Since she was unable to identify the desire of which her dream was a fulfilment, I was obliged to do so for her. ‘You wish your mother dead,’ I explained. She cried out in remonstrance that she had no such desire, though this was of course entirely to be expected since, had she been conscious of her true feelings, they would not have been suppressed. ‘The reason you wish your mother dead,’ I continued, ‘is to leave you free to marry Herr P, with whom you have been in love for more than two years.’ Fräulein Katharina, as I anticipated, indignantly denied that she had had any amorous feelings towards Herr P, whom she described as ‘ingratiating’ and ‘irritating’. She did concede, however, that she felt her mother’s remarriage followed with indecent haste on the death of her father.
When she had calmed herself, I continued therefore to explain the resolution. The person whose absence so distressed her was, as we have seen, Herr P. Her mother’s death ought to have freed him to marry Kitty, so it was to be expected that the lawyer would at least be present in what sounded like his own office. Her anxiety over her clothes (the funeral dress, the mud-spattered skirt) could be explained, as so often, by the reverse: she was anxious about her clothing precisely because she wished to be naked, as she had many times imagined herself with Herr P. The most conclusive detail of the dream, however, was the mouse hole in the wainscoting and her fear of the little animal which prevented her from arranging her dress or undress as she desired. Was it not true that Frau E— had called her ‘little weasel’? She herself had volunteered the fact that in the scene of childhood exposure, when she had enjoyed showing herself to her brother in the woods, she had also wanted to touch the genitals of her little friend Maria, while they were still wet, ‘to lure something warm out of her.’ In Katharina’s unconscious, the act of masturbating had become associated with the idea of small animals in their holes or burrows; doubtless Frau E—’s successful manipulation had involved the appearance of the clitoris from within its protective hood, like a timid animal that subsequently withdrew.
At the moment she felt she had triumphed over her mother and secured the love of Herr P, she feared that Herr P knew both of her connection with Frau E— and of her solitary habits which disqualified her from possessing that which she most desired. Even at that moment she had felt a need to ‘take things into her own hands’ – as though the frustrated part of her perversely still wished to demonstrate to Herr P that she was unworthy of him.
I then asked Katharina to return to the moment when her abdominal pains first started. The doctor came into her room to tell her that her father had died; she vomited her lunch back onto the tray: from that moment, she had not been free from pain. Naturally, she ascribed her reaction to grief: shock at the loss of her adored father, and chagrin at being absent from his bedside when it happened. However, it was clear that the emotion that she truly felt, in order to become pathogenic, must have been otherwise. What her vomiting in fact revealed was her revulsion at what the future now held in store for her: the death of the father had released her mother to marry Herr P – an idea she literally rejected or threw out. The intermittent pains in her lower abdomen were a mnemic symbol or aide-mémoire of that distressing emotion, which had been at once held outside the normal physiology of her consciousness.
Since her father’s death, she had been without a confidante: Frau E— was gone, her brother and sister were away, and her mother’s fondness for Herr P had ruled her out as a friend. The scope of Katharina’s duties was wide, and she performed the whole of the mental work that was placed on her, in the winding-up of her father’s estate, the organisation of his papers, and the emotional support she gave to other members of the family with her usual conscientiousness. In addition to the loss of her father and all that it entailed, she suffered, in losing Herr P, a severe blow to her self-confidence as a woman and, in short, the conditions could not have been more disposed to the retention in her nervous system of large amounts of undischarged mental excitation.
The irregularity of her menstrual periods, dating also from about this time, was evidently caused by her desire that she should in fact by now have been carrying Herr P’s child. Masturbation to orgasm is also known to precipitate amenorrhoea, and it was indeed my suspicion that such a practice had taken place which led me to the heart of Fräulein Katharina’s trauma, as we shall shortly see.
The pains in her arms and fingers had initially been caused by the excessive amount of work demanded of her by her father; I had no doubt that this trouble had begun as little more than writer’s cramp, an organic, secretarial version of ‘housemaid’s knee’ or some such trifling ailment. However, it had become complicated by two further factors. To begin with, she had been in competition with her mother for the attention of Herr P, and had tried to demonstrate to him how much more assiduous and reliable she was than the listless Frau von A; diligence in office work naturally occurred to her as the obvious way of impressing a serious young lawyer. I doubt whether even this aspect of the strain, however, would have survived the effective discontinuation of the manual work after her father’s death, becauseKatharina was sufficiently conscious of the competition.
No: the crucial development as far as suppression was concerned was the digito-manual nature of the pain and the fact that such activity had already become symbolically associated in her unconscious with the private habits that had disqualified her from becoming Herr P’s wife. It was this unacknowledged guilt which enabled the symptoms to persist in her shoulders, elbows and finger joints; indeed as time went by and Herr P and her mother became overtly attached, then engaged to be married, the situation worsened: the painful region was extended by the addition of adjacent areas; every fresh event in her life which had a pathogenic effect cathected a new region in her arms. She had signalled desperately to herself, and to me, with her repeated phrases such as ‘I really must get to grips with this’, or ‘I must take things into my own hands’, but it was only now that the connection was established that the business of resolution could take place.
