The Psychology of the Effect Produced by Morphia

The following short notes are not intended either as an exhaustive account of the peculiar condition which may be observed when morphia is used in cases of serious illness, or as a final, psycho-analytical explanation of the condition. It is rather a question, in the first place, of considering from a particular standpoint certain observations which have been made from time to time, and, secondly, of offering a suggestion of how the problems of clinical medicine may be attacked from the psycho-analytical point of view. I must add that, in spite of their very interesting content, it was not possible to submit these observations to a thorough psycho-analysis. A condition such as that which provided the opportunity for these observations does not admit of a relation favourable for analysis being set up between physician and patient. There is never more than a fragmentary transference, and the patient shuts himself off more and more from the outer world and answers questions either unsatisfactorily or not at all. Much must be arrived at actually by guessing and be supplemented out of previous knowledge of the patient.

Some years ago it fell to my lot to attend a colleague in advanced phthisis. In the last days of his life I tried to relieve his torturing struggle for breath by giving him repeated injections of morphia. The patient, a highly intelligent man, was quite clear about his own condition and had no illusions about his approaching death. In moments of euphoria, however, he tried to deceive his friend and physician, and to comfort me with hopeful remarks. The night before he died, it was necessary to give the injections frequently and the patient lay for the most part in a light stupor. On one occasion, as he woke up, he asked in a peculiar, brisk, objective manner: 'Well, my dear fellow, what shall we do now?' The question was asked just as if the two of us were in consultation on the case of another. This incident and the feeling I then had, but cou