The Interpretation of Dreams by Sigmund Freud
Analysis

The hall- a number of guests, whom we are receiving. We were living that summer at Bellevue, an isolated house on one of the hills adjoining the Kahlenberg. This house was originally built as a place of entertainment, and therefore has unusually lofty, hall-like rooms. The dream was dreamed in Bellevue, a few days before my wife's birthday. During the day my wife had mentioned that she expected several friends, and among them Irma, to come to us as guests for her birthday. My dream, then, anticipates this situation: It is my wife's birthday, and we are receiving a number of people, among them Irma, as guests in the large hall of Bellevue.

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. But even at the time I thought it improbable, since she is extremely reserved. She resists, as the dream shows. Another explanation might be that she does not need it; in fact, until now she has shown herself strong enough to master her condition without outside help. Now only a few features remain, which I can assign neither to Irma nor to her friend; pale, puffy, false teeth. The false teeth led me to the governess; I now feel inclined to be satisfied with bad teeth. Here another person, to whom these features may allude, occurs to me. She is not my patient, and I do not wish her to be my patient, for I have noticed that she is not at her ease with me, and I do not consider her a docile patient. She is generally pale, and once, when she had not felt particularly well, she was puffy. * I have thus compared my patient Irma with two others, who would likewise resist treatment. What is the meaning of the fact that I have exchanged her for her friend in the dream? Perhaps that I wish to exchange her; either her friend arouses in me stronger sympathies, or I have a higher regard for her intelligence. For I consider Irma foolish because she does not accept my solution. The other woman would be more sensible, and would thus be more likely to yield. The mouth then opens readily; she would tell more than Irma. *(2)

* The complaint of pains in the abdomen, as yet unexplained, may also be referred to this third person. It is my own wife, of course, who is in question; the abdominal pains remind me of one of the occasions on which her shyness became evident to me. I must admit that I do not treat Irma and my wife very gallantly in this dream, but let it be said, in my defence, that I am measuring both of them against the ideal of the courageous and docile female patient.

*(2) I suspect that the interpretation of this portion has not been carried far enough to follow every hidden meaning. If I were to continue the comparison of the three women, I should go far afield. Every dream has at least one point at which it is unfathomable: a central point, as it were, connecting it with the unknown.

What I see in the throat: a white spot and scabby turbinal bones. The white spot recalls diphtheria, and thus Irma's friend, but it also recalls the grave illness of my eldest daughter two years earlier, and all the anxiety of that unhappy time. The scab on the turbinal bones reminds me of my anxiety concerning my own health. At that time I frequently used cocaine in order to suppress distressing swellings in the nose, and I had heard a few days previously that a lady patient who did likewise had contracted an extensive necrosis of the nasal mucous membrane. In 1885 it was I who had recommended the use of cocaine, and I had been gravely reproached in consequence. A dear friend, who had died before the date of this dream, had hastened his end by the misuse of this remedy.

I quickly call Dr. M, who repeats the examination. This would simply correspond to the position which M occupied among us. But the word quickly is striking enough to demand a special examination. It reminds me of a sad medical experience. By continually prescribing a drug (sulphonal), which at that time was still considered harmless, I was once responsible for a condition of acute poisoning in the case of a woman patient, and hastily turned for assistance to my older and more experienced colleague. The fact that I really had this case in mind is confirmed by a subsidiary circumstance. The patient, who succumbed to the toxic effects of the drug, bore the same name as my eldest daughter. I had never thought of this until now; but now it seems to me almost like a retribution of fate- as though the substitution of persons had to be continued in another sense: this Matilda for that Matilda; an eye for an eye, a tooth for a tooth. It is as though I were seeking every opportunity to reproach myself for a lack of medical conscientiousness.

