A Case of Compulsive Handwashing

This study was undertaken in an effort to clarify the factors that played a rôle in the improvement of a patient with a severe case of compulsive handwashing. When the case had been in analysis for well over a year, an attempt was made to survey the material systematically, and in order to develop more clearly and graphically the relationship between the improvements and the daily occurrences inside and outside of the analysis, a curve was constructed. This curve (pages 98 to 100) indicates the course of the patient's clinical condition during twenty months of analysis, demonstrating at a glance all the improvements and exacerbations during this period.

It is obviously impossible at the present time to measure and chart with scientific precision the severity of a patient's neurosis from day to day. However, in this case it was possible to estimate with a reasonable degree of accuracy the comparative severity of the neurosis from one day to the next, for the outstanding symptom, compulsive handwashing, was largely responsible from the practical standpoint for the patient's inability to function normally. The amount of handwashing each day could be definitely determined with a fair degree of accuracy. The other outstanding symptom, compulsive praying, could also be estimated quantitatively. Another variable factor taken into account was the amount of useful activity and successful achievement that the patient had accomplished. The total estimate of the severity of the patient's neurosis on any particular day took into account (1) the presence or absence of symptoms; (2) the degree of