INSPIRATIONS FROM HISTORY
Year : 2017 | Volume
: 22 | Issue : 2 | Page : 132--135
The case of rat man: A psychoanalytic understanding of obsessive-compulsive disorder
Department of Psychiatry, Nepalgunj Medical College, Kohalpur, Nepal
Department of Psychiatry, Nepalgunj Medical College, C-8, C-Block, Doctor's Residence, Kohalpur-11, Banke
This article discusses case of Mr. Ernst Lanzer known as the “Rat Man” in the history of psychoanalysis. He was diagnosed as a case of obsessive-compulsive disorder by Sigmund Freud known as obsessional neurosis that time. The patient presented to Freud with number of distressing obsessions of which the main one was fear of a corporal punishment to his loved ones using rats. The patient underwent psychoanalytic treatment for his symptoms for 6 months following which he was declared cured. Freud has discussed the case in a published case note. Over the subsequent years, the case received wider attention from the psychoanalytic community and continues to be interpreted and discussed from different perspectives after nearly one century of his clinical interaction with Freud.
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Thapaliya S. The case of rat man: A psychoanalytic understanding of obsessive-compulsive disorder.J Mental Health Hum Behav 2017;22:132-135
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Thapaliya S. The case of rat man: A psychoanalytic understanding of obsessive-compulsive disorder. J Mental Health Hum Behav [serial online] 2017 [cited 2020 Oct 24 ];22:132-135
Available from: https://www.jmhhb.org/text.asp?2017/22/2/132/229101
In this section, we are discussing the case of Dr. Ernst Lanzer, published in case history as “Bemerkungen über einen Fall von Zwangsneurose” or “Notes Upon A Case of Obsessional Neurosis” by Sigmund Freud in 1909. This was the second of the six case histories that Freud published and the first in which he claimed that the patient had been cured by psychoanalysis. The patient presented to Sigmund Freud with number of obsessions of which the main obsession was preoccupation with fear of rats. Freud himself referred affectionately to his patient as the Rattenmann (man of the rats), leading to the name used in the subsequent literature as the “Rat Man.” In Freud's words, “rats had acquired a series of symbolic meanings, to which fresh ones were continually being added.” The patient underwent treatment for around 6 months after which he was declared cured by Freud. Freud originally presented the case of Rat Man in two sessions of the Wednesday Psychological Society in the Fall of 1907 and impressed the First International Psychoanalytic Congress at Salzburg in April of 1908 with the case while the patient was still in treatment.
We consider the case of the “Rat Man” an important landmark work of Sigmund Freud that helped in understanding of clinical presentation and psychoanalytic aspect of obsessive-compulsive disorder (OCD), then termed “obsessional neurosis” by Freud. Although many have criticized Freud's handling of the case and the value of the treatment, strong praise of Freud's efforts continues to appear. Moreover, this case is the only one for which Freud's spontaneous nightly process notes are available.
The biography of Ernst Lanzer was studied and many details were filled in after more than a century of his birth.
Austrian lawyer Dr. Ernst Lanzer, the patient of Freud was born in Vienna on January 22, 1878. He had six siblings. The deaths of her sister in 1881, his father in 1899, and his aunt in 1901 were significant events in his life that changed the course of his personal and professional life.
In 1897, Lanzer joined in the Law Faculty of the University of Vienna, but he could not complete his doctorate until 10 years later, shortly before his analysis with Freud. His romantic relationship with the poor girl Giesla Adler was complicated due to symptoms of his illness and interference by his father. Lanzer entered into an analysis with Freud on October 1, 1907. After relief in the symptoms, he found his first employment in 1908 and secured his job as an attorney in 1913. He made a childless marriage with Giesla in 1908, 10 years after he first fell in love with her. In August 1914, during advent of the world war, he was activated into military service. He was taken prisoner in Russia on November 21, 1914, and died 4 days later.
Ernst Lanzer presented to Freud when he was a young man aged 29 years of University education. He was suffering from obsessional thoughts and behaviors since childhood. The symptoms had worsened over the past 6 years interfering with his completion of the state law examination after few years after his father's death. Ernst's father had never approved of his desire to marry his long-time girlfriend, Gisela and demanded that Ernst give her up.