Dr. M is pale; his chin is shaven, and he limps. Of this so much is correct, that his unhealthy appearance often arouses the concern of his friends. The other two characteristics must belong to another person. An elder brother living abroad occurs to me, for he, too, shaves his chin, and if I remember him rightly, the M of the dream bears on the whole a certain resemblance to him. And some days previously the news arrived that he was limping on account of an arthritic affection of the hip. There must be some reason why I fuse the two persons into one in my dream. I remember that, in fact, I was on bad terms with both of them for similar reasons. Both had rejected a certain proposal which I had recently made them.

My friend Otto is now standing next to the patient, and my friend Leopold examines her and calls attention to a dulness low down on the left side. My friend Leopold also is a physician, and a relative of Otto's. Since the two practice the same specialty, fate has made them competitors, so that they are constantly being compared with one another. Both of them assisted me for years, while I was still directing a public clinic for neurotic children. There, scenes like that reproduced in my dream had often taken place. While I would be discussing the diagnosis of a case with Otto, Leopold would examine the child anew and make an unexpected contribution towards our decision. There was a difference of character between the two men like that between Inspector Brasig and his friend Karl. Otto was remarkably prompt and alert; Leopold was slow and thoughtful, but thorough. If I contrast Otto and the cautious Leopold in the dream I do so, apparently, in order to extol Leopold. The comparison is like that made above between the disobedient patient Irma and her friend, who was believed to be more sensible. I now become aware of one of the tracks along which the association of ideas in the dream proceeds: from the sick child to the children's clinic. Concerning the dulness low on the left side, I have the impression that it corresponds with a certain case of which all the details were similar, a case in which Leopold impressed me by his thoroughness. I thought vaguely, too, of something like a metastatic affection, but it might also be a reference to the patient whom I should have liked to have in Irma's place. For this lady, as far as I can gather, exhibited symptoms which imitated tuberculosis.

An infiltrated portion of skin on the left shoulder. I know at once that this is my own rheumatism of the shoulder, which I always feel if I lie awake long at night. The very phrasing of the dream sounds ambiguous: Something which I can feel, as he does, in spite of the dress. "Feel on my own body" is intended. Further, it occurs to me how unusual the phrase infiltrated portion of skin sounds. We are accustomed to the phrase: "an infiltration of the upper posterior left"; this would refer to the lungs, and thus, once more, to tuberculosis.

In spite of the dress. This, to be sure, is only an interpolation. At the clinic the children were, of course, examined undressed; here we have some contrast to the manner in which adult female patients have to be examined. The story used to be told of an eminent physician that he always examined his patients through their clothes. The rest is obscure to me; I have, frankly, no inclination to follow the matter further.

Dr. M says: "It's an infection, but it doesn't matter; dysentery will follow, and the poison will be eliminated." This, at first, seems to me ridiculous; nevertheless, like everything else, it must be carefully analysed; more closely observed it seems after all to have a sort of meaning. What I had found in the patient was a local diphtheritis. I remember the discussion about diphtheritis and diphtheria at the time of my daughter's illness. Diphtheria is the general infection which proceeds from local diphtheritis. Leopold demonstrates the existence of such a general infection by the dulness, which also suggests a metastatic focus. I believe, however, that just this kind of metastasis does not occur in the case of diphtheria. It reminds me rather of pyaemia.

It doesn't matter is a consolation. I believe it fits in as follows: The last part of the dream has yielded a content to the effect that the patient's sufferings are the result of a serious organic affection. I begin to suspect that by this I am only trying to shift the blame from myself. Psychic treatment cannot be held responsible for the continued presence of a diphtheritic affection. Now, indeed, I am distressed by the thought of having invented such a serious illness for Irma, for the sole purpose of exculpating myself. It seems so cruel. Accordingly, I need the assurance that the outcome will be benign, and it seems to me that I made a good choice when I put the words that consoled me into the mouth of Dr. M. But here I am placing myself in a position of superiority to the dream; a fact which needs explanation.

But why is this consolation so nonsensical?

