by a dream he had the night after my monition. He fell asleep in a mood veering from anger to anxiety and dreamed: “I was in bed with my father and he tried to rape me. In this dream I felt like a woman, afraid and affectionate at the same time.” He himself felt that this dream—clearly enough of the castration type— was important for his understanding, With my apparently correct and inno- cent interference I had sprung a mine and we subsequently got plenty of material from his childhood, memories and daydreams which illuminated his anxicty states. One of these fantasies was that a woman jumps at him and cuts his throat with a knife. To this fantasy belongs one of the oldest,TRANSFERENCE IN A CASE OF PHOBIA 7 perhaps the oldest memory of my patient. He was then about three years of age and his father took him for a walk in the woods. A roebuck lunged at the father with its horns and threw him down. George can still visualize his father lying on the ground, the buck’s horns entangled in his trousers. The father grabbed the animal by the throat with one hand, with the other hand took out his pocket-knife, opened it with his teeth and slaughtered the animal with one slash across its throat. The youngster stood by and screamed. I was later able to veri this memory for the father also remembered it. The incident had really happened: a terrible father to whom one had to submit and a son who wavers between submission and rebellion, anxiety and wrath, The neurosis is in the conflict. In this way—by interpretation of his tranference—we clarified his attitudes to father, mother, sisters, friends and to life in general. Finally, he brought me the manuscript of a play he had written but not finished before he started analysis. The hero of the play is a revolutionist, his father a person in high governmental position. The father’s secretary is a friend of the hero and therefore terrified when he discovers docu- ments which prove the hero’s high treason beyond any doubt. He at- tempts to persuade the hero to give up his revolutionary, subversive schemes. If he consented to do this, out of his friendship for him. he would not report the treason but destroy the dangerous documents. The hero makes up his mind to shoot his friend (it is clear that the friend symbolizes the father). The friend says to the hero in the big scene: “You are not really a revolutionist, you just pretend to be. You are incapable of any real deed!” Then the hero shoots him. But before he does so, he exclaims: “What! not capable of a real deed? Your wife was my sweetheart!” There is another episode in the play: a young girl is madly in love with the hero who persuades her to become his father's mistress. The money which she obtains from the father, she brings to the son for his revolutionary aims. The play unconsciously expresses the patient's conflict. The girl he sends to his father is himself, his feminine component, thus fulfilling his wish to be loved by his father. The rebel is the masculine component. He seduces the friend’s (the father’s) wife, in this way putting himself in his father’s place. Here we see his revenge for his father’s indifference. What we saw in George’s analysis in the form of transference, appears in the play in the form of fiction, another form of transference and re- enactivation. ox Central Park West, New York City.