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The patient, a thirty-nine year old housewife, entered analysis because of an hysterical disturbance in voice production. The onset of her condition was quite gradual. It was first observed when she was completing her last year at high school at the age of 17. Several medical consultations at that time led her to believe that she could not be cured, and she pursued the matter no further. In recent years the incapacity became more disabling so that in quiet desperation she finally decided on a complete reexamination of her condition. The otolaryngological consultant explained that she was suffering not from an organic disturbance of the vocal cords but from a dysfunction of emotional origin for which he recommended psychiatric treatment. Her husband, despite serious misgivings, consented to give his wife a modest sum of money to cover a short term of psychiatric treatment, with the definite understanding that treatment would be terminated at the expiration of this period.
In the first interview it was immediately apparent that the physical process of speaking was laborious and that the patient had to exert herself to make herself audible. It was necessary to sit quite close to the patient for her voice was normally no louder than a soft whisper. Often no distinct syllabic form was discernible—only the breathy sound associated with forced expiration. She was timid, uneasy, and self-conscious. Despite these handicaps, however, she bore herself well and struck one as an intelligent and attractive person. One sensed in her a longing to be understood, coupled with a fear that she might reveal something dangerous to herself.
The patient was born in a small New England town. After completing high school she attended business school, and subsequently did secretarial work. At 21 she decided she wanted a college education and attended a midwestern university, graduating at the age of 25. She married at the age of 29 and has had no children.
Of primary import in the family history