Dysentery. Some sort of far-fetched theoretical notion that the toxins of disease might be eliminated through the intestines. Am I thereby trying to make fun of Dr. M's remarkable store of far- fetched explanations, his habit of conceiving curious pathological relations? Dysentery suggests something else. A few months ago I had in my care a young man who was suffering from remarkable intestinal troubles; a case which had been treated by other colleagues as one of "anaemia with malnutrition." I realized that it was a case of hysteria; I was unwilling to use my psycho-therapy on him, and sent him off on a sea-voyage. Now a few days previously I had received a despairing letter from him; he wrote from Egypt, saying that he had had a fresh attack, which the doctor had declared to be dysentery. I suspect that the diagnosis is merely an error on the part of an ignorant colleague, who is allowing himself to be fooled by the hysteria; yet I cannot help reproaching myself for putting the invalid in a position where he might contract some organic affection of the bowels in addition to his hysteria. Furthermore, dysentery sounds not unlike diphtheria, a word which does not occur in the dream.

Yes, it must be the case that with the consoling prognosis, Dysentery will develop, etc., I am making fun of Dr. M, for I recollect that years ago he once jestingly told a very similar story of a colleague. He had been called in to consult with him in the case of a woman who was very seriously ill, and he felt obliged to confront his colleague, who seemed very hopeful, with the fact that he found albumen in the patient's urine. His colleague, however, did not allow this to worry him, but answered calmly: "That does not matter, my dear sir; the albumen will soon be excreted!" Thus I can no longer doubt that this part of the dream expresses derision for those of my colleagues who are ignorant of hysteria. And, as though in confirmation, the thought enters my mind: "Does Dr. M know that the appearances in Irma's friend, his patient, which gave him reason to fear tuberculosis, are likewise due to hysteria? Has he recognized this hysteria, or has he allowed himself to be fooled?"

But what can be my motive in treating this friend so badly? That is simple enough: Dr. M agrees with my solution as little as does Irma herself. Thus, in this dream I have already revenged myself on two persons: on Irma in the words, If you still have pains, it is your own fault, and on Dr. M in the wording of the nonsensical consolation which has been put into his mouth.

We know precisely how the infection originated. This precise knowledge in the dream is remarkable. Only a moment before this we did not yet know of the infection, since it was first demonstrated by Leopold.

My friend Otto gave her an injection not long ago, when she was feeling unwell. Otto had actually related during his short visit to Irma's family that he had been called in to a neighbouring hotel in order to give an injection to someone who had been suddenly taken ill. Injections remind me once more of the unfortunate friend who poisoned himself with cocaine. I had recommended the remedy for internal use only during the withdrawal of morphia; but he immediately gave himself injections of cocaine.

With a preparation of propyl... propyls... propionic acid. How on earth did this occur to me? On the evening of the day after I had written the clinical history and dreamed about the case, my wife opened a bottle of liqueur labelled "Ananas," * which was a present from our friend Otto. He had, as a matter of fact, a habit of making presents on every possible occasion; I hope he will some day be cured of this by a wife. *(2) This liqueur smelt so strongly of fusel oil that I refused to drink it. My wife suggested: "We will give the bottle to the servants," and I, more prudent, objected, with the philanthropic remark: "They shan't be poisoned either." The smell of fusel oil (amyl...) has now apparently awakened my memory of the whole series: propyl, methyl, etc., which furnished the preparation of propyl mentioned in the dream. Here, indeed, I have effected a substitution: I dreamt of propyl after smelling amyl; but substitutions of this kind are perhaps permissible, especially in organic chemistry. -

* "Ananas," moreover, has a remarkable assonance with the family name of my patient Irma.

*(2) In this the dream did not turn out to be prophetic. But in another sense it proved correct, for the "unsolved" stomach pains, for which I did not want to be blamed, were the forerunners of a serious illness, due to gall-stones.

