A Psychoanalytic Study of a Severe Case of Compulsion Neurosis

To gain some understanding of why this thought became obsessive, that is to say, why all the affects belonging to the tuberculosis complex were transferred to it, we need only to represent to ourselves what must have been the state of Stella's mind at that time. The theme of tuberculosis was one that for a long time she had not faced squarely. As soon as she began to realize, in her girlhood, that tuberculosis would diminish her value in the eyes of men, she not only denied to others that she had had the disease but refused to admit even to herself that she had ever had it. Thus, she disputed the significance of repeated hemorrhages, loss of weight, cough, and similar symptoms, and, although all the doctors who ever examined her at the times she showed symptoms had made the same diagnosis of tuberculosis, she always told herself that as the result of prejudice or some other influence they were mistaken, basing this contention on the fact that she had never had a positive sputum, and that for the greater part of her life she had maintained fairly good health though working in an unfavorable climate and under unfavorable conditions.

But for Stella to maintain a conscious belief that she was not and had never been tubercular would mean simply that she repressed and refused to admit to her consciousness various perceptions that would inevitably lead to the formation of a directly opposite opinion. In other words, even supposing that she could believe consciously that she never had had the disease, yet unconsciously she entertained an entirely different conviction. Thus, though at the time of her affair with Max she knew in a way that she was having a relapse, she would not admit to herself that such was the case.

The concern consequent upon her unwilling and unadmitted knowledge of her condition was temporarily diminished by her visit