The chief symptoms were fears that something might happen to two people he loved – his father and the lady whom he was loved and wished to marry. He had started having these fears when he had heard from military captain about a brutal punishment being practised in Eastern Europe in which pot full of wild rats were kept over back of the victim so that they would eat their way into the anal cavity. He had then started having irrational fear that his father and girlfriend could be a potential victim of such a torture. He would be involved in compulsive behaviors such as counting and even praying to ward off the possible evil. The thoughts would intrude into his mind so much that he had difficulty concentrating at his law studies. He also held belief that his mere thinking of such an evil could eventually lead to torture of the friendly father despite the fact that he had already died.
He had also reported of compulsive impulses such as an impulse to cut his throat with a razor. He had wasted years of life fighting against these ideas in his own words because of which he had lost the course of his life. He had tried various treatments without any significant improvement. Freud also observed during the first visit that he was frequently preoccupied about his sexual life. His predominant obsession that compelled him for seeking help was irrational fear about a torture that rats would eat their way into the anal cavity of the potential victims, his father and girlfriend. Freud called this “The Great obsessive fear.”
Summary of Psychoanalysis
Freud's case note after a brief initial introduction discusses the details of the first seven sessions of the treatment. The patient speaks in the first person extensively his interactions with Freud for which he offers some commentary. Having explored the patients' score conflict by free association technique, Freud goes on to summarize the findings from rest of the analysis. First, he demonstrates the meaningfulness of the patient's symptoms surrounding the core conflict giving numerous examples of the adult patient's obsessions and their explanations. Next, Freud discusses the events that precipitated the neurosis and practically crippled the patient in his adult life. Then, in the final section, Freud traces the neurosis to a “father complex” that originated in the patient's childhood. Freud completes his analysis by returning to the proximate situation that brought the patient into therapy and offers a brilliant analysis of the formation of his main symptom.
In the initial sessions the analysis, the patient reveals his childhood experiences related to sexuality from as young as 6 years of age. He was sexually intimate with a young woman, had strong wish to look women naked what Freud terms as “scopophilia” and recalled experiencing penile erections at the age of 6 years old. Freud hypothesizes that neurosis had already taken its shape since his early childhood, rooted in an erotic instinct, and a revolt against it and was associated with distressing affect and performance of defensive acts. He further emphasizes that obsessional neuroses are different from hysterias in that the factors which go to form a psychoneurosis are to be found in the patient's infantile sexual life and not in his present one. Further, Freud discusses about what he terms as the great obsessive fear, the fear of the rats from which the patient bears his famous name, “Rat Man.” Freud asserts that his fear of corporal punishments of his girlfriend and father had stemmed from conflicting ideas of loving and aggressive impulses relating to the people concerned – termed “ambivalence” by Eugen Bleuler. Freud hypothesizes that the obsessive wish got associated with an obsessive fear. Hence, the patient's obsessive fear when restored to its original meaning from childhood, would run as follows: “If I have this wish to see a woman naked, my father will be bound to die.”
When traced to childhood, it was further revealed that from the age of 12, he had fallen in love with a girl. Upon not being able to express his desire, he would have idea that she would be kind and attentive toward him if some misfortune would fall upon his personal life. Patient would then think of his father's death. Freud thus interprets that every fear corresponded to a former wish which was subsequently repressed. Freud further concludes that he had hatred for his father in the unconscious though his intense love prevented it from becoming conscious. Freud discusses that childhood neurosis develops out of residuum of early conflicts and repressions and obsessions could be given a sense in patient's mental life, so as to make them comprehensible and even obvious. Freud also claims that the most eccentric obsessive ideas can be cleared up if they are investigated deeply enough and brought into temporal relationship with the patient's experiences.
Freud gives several examples from patient's life wherein the obsessive symptoms could be explained in temporal relationship to the events surrounding them. In one instant, patient's girlfriend was away to care of her sick grandmother and he was trying his best to prepare for his examination. He suddenly had thought commanding himself to cut his throat with a razor and almost rushed to the cupboard to fetch his razor after which he had thought of killing the old woman instead. Freud's interprets this compulsive idea as a fit of rage to kill the old woman for creating obstacle in fulfilling his love for the lady whereas his suicidal thought was a punishment for the murderous passion. Freud gives the interpretation of the obsessional neurosis to the patient saying that the unconscious part of the self had become separated off from it in infancy, which had not shared the later stages of its development, and which had in consequence become repressed. It was the derivatives of this repressed unconscious that were responsible for the involuntary thoughts which constituted his illness.