Trimethylamin. In the dream I see the chemical formula of this substance- which at all events is evidence of a great effort on the part of my memory- and the formula is even printed in heavy type, as though to distinguish it from the context as something of particular importance. And where does trimethylamin, thus forced on my attention, lead me? To a conversation with another friend, who for years has been familiar with all my germinating ideas, and I with his. At that time he had just informed me of certain ideas concerning a sexual chemistry, and had mentioned, among others, that he thought he had found in trimethylamin one of the products of sexual metabolism. This substance thus leads me to sexuality, the factor to which I attribute the greatest significance in respect of the origin of these nervous affections which I am trying to cure. My patient Irma is a young widow; if I am required to excuse my failure to cure her, I shall perhaps do best to refer to this condition, which her admirers would be glad to terminate. But in what a singular fashion such a dream is fitted together! The friend who in my dream becomes my patient in Irma's place is likewise a young widow.

I surmise why it is that the formula of trimethylamin is so insistent in the dream. So many important things are centered about this one word: trimethylamin is an allusion, not merely to the all-important factor of sexuality, but also to a friend whose sympathy I remember with satisfaction whenever I feel isolated in my opinions. And this friend, who plays such a large part in my life: will he not appear yet again in the concatenation of ideas peculiar to this dream? Of course; he has a special knowledge of the results of affections of the nose and the sinuses, and has revealed to science several highly remarkable relations between the turbinal bones and the female sexual organs. (The three curly formations in Irma's throat.) I got him to examine Irma, in order to determine whether her gastric pains were of nasal origin. But he himself suffers from suppurative rhinitis, which gives me concern, and to this perhaps there is an allusion in pyaemia, which hovers before me in the metastasis of the dream.

One doesn't give such injections so rashly. Here the reproach of rashness is hurled directly at my friend Otto. I believe I had some such thought in the afternoon, when he seemed to indicate, by word and look, that he had taken sides against me. It was, perhaps: "How easily he is influenced; how irresponsibly he pronounces judgment." Further, the above sentence points once more to my deceased friend, who so irresponsibly resorted to cocaine injections. As I have said, I had not intended that injections of the drug should be taken. I note that in reproaching Otto I once more touch upon the story of the unfortunate Matilda, which was the pretext for the same reproach against me. Here, obviously, I am collecting examples of my conscientiousness, and also of the reverse.

Probably too the syringe was not clean. Another reproach directed at Otto, but originating elsewhere. On the previous day I happened to meet the son of an old lady of eighty-two, to whom I am obliged to give two injections of morphia daily. At present she is in the country, and I have heard that she is suffering from phlebitis. I immediately thought that this might be a case of infiltration caused by a dirty syringe. It is my pride that in two years I have not given her a single infiltration; I am always careful, of course, to see that the syringe is perfectly clean. For I am conscientious. From the phlebitis I return to my wife, who once suffered from thrombosis during a period of pregnancy, and now three related situations come to the surface in my memory, involving my wife, Irma, and the dead Matilda, whose identity has apparently justified my putting these three persons in one another's places.

I have now completed the interpretation of the dream. * In the course of this interpretation I have taken great pains to avoid all those notions which must have been suggested by a comparison of the dream-content with the dream-thoughts hidden behind this content. Meanwhile the meaning of the dream has dawned upon me. I have noted an intention which is realized through the dream, and which must have been my motive in dreaming. The dream fulfills several wishes, which were awakened within me by the events of the previous evening (Otto's news, and the writing of the clinical history). For the result of the dream is that it is not I who am to blame for the pain which Irma is still suffering, but that Otto is to blame for it. Now Otto has annoyed me by his remark about Irma's imperfect cure; the dream avenges me upon him, in that it turns the reproach upon himself. The dream acquits me of responsibility for Irma's condition, as it refers this condition to other causes (which do, indeed, furnish quite a number of explanations). The dream represents a certain state of affairs, such as I might wish to exist; the content of the dream is thus the fulfilment of a wish; its motive is a wish.

* Even if I have not, as might be expected, accounted for everything that occurred to me in connection with the work of interpretation.

