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Göttingen, 22.ii.1919
Dear Professor,
The reason I am writing again so soon after receiving your letter is that last year in the case of my little patient you encouraged me to come to you with problems of this sort. This time it is a question of a young (twenty-one-year-old) girl, whose sufferings I know of only through correspondence. But I have the impression that even the little that can be achieved through writing has a good effect upon her. Personal treatment is for the time being out of the question, as she cannot leave her home.
I first learnt of her physical symptoms (at first pains in the abdomen, now in the neck; the former increase with walking, the latter when reading and concentrating). Then I learnt of her erotic phantasies (which had decreased with the definite establishment of the physical symptoms). All of these related to homosexual love (from the eleventh to the twentieth year a passion for a dark young woman, of aristocratic type, just seen in passing). Finally I learnt that from a previous period there existed a high degree of obsessional superstition, which indeed still persists in a modified form (perhaps also partly superseded by the physical symptoms which by acting as a punishment dispel it?): i.e., the compulsion to adjust with her hand every door key which is not quite horizontal—which I interpret as meaning the compulsion to clasp with her hand the part of the key sticking out somewhat vertically like a phallus. Further: the fixation on uneven numbers; every group of steps must end with the right foot; the morning must start with one extra step, so that the pairs of steps throughout the day will remain uneven in number; rhythm in brushing the teeth, etc. The accompanying phantasies, i.e., the catastrophic happening which would take place without the obsessional protection, have so far only found expression in the form of ‘for example’, but doubtless they represent in fact the real dangers: the house being burnt down, the death of the mother