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Our knowledge today has enabled us to examine the structure of mental diseases, and to develop therapeutic techniques. Many of the milder types, particularly psychoneurosis, have been successfully treated, but there was a general hesitancy to tackle the more severe ones, such as the psychoses. Freud himself expressed scepticism in this regard. He told me personally that psychoses seemed to have a nucleus similar to that of cancer, which resisted therapeutic efforts. My reply to him was that in the cases I treated I had found that there were several nuclei, rather than a single one, and that I, as well as a number of my colleagues in London, seemed to have grasped the structure of these nuclei. When I related to Freud extracts of the case that I will describe in this paper, he referred to this method of working as “promising.”
Ruth, a girl of twenty-two years of age, came to the clinic for treatment at the end of May, 1933, accompanied by both parents. She was a child of very poor people from the Jewish East End. She was suffering from very severe agoraphobia which had been developing gradually since her fourteenth year. She feared then that she would become dizzy or faint in the streets. The range of her travelling had been more and more restricted and from the age of 17 she had been completely tied to her home. She had lost contact with all her girl friends and had had to give up her work as apprentice in a tailor's shop.
Ruth was the second child and eldest daughter. A younger brother died when Ruth was 61/2. From her earliest childhood the patient was extremely difficult. As a baby she cried so much that the landlord threatened to give the family notice. The difficulties and irritability increased after the birth of a sister when Ruth was two years and nine months old. In the latency period her disturbances diminished and she entered school in an acceptable condition. Being away from her home circle brought about an improvement. During puberty her condition grew wor