You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
The analysis of a young woman of twenty-two living in a narrowly circumscribed working-class household forced upon my notice the repercussions which a psychoneurosis and its treatment may have on the immediate surroundings, and stimulated speculation on the effects that modification of the environment may possibly have on analysis.
The patient, whom I have called Elsie Smith, lived with her father, a night porter at a club, and her mother, and was the second of three children of whom the elder son was married and the younger had died from diphtheria at eight when Elsie was eighteen. This last event had had a profound effect on her.
When she started treatment in 1927 the patient had been suffering for about two years from a variety of obsessional symptoms associated with attacks of anxiety and for about a year had been disabled from earning her living as a dressmaker. At times she nearly crossed the border into melancholia or paranoia, and at others hysterical manifestations of an anxiety or conversion type predominated.
As a child she had been subject to catarrhal affections. She developed a character of obsessional type and was particular and hyper-conscientious in her work. She was more at her ease with boy companions than girls and found them easier to understand, but she was always rather timid and no tomboy.
Her present illness preceded a contemplated marriage and caused her fiancé to postpone it. The onset was gradual, but she described an antecedent occasion when she was on a country walk with her fiancé and felt giddy. On that day her mother had not been well, and she had had scruples about leaving her.
She gradually became more nervous and worried at work and sensitive to the persecutions of a senior girl who had the same surname as herself. This girl appeared to represent her mother and her own super-ego. She sometimes identified me with her.
She grew unable to be alone and developed a fear that she would shut people in cupboards. Some fellow-workers ha