Sigmund Freud PSYCHO-ANALYTIC NOTES ON AN AUTOBIOGRAPHICAL ACCOUNT OF A CASE OF PARANOIA (DEMENTIA PARANOIDES) [excerpts]
I CASE HISTORY
...Dr. Schreber’s first illness began in the autumn of 1884, and by the end of 1885 he had completely recovered...
he spent six months in Flechsig’s clinic... a formal report... described the disorder as an attack of severe hypochondria. Dr. Schreber assures us that this illness ran its course ‘without the occurrence of any incidents bordering upon the sphere of the supernatural’. (35.)
...We learn that Dr. Schreber had been married long before the time of his ‘hypochondria’. ‘The gratitude of my wife’, he writes, ‘was perhaps even more heartfelt; for she revered Professor Flechsig as the man who had restored her husband to her, and hence it was that for years she kept his portrait standing upon her writing-table.’ (36.) And in the same place: ‘After my recovery from my first illness I spent eight years with my wife - years, upon the whole, of great happiness, rich in outward honours, and only clouded from time to time by the oft repeated disappointment of our hope that we might be blessed with children.’
In June, 1893, he was notified of his prospective appointment as Senatspräsident, and he took up his duties on the first of October of the same year. Between these two dates he had some dreams, though it was not until later that he came to attach any importance to them. He dreamt two or three times that his old nervous disorder had come back; and this made him as miserable in the dream as the discovery that it was only a dream made him happy when he woke up. Once, in the early hours of the morning, moreover, while he was in a state between sleeping and waking, the idea occurred to him ‘that after all it really must be very nice to be a woman submitting to the act of copulation’. (36.) This idea was one which he would have rejected with the greatest indignation if he had been fully conscious.
The second illness set in at the end of October 1893 with a torturing bout of sleeplessness. This forced him to return to the Flechsig clinic... he complained that he had softening of the brain, that he would soon be dead... ideas of persecution were already finding their way into the clinical picture... a high degree of hyperaesthesia was observable - great sensitiveness to light and noise. - Later, the visual and auditory illusions became much more frequent, and, in conjunction with coenaesthetic disturbances, dominated the whole of his feeling and thought. He believed that he was dead and decomposing... he asserted that his body was being handled in all kinds of revolting ways; and... went through worse horrors than any one could have imagined, and all on behalf of a holy purpose... He made repeated attempts at drowning himself in his bath, and asked to be given the "cyanide that was intended for him". His delusional ideas gradually
assumed a mystical and religious character; he was in direct communication with God, he was the plaything of devils, he saw "miraculous apparitions", he heard "holy music", and in the end he even came to believe that he was living in another world.’ (380.)
It may be added that there were certain people by whom he thought he was being persecuted and injured, and upon whom he poured abuse. The most prominent of these was his former physician, Flechsig, whom he called a ‘soul-murderer’; and he used to call out over and over again: ‘Little Flechsig!’ ... He was... brought in June 1894 to the SonnensteinAsylum... where he remained until his disorder assumed its final shape...
Dr. Weber, in his Report of 1899, makes the following remarks: ‘...at the present time, apart from certain obvious psychomotor symptoms which cannot fail to strike even the superficial observer as being pathological... Dr. Schreber shows no signs of confusion or of psychical inhibition, nor is his intelligence noticeably impaired. His mind is collected, his memory is excellent, he has at his disposal a very considerable store of knowledge (not merely upon legal questions, but in many other fields), and he is able to reproduce it in a connected train of thought. He takes an interest in following events in the world of politics, science and art, etc., and is constantly occupied with such matters... and an observer who was uninstructed upon his general condition would scarcely notice anything peculiar in these directions. In spite of all this, however, the patient is full of ideas of pathological origin, which have formed themselves into a complete system; they are more or less fixed, and seem to be inaccessible to correction by means of any objective appreciation and judgement of the external facts.’ ... ‘Since for the last nine months Herr Präsident Schreber has taken his meals daily at my family board, I have had the most ample opportunities of conversing with him upon every imaginable topic. Whatever the subject was that came up for discussion (apart, of course, from his delusional ideas), whether it concerned events in the field of administration and law, of politics, art, literature or social life - in short, whatever the topic, Dr. Schreber gave evidence of a lively interest, a well-informed mind, a good memory, and a sound judgement; his ethical outlook, moreover, was one which it was impossible not to endorse. So, too, in his lighter talk with the ladies of the party, he was both courteous and affable, and when he touched upon matters in a more humorous vein he invariably displayed tact and decorum. Never once, during these innocent talks round the dining-table, did he introduce subjects which should more properly have been raised at a medical consultation.’ (397-8.) Indeed, on one occasion during this period when a business question arose which involved the interests of his whole family, he entered into it in a manner which showed both his technical knowledge and his common sense.
