Prologue

Aaron H. Esman (1989) is the first psychoanalyst to show the dissimilarities between the current psychiatric, behavioral, and neuroscience research—and their derivative theories and therapeutic strategies—regarding the obsessive-compulsive disorder (OCD) and the historic obsessional neurosis of Sigmund Freud (1894), 1895b, 1896, 1907, 1909, 1913a, b, 1926).

The 30-year evolution of Freud's views about the obsessional neurosis are fundamental to his general psychological theory of mind that followed his initial study on hysteria. Even early on, Freud's (1895a, 1909, 1913b) study of the obsessional neurosis established a remarkable excursion into the unconscious. These assumptions about psychoanalytic theory are relevant today and include psychic determinism, repression, unconscious drive derivative, psychic conflict, symptom formation, primary and secondary defenses, unconscious memory, return of the repressed, compromise formation, and displacement (Jones, 1953, pp. 278-279, 282). The “Rat Man” and “Wolf Man” are landmarks of the psychoanalytic case study that remain central to Freud's genetic, dynamic, and topographic metapsychology. Ernest Jones (1955) points out that the obsessional neurosis was elemental in Freud's evolving technique, a model for analysts today: “his timing of interpretations, his characteristic use of analogies to illustrate a point,… the preliminary guesses he would make privately which might subsequently be either confirmed or disproved, and altogether the tentative manner in which such piecemeal work proceeded” (p. 230). Freud's (1904) procedure of free association established the corner stones of psychoanalytic method: transference, resistance, and the theory of repression. Thus Freud's innovation of mental structure and function owe a considerable debt to his study of the obsessional neurosis.

Over the past 3 decades only a few analysts have addressed the pathogenesis, psychopathology, or analytic treatment of the