This much is apparent at first sight. But many other details of the dream become intelligible when regarded from the standpoint of wish-fulfilment. I take my revenge on Otto, not merely for too readily taking sides against me. in that I accuse him of careless medical treatment (the injection), but I revenge myself also for the bad liqueur which smells of fusel oil, and I find an expression in the dream which unites both these reproaches: the injection of a preparation of propyl. Still I am not satisfied, but continue to avenge myself by comparing him with his more reliable colleague. Thereby I seem to say: "I like him better than you." But Otto is not the only person who must be made to feel the weight of my anger. I take my revenge on the disobedient patient, by exchanging her for a more sensible and more docile one. Nor do I pass over Dr. M's contradiction; for I express, in an obvious allusion, my opinion of him: namely, that his attitude in this case is that of an ignoramus (Dysentery will develop, etc.). Indeed, it seems as though I were appealing from him to someone better informed (my friend, who told me about trimethylamin), just as I have turned from Irma to her friend, and from Otto to Leopold. It is as though I were to say: Rid me of these three persons, replace them by three others of my own choice, and I shall be rid of the reproaches which I am not willing to admit that I deserve! In my dream the unreasonableness of these reproaches is demonstrated for me in the most elaborate manner. Irma's pains are not attributable to me, since she herself is to blame for them, in that she refuses to accept my solution. They do not concern me, for being as they are of an organic nature, they cannot possibly be cured by psychic treatment. Irma's sufferings are satisfactorily explained by her widowhood (trimethylamin!); a state which I cannot alter. Irma's illness has been caused by an incautious injection administered by Otto, an injection of an unsuitable drug, such as I should never have administered. Irma's complaint is the result of an injection made with an unclean syringe, like the phlebitis of my old lady patient, whereas my injections have never caused any ill effects. I am aware that these explanations of Irma's illness, which unite in acquitting me, do not agree with one another; that they even exclude one another. The whole plea- for this dream is nothing else- recalls vividly the defence offered by a man who was accused by his neighbour of having returned a kettle in a damaged condition. In the first place, he had returned the kettle undamaged; in the second place it already had holes in it when he borrowed it; and in the third place, he had never borrowed it at all. A complicated defence, but so much the better; if only one of these three lines of defence is recognized as valid, the man must be acquitted.

Still other themes play a part in the dream, and their relation to my non-responsibility for Irma's illness is not so apparent: my daughter's illness, and that of a patient with the same name; the harmfulness of cocaine; the affection of my patient, who was traveling in Egypt; concern about the health of my wife; my brother, and Dr. M; my own physical troubles, and anxiety concerning my absent friend, who is suffering from suppurative rhinitis. But if I keep all these things in view, they combine into a single train of thought, which might be labelled: Concern for the health of myself and others; professional conscientiousness. I recall a vaguely disagreeable feeling when Otto gave me the news of Irma's condition. Lastly, I am inclined, after the event, to find an expression of this fleeting sensation in the train of thoughts which forms part of the dream. It is as though Otto had said to me: "You do not take your medical duties seriously enough; you are not conscientious; you do not perform what you promise." Thereupon this train of thought placed itself at my service, in order that I might give proof of my extreme conscientiousness, of my intimate concern about the health of my relatives, friends and patients. Curiously enough, there are also some painful memories in this material, which confirm the blame attached to Otto rather than my own exculpation. The material is apparently impartial, but the connection between this broader material, on which the dream is based, and the more limited theme from which emerges the wish to be innocent of Irma's illness, is, nevertheless, unmistakable.

I do not wish to assert that I have entirely revealed the meaning of the dream, or that my interpretation is flawless.

I could still spend much time upon it; I could draw further explanations from it, and discuss further problems which it seems to propound. I can even perceive the points from which further mental associations might be traced; but such considerations as are always involved in every dream of one's own prevent me from interpreting it farther. Those who are overready to condemn such reserve should make the experiment of trying to be more straightforward. For the present I am content with the one fresh discovery which has just been made: If the method of dream- interpretation here indicated is followed, it will be found that dreams do really possess a meaning, and are by no means the expression of a disintegrated cerebral activity, as the writers on the subject would have us believe. When the work of interpretation has been completed the dream can be recognized as a wish fulfilment.