In the numerous applications to the courts, by which Dr. Schreber endeavoured to regain his liberty, he did not in the least disavow his delusions or make any secret of his intention of publishing the Denkwürdigkeiten. On the contrary, he dwelt upon the importance of his ideas to religious thought, and upon their invulnerability to the attacks of modern science; but at the same time he laid stress upon the ‘absolute harmlessness’ (430) of all the actions which, as he was aware, his delusions obliged him to perform. Such, indeed, were his acumen and the cogency of his logic that finally, and in spite of his being an acknowledged paranoic, his efforts were crowned with success. In July, 1902, Dr. Schreber’s civil rights were restored, and in the following year his Denkwürdigkeiten eines Nervenkranken appeared, though in a censored form and with many valuable portions omitted.
The Court Judgement that gave Dr. Schreber back his liberty summarizes the content of his delusional system in a few sentences: ‘He believed that he had a mission to redeem the world and to restore it to its lost state of bliss. This, however, he could only bring about if he were first transformed from a man into a woman.’ (475.)
For a more detailed account of his delusions as they appeared in their final shape we may turn to Dr. Weber’s Report of 1899: ‘The culminating point of the patient’s delusional system is his belief that he has a mission to redeem the world, and to restore mankind to their lost state of bliss. He was called to this task, so he asserts, by direct inspiration from God, just as we are taught that the Prophets were; for nerves in a condition of great excitement, as his were for a long time, have precisely the property of exerting an attraction upon God - though this is touching on matters which human speech is scarcely, if at all, capable of expressing, since they lie entirely outside the scope of human experience and, indeed, have been revealed to him alone. The most essential part of his mission of redemption is that it must be preceded by his transformation into a woman. It is not to be supposed that he wishes to be transformed into a woman; it is rather a question of a "must" based upon the Order of Things, which there is no possibility of his evading, much as he would personally prefer to remain in his own honourable and masculine station in life. But neither he nor the rest or mankind can regain the life beyond except by his being transformed into a woman (a process which may occupy many years or even decades) by means of divine miracles. He himself, of this he is convinced, is the only object upon which divine miracles are worked, and he is thus the most remarkable human being who has ever lived upon earth. Every hour and every minute for years he has experienced these miracles in his body, and he has had them confirmed by the voices that have conversed with him. During the first years of his illness certain of his bodily organs suffered such destructive injuries as would inevitably have led to the death of any other man: he lived for a long time without a stomach, without intestines, almost without lungs, with a torn oesophagus, without a bladder, and with shattered ribs, he used sometimes to swallow part of his own larynx with his food, etc. But divine miracles ("rays") always restored what had been destroyed, and therefore, as long as he remains a man, he is altogether immortal. These alarming phenomena have ceased long ago, and his "femaleness" has become prominent instead. This is a matter of a process of development which will probably require decades, if not centuries, for its completion, and it is unlikely that anyone now living will survive to see the end of it. He has a feeling that enormous numbers of "female nerves" have already passed over into his body, and out of them a new race of men will proceed, through a process of direct impregnation by God. Not until then, it seems, will he be able to die a natural death, and, along with the rest of mankind, will he regain a state of bliss. In the meantime not only the sun, but trees and birds, which are in the nature of "bemiracled residues of former human souls", speak to him in human accents, and miraculous things happen everywhere around him.
...The psycho-analyst, in the light of his knowledge of the psychoneuroses, approaches the subject with a suspicion that even thought-structures so extraordinary as these and so remote from our common modes of thinking are nevertheless derived from the most general and comprehensible impulses of the human mind...
The medical officer lays stress upon two points as being of chief importance: the patient’s assumption of the role of Redeemer, and his transformation into a woman. The Redeemer delusion is a phantasy that is familiar to us through the frequency with which it forms the nucleus of religious paranoia. The additional factor, which makes the redemption dependent upon the man being previously transformed into a woman, is unusual and in itself bewildering, since it shows such a wide divergence from the historical myth... the idea of being transformed into a woman (that is, of being emasculated) was the primary delusion, that he began by regarding that act as constituting a serious injury and persecution, and that it only became related to his playing the part of Redeemer in a secondary way. There can be no doubt, moreover, that originally he believed that the transformation was to be effected for the purpose of sexual abuse and not so as to serve higher designs. The position may be formulated by saying that a sexual delusion of persecution was later on converted in the patient’s mind into a religious delusion of grandeur. The part of persecutor was at first assigned to Professor Flechsig, the physician in whose charge he was; later, his place was taken by God Himself.