I felt that, having laid out the groundwork of the resolution in the course of this consultation, I should leave the patient time to reflect on what we had discovered before I moved on to what one might call the dénouement. I therefore concluded the session and arranged to see the patient the following day.
April 26 [morning]
Fräulein Katharina appeared in a subdued mood. The skin of her face was slightly flushed. She told me she had slept badly, though admitted to a complete absence of pain in the lower abdomen and a considerable improvement in the joints of the arms and fingers. One might describe her demeanour as chastened, though she continued to be as obliging as before in her dealings with me.
I began by tidying up, as I put it, a few of the lesser symptoms with which she had presented me. Her low spirits, her insomnia and minor anxiety states were no more than the reaction of a young woman of unusual sensibility to the experiences she had gone through. The zöophobia, on the other hand, which I had at first been inclined to put into the same category, could now be seen in fact to be somewhat more significant.
While it seems beyond dispute that Fräulein Katharina’s heredity included a predisposition to hysteria, it would be unfair to describe her, as the diagnosis of that disease strictly requires, as degenerate. On the contrary, the moral seriousness with which she viewed her duties, the compassion and energy she displayed were the equal of a man’s – and in this respect her father’s words to her were touchingly vindicated. Kitty’s degree of education, regard for truth and tender feelings for others drove me to conclude that, despite what we have learned, a predisposition to hysteria may be compatible with a fine character and a well-governed mode of life.
I tried to reassure Fräulein Katharina of this paradox, as I persuaded her to confront the central moment of her story: the moment at which the young locum tenens came into her room without knocking. I suggested that it was this incident, more even than the death of her father, which had been most diffi
cult for her to deal with in conscious life. It was not, in fact, the young doctor who had surprised her. In her story, as in real life, he was a delegate or proxy standing in for someone more important: Herr P. It was the man she loved who had in fact entered her room without knocking and had caught her ‘red-handed’. In the moment of her shame, when she felt that her ‘hands were tied’ she became aware that, having seen her engaged in this private act, he would never be able to view her as a future wife. It was not surprising that, with everything else going on in her life, this disappointment had proved too crushing for her to assimilate.
We moved then to the question of her aphonia, which I had wrongly thought at first to be connected to her anxiety about speaking a foreign language3 while temporarily removed from the company of the man she loved. I suggested that a more likely explanation was that at the moment she had been interrupted in her room she had in fact been fantasising about the act of fellatio with Herr P, and that it had been the pain of her absence from him while in Paris that caused this somatic representation of what she had lost. I did not doubt that the circumstances of the other instance of her aphonia, which she claimed not to remember, had also involved a separation.
Fräulein Katharina was reluctant to concede the truth of my interpretation of events. She was adamant that it was the young doctor, the locum, who had burst into her room without knocking and she had been engaged in no indecent action at the time. She admitted it was possible that she had become confused about the details and that there had certainly been more than one incident in which Herr P had himself knocked at her door. Although she would not concede that the incident I had interpolated into her story was necessarily true, she was not in a position to recognise it as something she had actually experienced: I believed it would have taken hypnosis to achieve that.
Having explained to Fräulein Katharina the genesis of all her symptoms, I warned her that it might be some time before she felt a full remission from them. Just as it took some time for the conversion of trauma to manifest itself in the production of hysterical phenomena (Charcot called this the ‘period of working out’, or ‘elaboration’, and one thinks of the case of the coachman Henri R), so the reverse was also true: some time was required for the catharsis to work through her system.
In fact, Katharina reported a considerable improvement in her symptoms over the next few days, and when I last saw her appeared to be well on the way to making a full recovery.
Thomas carefully replaced the papers on the desk. His astonished eyes were dry and stinging because he had barely allowed himself to blink in the time his gaze raked down the pages.
‘Jesus suffering God,’ he said, and steadied himself against the edge of Jacques’s desk.
He looked up to the sky outside the window, exhaled deeply, then set himself in motion.
He ran into the hall and shouted, ‘Sonia! Sonia!’
She appeared upstairs and looked down at him from the galleried landing. ‘What on earth is the matter? Why are you shouting like that?’
‘What room is Katharina in? That young fair-haired woman, a patient of Jacques’s.’
‘Eighteen, I think. Why? What is it?’
‘Tell Josef to get the trap ready at once. We may have to go to the surgeon in town.’
‘Why? Why? What’s the matter?’
But Thomas was already gone, his running footsteps echoing in the cloister as he made for Katharina’s room.
He hammered at the door. ‘Fräulein, forgive me. May I take your temperature?’
Ten minutes later, a startled and re-examined Katharina was ready in the hall of the main house, her scarlet overcoat belted at the waist, a hat pinned over her fair hair, her reading glasses folded away in her pocket, while Josef brought the covered trap to the front door. Sonia stood watching anxiously.
‘Where is Jacques?’ said Thomas.
‘I think he is in the laboratory with Franz.’
