Analysis

I reproach Irma for not having accepted the "solution." I say, "If you still have pains, it is really your own fault." I might even have said this while awake; I may have actually said it. At that time I was of the opinion (recognized later to be incorrect) that my task was limited to informing patients of the hidden meaning of their symptoms. Whether they then accepted or did not accept the solution upon which success depended- for that I was not responsible. I am grateful to this error, which, fortunately, has now been overcome, since it made life easier for me at a time when, with all my unavoidable ignorance, I was expected to effect successful cures. But I note that, in the speech which I make to Irma in the dream, I am above all anxious that I shall not be blamed for the pains which she still suffers. If it is Irma's own fault, it cannot be mine. Should the purpose of the dream be looked for in this quarter?

Irma's complaints- pains in the neck, abdomen, and stomach; she is choked by them. Pains in the stomach belonged to the symptom- complex of my patient, but they were not very prominent; she complained rather of qualms and a feeling of nausea. Pains in the neck and abdomen and constriction of the throat played hardly any part in her case. I wonder why I have decided upon this choice of symptoms in the dream; for the moment I cannot discover the reason.

She looks pale and puffy. My patient had always a rosy complexion. I suspect that here another person is being substituted for her.

I am startled at the idea that I may have overlooked some organic affection. This, as the reader will readily believe, is a constant fear with the specialist who sees neurotics almost exclusively, and who is accustomed to ascribe to hysteria so many manifestations which other physicians treat as organic. On the other hand, I am haunted by a faint doubt- I do not know whence it comes- whether my alarm is altogether honest. If Irma's pains are indeed of organic origin, it is not my duty to cure them. My treatment, of course, removes only hysterical pains. It seems to me, in fact, that I wish to find an error in the diagnosis; for then I could not be reproached with failure to effect a cure.

I take her to the window in order to look into her throat. She resists a little, like a woman who has false teeth. I think to myself, she does not need them. I had never had occasion to inspect Irma's oral cavity. The incident in the dream reminds me of an examination, made some time before, of a governess who at first produced an impression of youthful beauty, but who, upon opening her mouth, took certain measures to conceal her denture. Other memories of medical examinations, and of petty secrets revealed by them, to the embarrassment of both physician and patient, associate themselves with this case.- "She surely does not need them," is perhaps in the first place a compliment to Irma; but I suspect yet another meaning. In a careful analysis one is able to feel whether or not the arriere-pensees which are to be expected have all been exhausted. The way in which Irma stands at the window suddenly reminds me of another experience. Irma has an intimate woman friend of whom I think very highly. One evening, on paying her a visit, I found her at the window in the position reproduced in the dream, and her physician, the same Dr. M, declared that she had a diphtheritic membrane. The person of Dr. M and the membrane return, indeed, in the course of the dream. Now it occurs to me that during the past few months I have had every reason to suppose that this lady too is hysterical. Yes, Irma herself betrayed the fact to me. But what do I know of her condition? Only the one thing, that like Irma in the dream she suffers from hysterical choking. Thus, in the dream I have replaced my patient by her friend. Now I remember that I have often played with the supposition that this lady, too, might ask me to relieve her of her symptoms.