'Notes Upon a Case of Obsessional Neurosis' (Rat Man)
"NOTES UPON A CASE OF OBSESSIONAL NEUROSIS" (RAT MAN)
Dr. Ernst Lanzer, alias the "Rat Man," consulted Freud on October 1, 1907, and began an analysis that allegedly lasted a little more than eleven months and ended in a complete cure. The patient's presenting symptoms were florid: Obsessions lasting from childhood had intensified most dramatically in the previous four years. In the recent past Lanzer's obsessional ideation involved lethal injury dealt to his girlfriend or even to his dead father. Lanzer also complained about compulsive impulses, such as cutting his own throat with a razor; he also described his personal prohibitions, which sometimes concerned quite trivial matters. As a result, procrastination affected both his personal and professional life, including the efforts to finish his legal education, to work, and to marry.
The importance which Freud attributed to the case of the "Rat Man" is revealed by these facts: During its duration, he gave four "progress reports" to the Vienna Psychoanalytic Society; he made it the subject of his lecture at the First International Congress of Psychoanalysis in Salzburg; and it was the only case for which he retained day-to-day process notes. In sum, since Dr. Lanzer had previously consulted Wagner-Jauregg, Vienna's most famous psychiatrist, Freud was moved to make the case a psychoanalytic showpiece, much as he was later to do with the "Wolf Man," who had previously seen the leading psychiatrist in all Europe, Emil Kraepelin. During his second hour on the couch Lanzer recounted an incident that was the origin of his famous pseudonym.
While on maneuvers the previous summer, he lost his pince-nez; subsequently on the same day he heard a "cruel captain" describe an Asian torture in which a heated pot containing live rats is applied to the buttocks of the intended victim. Upon hearing the sadistic story, the Rat Man imagined that the torture was being applied simultaneously to both his ladyfriend and to his father. To prevent the fulfillment of that fantasy, the Rat Man resorted to the defensive formula "But whatever you are thinking of," accompanied by a gesture of repudiation. An immediate derivative of the rat story was Lanzer's crazed compulsions about reimbursing his military comrade who paid for his new pair of pince-nez, sent by post. Subsequently in Lanzer's mind, the rat, symbolically thriving in a colony of good and bad objects and their identifying features, could signify, among other things: the Rat Man himself, his mother, his girlfriend, babies, anuses, genitalia, money, the acts of gambling, marrying, devouring, penetrating, containing.
Freud's claim about completely restoring his patient's health is a notable exaggeration. However, although carrying out conspicuous indoctrination, neglecting immediate transference reactions (especially of the negative kind), and diminishing the role of women in the Rat Man's analysis, Freud was able to achieve a measure of therapeutic success by focusing on and clarifying his patient's oedipal relationship to his father. In addition, Freud repeatedly demonstrated to his patient that his obsessional compulsions could be dynamically understood when their original wording was recovered. In sum, Freud was able to some degree to allay his patient's panic and render him more functional, both personally and professionally.
Although a classic psychoanalytic study of the obsessional-compulsive personality, the case has its own share of historical fictionalization. Lecturing before the Vienna Society Psychoanalytic on November 20, 1907, Freud boasted that the name of Lanzer's ladyfriend could be inferred from his anagrammatic, magically defensive prayers even though her name was not yet disclosed; Freud's process notes reveal that he learned it by October 27. Freud went on to discuss the case at the First International Psychoanalytic Congress in 1908; according to Jones's erroneous although generally accredited account, Freud lectured for an incredible five hours on the clinical material. On a more serious score, a minute comparison of Freud's process notes and their write-up in the case history shows that in critical places he lied, constantly giving the effect that the treatment lasted longer than it actually did.
There is also considerable confusion in Freud's write-up of his case history, which manifests a remarkable imbalance between its first and second parts. Anal eroticism and the reverberations of the rat story dominate the first, practical half of Freud's text; but in its second half there are but two incidental references to anality and one passing reference to the rat story. Freud had to wait four more years before gathering the insight into the etiological link between anal eroticism and obsessional neurosis. Thus, in his second section, Freud can only clarify such issues as the phenomenology and structure of obsessional ideas, the psychological significance of obsessional thinking, characteristic attitudes to superstition and death, and a non-phasic consideration of compulsion and doubt as originating in the drives.
In his private correspondence Freud recurrently called attention to the disconnectedness of his case, a textual feature mimetic of the disconnected nature of his patient's perceptions and obsessions. Thus, Freud's expression, through counter-transference, was infected by its contents: obsessional neurosis, which, by severing causal connections (through defensive isolation), is a pathology that affects both the contiguity of psychic material and its expression. Accordingly, the very symptomatic nature of Freud's writing in his case history reveals several problems. He confused precipitating causes; he elaborated little on the links among heterosexual object choices in the patient's oedipal and preoedipal life; he did not harmonize his clinical and theoretical considerations; he did not integrate his explanatory principles of anality, ambivalence and economic theory; and finally, he omitted to neatly tie together his patient's child and adult symptomatologies.
See also: Act, passage to the; Ambivalence; Archeology, metaphor of; Compulsion; Construction-reconstruction; Death and psychoanalysis; Doubt; Dream screen; Face-to-face situation; Instinctual impulse; Intellectualization; Isolation; Lanzer, Ernst; Negation; Nuclear complex; Obsession; Obsessional neurosis; Omnipotence of thought; Organic repression; Rationalization; Symbolism; Technique with adults, psychoanalytic; Therapeutic alliance; Undoing.
Freud, Sigmund. (1909d). Bemerkungen über einen Fall von Zwangsneurose (Der "Rattenmann"). Jb. psychoanal. psychopathol. Forsch., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE, 10: 151-318.
Freud, Sigmund. (1909d). Notes upon a case of obsessional neurosis. SE, 10: 151-318.
——. (1974a [1906-13]). The Freud/Jung letters: The correspondence between Sigmund Freud and C. G. Jung (William McGuire, Ed.; Ralph Manheim and R. F. C. Hull, Trans.). Princeton, NJ: Princeton University Press.
——. (1993). Freud's oratorical marathon: The shrinking of another myth. International Journal of Psycho-Analysis, 74, 837.