Letter 1021 Extracts from the Fliess Papers

… Some other things of less importance have turned up-for instance, that hysterical headaches rest on an analogy in phantasy which equates the top with the bottom end of the body (hair in both places-cheeks [Backen] and buttocks [Hinter-backen (literally, ‘hind-cheeks)]-lips [Lippen] and labia [Scham-lippen (literally, ‘shame-lips’)]-mouth = vagina, so that an attack of migraine can be used to represent a forcible defloration, while nevertheless the whole ailment also represents a situation of wish-fulfilment.2 The determining action of sexuality becomes ever clearer. In one woman patient (whom I have set right with the key of phantasy) there were constant states of despair with a melancholic conviction that she was no use, was incapable of anything, etc. I always thought that in her early childhood she had witnessed an analogous state, a genuine melancholia, in her mother. This was in accordance with the earlier theory but two years brought no confirmation of it. And now it has turned out that when she was a girl of fourteen she discovered that she had atresia hymenalis [an imperforate hymen] and was in despair that she would be no use as a wife: melancholia-that is, fear of impotence. Other states, in which she cannot make up her mind to choose a hat or a dress, go back to her struggle at the time when she had to choose her husband.

With another woman patient I have convinced myself that there really is such a thing as hysterical melancholia and what its indications are. I have also noted how the same memory appears in the most numerous translations and I have gained a first glimpse of melancholia occurring through summation. This patient is, moreover, totally anaesthetic, as she should be according to an idea dating back to the earliest period of my work on the neuroses [p. 200 above].

Of a third woman I have had this most interesting information. An important and wealthy man (a bank director), aged about sixty, came to see me and entertained me with the peculiarit