‘Please tell him nothing about this. I will not be back for dinner, so please tell him I was called away to see a patient at the hospital. Or some such thing. Come, Fräulein.’
In the hour or so it took them to reach the town, Thomas discovered that a great deal of what Jacques had written about Kitty was accurate. She was a young woman of composure and clear thinking who seemed embarrassed to have so disturbed the routine of the sanatorium and quizzical about the need for a further medical opinion; she also, to Thomas, appeared to be someone who was acutely ill and whose stoical self-control had not been in her own interest.
To pass the time as the trap bounced along, Thomas talked to her about his life. This was not his normal conversational procedure, but he felt that the one thing Kitty had talked enough about was herself. He liked her shy, slightly sceptical response to his narrative (‘Really?’ she said. ‘Another brush with the authorities?’); it drove him to greater candour than he intended. They talked in English, which Kitty spoke as a native, though with a faint accent that Thomas could not place.
It was dark by the time they reached the hospital lodge and descended from the trap. Thomas gave Josef some money to go and buy supper for himself and told him to return in two hours. In the hospital, he was able to find Herr Obmann, the surgeon, and to explain the situation to him. Obmann sent for an anaesthetist, HerrAichwalder, who had to be fetched from his dinner at home. Kitty, by now candidly alarmed, was taken to a private room, undressed and given a sedative.
Thomas told her that the operation was a minor one and that she must not worry herself. It was possible that he and Herr Obmann were in any case incorrect in their diagnosis, in which case they would make sure any scar was all but invisible. A nurse came in to shave her, and Thomas left the hospital.
He went to a small tavern, but found that he was too agitated to eat. If his suspicions were correct, the consequences for him and Jacques were appalling; he was not sure the schloss could survive them. There was another factor in his anxiety that he could not yet identify, but it made him push back his plate and return to the hospital, where he paced up and down the dimly lit brick corridors, waiting for any word from the operating theatre.
Towards eleven o’clock, a weary-looking Herr Obmann emerged from the theatre with traces of blood on his apron. He sighed as he approached Thomas.
‘Let us go outside,’ he said.
In the hospital forecourt, Thomas gestured to the waiting Josef to be patient, while Obmann sat down heavily on a bench and lit a cigar.
‘Quite a battle,’ he said.
‘For God’s sake, man,’ said Thomas. ‘Tell me!’
Obmann looked at him curiously. ‘Calm yourself, Doctor. It was a straightforward procedure. I removed two cysts from the same ovary. One was the size of a hen’s egg, the other about as large as a Seville orange. The larger one had twisted on its pedicle, cutting off its own blood supply, and had also twisted the fallopian tube. It was exerting considerable pressure on the neighbouring organs. I imagine it must have been extremely uncomfortable.’
‘Nothing else?’
‘No . . . That was it. A nasty thing, but a straightforward one.’
‘And will she be fertile still?’
‘I see no reason why not. The other ovary was healthy.’
‘Thank God.’
‘You were right to bring her to me.’
‘How has she put up with the pain for so long?’
‘I imagine it was intermittent. It all depends on the degree of twisting. Sometimes by twisting they can free themselves. And the smaller one she would not have felt at all.’
‘But there was no suggestion of cancer?’
‘I have taken a biopsy, but it is unlikely. Nine out of ten are harmless. We will keep her here for the time being.’
‘Certainly,’ said Thomas. ‘I believe that she also has rheumatic fever.’
‘It is no use asking a butcher like me about that.’
‘I know. But I should like a second opinion from Maierbrugger.’
‘He is coming
the day after tomorrow.’
‘Perfect. May I see her?’
Obmann shrugged. ‘She’s asleep, but you know where she is. You know your way around.’
‘Thank you, Obmann.’ Thomas held out his hand. ‘Thank you very much.’
Back in the darkened hospital, he went up to Kitty’s room on the first floor and knocked gently. The nurse opened the door and Thomas went in. By the light of the candle next to the bed, he could see Kitty’s pale face, flushed with a slight fever, the hair a little damp at the temples where a strand of it lay over the tiny freckles on her forehead.
‘Look after her, won’t you?’ he said.
‘Yes, Doctor. Of course.’
‘Don’t leave her bedside. I will make sure you are . . . Rewarded.’
The nurse nodded. ‘I shall not move.’
Thomas leaned over the bed and stroked the hair back from Kitty’s forehead. He felt his heart seethe behind his ribs.
* * *
1 I had a most arresting example of this zöophobia when one of the stray cats occasionally found in the gardens pressed itself against the windowpane of the consulting room, causing Katharina to jump in exaggerated fright. She explained that as the creature turned sideways to rub itself against the glass, she felt as though a single eye was watching her.
2 Hysterical symptoms regularly become attached to what were originally manifestations of an organic disorder. Neck and arm cramps, for instance, can be employed for the purpose of hysterical attacks, where the patient does not have the typical symptomatology of hysteria at her disposal.
3 It will be remembered that the first instance came when she went to visit her brother Gustav in Paris.