The Psychoanalytic Quarterly: 23, 1953, No. 3

Ida MacAlpine and Richard A. Hunter. 'The Schreber Case. A Contribution to Schizophrenia, Hypochondria and Psychomatic Symptom-Formation.'

Investigating intractable pruritus ani by means of psychotherapy the authors were struck by the similarity of the hypochondriacal symptoms of which their patients complained with those of Schreber. They found their origin in primitive fantasies of intestinal procreation. Though these had secondary homosexual implications for men, and carried a castration threat, they were equally incompatible with mature sexual functioning in men and women.

Schreber's memoirs are also filled with the mysteries of the origin of life—birth, death, resurrection, the migration of souls—and his extensive knowledge of these subjects from every aspect shows the unconscious determination of his thoughts before he became ill. His first psychotic experience—the hallucination of a crackling noise in the wall as though a mouse were there—was a transparent reference to parturition, and the authors show how frequent are unconscious references to periods of nine in his description and the timing of his illness. Moreover, it was his hypochondriacal symptoms, with their similarities to various myths of birth, which caused him his most acute suffering in the catatonic years when his illness was at its height.

They believe that it was Freud's desire to maintain paranoia as an independent clinical entity not necessarily related to schizophrenia which accounted for his emphasis on homosexual mechanisms as primary. Had he concentrated on the hypochondriacal symptoms he would have seen Schreber's doubt about his sex—a frequent phenomenon with schizophrenics—as necessitated by them. Freud himself admitted that no theory of paranoia could be complete which failed to explain the accompanying hypochondria. Moreover, had the hope of being turned into a woman been the most pathogenic factor it is difficult to see how Schreber could have recovered retaining this idea.