Emergence of Sleep During Psycho-Analysis—A Clinical Note

This is a report of two consecutive hours from the early part of the second year of the analysis of a 36-year-old physician.

His main symptom is his belief that various people infect him by throwing or squirting gonorrheal pus over him and sometimes by spitting or urinating upon him. During such periods of infection, which sometimes occur several times a day, he shuts himself away and for hours attempts to disinfect himself by desperate and frantic methods which are always accompanied by an overwhelming sense of guilt. In the interim periods he is rarely free of the fear of being infected by others, and his thoughts are concerned almost constantly with ways in which he can detect his potential enemies and forestall their attack. In spite of these severe handicaps, he is able to discharge his responsibilities as a husband, father, and busy G.P. He is rarely early in arriving for his analytic hours, partly to avoid remaining in the potentially dangerous waiting room, and if he finds the consulting room to be empty, he often waits there.

At the beginning of the first of these two hours I approached the consulting room and observing it to be empty through the half-open door, I went to the waiting room. Not finding him there, I returned to the consulting room and saw him through the doorway waiting there for me. After reclining upon the couch he spoke at some length of his dissatisfaction with his ability to associate freely. He had resolved that that day, being not only the first day of the week, but also the first day of the month, he would make a determined effort to give his associations in the way he believed was expected of him, namely by reporting words or phrases while in a state of reverie. As he talked he seemed to drowse and after a brief pause said 'I didn't know you were coming.' After a longer pause, during which he seemed to continue to drowse, I replied, 'I didn't know you were here.' Immediately he became attentive and said he had visualized a pr