In subsequent sessions of psychoanalysis, the patient describes about obsessional ideas surrounding death of his father. Freud interprets that something in the sphere of sexuality stood between the father and son. The evidence was the father had come into some sort of opposition to the son's prematurely developed erotic life such as prohibition of masturbatory acts in the childhood and opposition of relationship with the lady. Freud further emphasizes the temporal relationship between his romantic relationship and obsessions. Like in one instance he was compelled to count the thunderstorm repeatedly when he was hanging out with his girlfriend as a defensive measure against fears that she was in danger of death. Upon departure, patient had developed a compulsive and symbolic act of removing the stone from the road along which she was to drive, and then of undoing this deed of love by replacing the stone where it had lain, so that her carriage might meet accident and she herself be hurt. Freud asserts that patient was having a battle of love and hate and the object of both these feelings was one and the same person.
Near the end of the case note, Freud proposes that the rat idea is central to numerous meanings in patient's mental life, representing a number of his instincts. He particularly emphasized that the fear of rat boring way into the anal canal was related to anal eroticism; his father's filthy sexual excesses in the military; symbolism for the penis as a carrier of syphilitic infection; the desired punishment and death of his loved ones; his own greedy impunity; the proclivity to being persecuted, etc. Freud elaborates on such defense mechanisms as rationalization, doubt, undoing, and displacement that takes place in cases of obsessional neurosis. Interpreting about patient's compulsive behaviors, he discusses that compulsive acts occur in two successive stages, of which the second neutralizes the first, are a typical occurrence in cases of obsessional neurosis. The patient's consciousness naturally misunderstands them and puts forward a set of secondary motives to rationalize them. However, they also have representation conflict between two equal opposing impulses between love and hate.
Subsequent Interpretations and Comments
There is currently an impressive body of literature on the case available that continues to develop. The case has been reinterpreted from different perspectives such as the patient's structural dynamics, ego functions, including identity formation, object relations, interpersonal, and self-psychoanalysis and Freud's therapeutic practice in the case.
A number of significant discrepancies between the published case history and Freud's process notes, which were discovered among his papers after his death, have been pointed out. Freud has also been accused of presenting muddled and inconsistent facts with omissions of information including overemphasis on the father to the exclusion of the mother's role in patient's life. The case also has been revisited and the role of conflicts in patient's relationship with the mother has been discussed.
It has also been accused that Freud has made exaggerated claims about the treatment success. However, it has been generally accepted that Freud made the fundamental discoveries concerning the dynamics and structure of obsessional neurosis and obtained a certain degree of success in restoring his patient to functional life. Others have suggested that by concentrating on building rapport with his patient, at the expense of analyzing the negative transference, Freud merely achieved a temporary transference cure.
Although many have criticized Freud's handling of the case and debates about the value of his treatment have abounded, strong praise of Freud's efforts continues to appear. Moreover, this case is the only one for which Freud's spontaneous nightly process notes are available. It has been appreciated that Freud's interpersonal presence in this case shows such humanizing virtues as openness, respect, strength, mercy, trustworthiness, encouragement, and maternal acceptance at the heart of the therapeutic relationship.
At present, use of selective serotonin reuptake inhibitors (SSRIs) along with behavioral therapy focused on exposure and response prevention, has emerged as the treatment of choice for OCD. As a result, there is rather strong criticism of the use of psychodynamic psychotherapies in treating OCD. The symptoms of OCD are generally regarded as meaningless and irrational and unresponsive to psychoanalysis or psychoanalytic psychotherapy. Yet, therapists have discussed that patients may gain substantial gains, at least as substantial as those achieved with behavior therapy and an SSRI-with long-term psychoanalytic psychotherapy. However, one critical point to keep in mind is that psychological therapies need to be individualized and same techniques may not be generalized to all the cases.
We conclude that the case of Rat Man is at least of historical importance to clinicians for the efforts put by Freud and subsequent interests shown by the psychoanalysts.
Dr. Siddharth Sarkar, Assistant Professor Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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