Analysis of an Obsessional Neurosis in a Child

In April 1919 a doctor sent a boy aged ten and a half years to me for analysis. The child was small for his age and very thin; he suffered from numerous obsessional symptoms. He was unable to touch anything himself so that his mother had to dress him and feed him. If anyone, above all his mother, touched anything with one hand the object touched had to be put back again in its former place, the same action carried out with the other hand, and then finally with both hands. He was particularly sensitive if anyone placed one object beside another one. He himself simply would not touch anything at all; if, however, this happened by chance then his mother had to carry out the ceremonial. In consequence of this, every action was bound up with so many ceremonies that it often took several hours to carry them out; his mother asked me to reserve an hour in the afternoon for her as she could not get the boy dressed and ready till half past twelve. The child was literally starved, because while eating he spat out every mouthful once or several times into his mother's hand because it was not put into his mouth 'properly'. Both he and his mother had to take up a certain position before eating; if one foot was in advance of the other a ceremonial had to take place until both feet were perfectly in line. If anything happened contrary to his compulsion he literally writhed with pain. At such times he would often seem to lose consciousness, then he would fall into a rage, throw himself on his mother, tear her clothes off, twist her hands as hard as ever he could, and often bite her (on her first visit to me she showed me a scar on her cheek where he had bitten her); this would end in a fit of convulsive sobbing and he would fall exhausted into a chair. These attacks of loss of consciousness had led one of the best-known neurologists in Warsaw to diagnose the case as one of epilepsy. When the boy was told after one of these attacks what