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In this article the clinical phenomenology of an inadequately 'understood and described' neurotic manifestation engages Reik's minute observational interest. Beginning with the premise that psychological differences in the neuroses are reflected in characteristic differences in social behavior, Reik describes the peculiarly open-yet-hidden way in which obsessional acts and ceremonials pervade the social behavior of the compulsive neurotic.
By clinical examples, Reik demonstrates the highly and ingeniously complicated way in which the obsessional patient weaves his ritual into the texture of reality situations. That this activity is in its surface manifestations conscious, does not lessen its complexity; as a matter of fact, the forces of intellect are enlisted to such an extent that one can not conceive of a dullard remotely achieving the adroit 'stage management' required for the camouflage. Such practiced perfection in making socially presentable the unpresentable neurotic act, is not easily accomplished. The preliminary stages are the 'thought rehearsals', indispensable to the smooth running off of the 'social' presentation. These 'trial performances', which Reik describes as a 'peculiar kind of protective measure', have the aim of eliminating anticipated disturbances in 'carrying out … obsessional acts and ceremonials'.
Disturbances are anticipated because the patient is aware of the lack of consonance between his compulsive acts and the realities of adult life. 'This breach between … the magical way of thinking dominating the obsessional neurosis, and the rationalistic way of thinking characteristic of our culture',