...It may be added that the ‘voices’ which the patient heard never treated his transformation into a woman as anything but a sexual disgrace, which gave them an excuse for jeering at him. ‘Rays of God! not infrequently thought themselves entitled to mock at me by calling me "Miss" Schreber", in allusion to the emasculation which, it was alleged, I was about to undergo.’ Or they would say: ‘So this sets up to have been a Senatspräsident, this person who lets himself be f--d!’# Or again: ‘Don’t you feel ashamed in front of your wife?’
That the emasculation phantasy was of a primary nature and originally independent of the Redeemer motif becomes still more probable when we recollect the ‘idea’ which, as I mentioned on an earlier page, occurred to him while he was half asleep, to the effect that it must be nice to be a woman submitting to the act of copulation.
Schreber himself gives the month of November, 1895, as the date at which the connection was established between the emasculation phantasy and the Redeemer idea and the way thus paved for his becoming reconciled to the former. ‘Now, however,’ he writes, ‘I became clearly aware that the Order of Things imperatively demanded my emasculation, whether I personally liked it or no, and that no reasonable course lay open to me but to reconcile myself to the thought of being transformed into a woman. The further consequence of my emasculation could, of course, only be my impregnation by divine rays to the end that a new race of men might be created.’ ...The attitude of our patient towards God is so singular and so full of internal contradictions that it requires more than alittle faith to persist in the belief that there is nevertheless ‘method’ in his ‘madness’... At every point in his theory we shall be struck by the astonishing mixture of the commonplace and the clever, of what has been borrowed and what is original.
It not infrequently happens in the Denkwürdigkeiten that an incidental note upon some piece of delusional theory gives us the desired indication of the genesis of the delusion and so of its meaning... In this connection see my discussion below on the significance of the sun.... When the work of creation was finished, God withdrew to an immense distance (10-11 and 252) and, in general, resigned the world to its own laws. He limited His activities to drawing up to Himself the souls of the dead. It was only in exceptional instances that He would enter into
relations with particular, highly gifted persons, or would intervene by means of a miracle in the destinies of the world. God does not have any regular communication with human souls, in accordance with the Order of Things, till after death." When a man dies, his spiritual parts (that is,
his nerves) undergo a process of purification before being finally reunited with God Himself as ‘fore-courts of Heaven’. Thus it comes about that everything moves in an eternal round, which lies at the basis of the Order of Things. In creating anything, God is parting with a portion of Himself, or is giving a portion of His nerves a different shape. The apparent loss which He thus sustains is
made good when, after hundreds and thousands of years, the nerves of dead men, that have
entered the state of bliss, once more accrue to Him as ‘fore-courts of Heaven’ (18 and 19 n.).
Souls that have passed through the process of purification enter into the enjoyment of a state of
bliss.# In the meantime they have lost some of their individual consciousness, and have become
fused together with other souls into higher unities. Important souls, such as those of men like
Goethe, Bismarck, etc., may have to retain their sense of identity for hundreds of years to come,
before they too can become resolved into higher soul-complexes, such as ‘Jehovah rays’ in the
case of ancient Jewry: or ‘Zoroaster rays’ in the case of ancient Persia. In the course of their
purification ‘souls learn the language which is spoken by God himself, the so-called "basic
language", a vigorous though somewhat antiquated German...
God Himself is not a simple entity. ‘Above the "fore-courts of Heaven" hovered God Himself, who,
in contradistinction to these "anterior realms of God", was also described as the "posterior realms
of God". The posterior realms of God were, and still are, divided in a strange manner into two
parts, so that a lower God (Ahriman) was differentiated from an upper God (Ormuzd).’ (19.) As
regards the significance of this division Schreber can tell us no more than that the lower God was
more especially attached to the peoples of a dark race (the Semites) and the upper God to those
of a fair race (the Aryans); nor would it be reasonable, in such sublime matters, to expect more of
human knowledge. Nevertheless, we are also told that ‘in spite of the fact that in certain respects
God Almighty forms a unity, the lower and the upper God must be regarded as separate Beings, each of which possesses its own particular egoism and its own particular instinct of selfpreservation, even in relation to the other, and each of which is therefore constantly endeavouring to thrust itself in front of the other’ (140 n.)....
For there is a flaw in the Order of Things, as a result of which the existence of God Himself seems
to be endangered. Owing to circumstances which are incapable of further explanation, the
nerves of living men, especially when in a condition of intense excitement, may exercise such
powerful attraction upon the nerves of God that He cannot get free from them again, and thus
His own existence may be threatened (11). This exceedingly rare occurrence took place i
Schreber’s case and involved him in the greatest sufferings. The instinct of self-preservation was
aroused in God (30), and it then became evident that God was far removed from the perfection
ascribed to him by religions. Through the whole of Schreber’s book there runs the bitter complaint
that God, being only accustomed to communication with the dead, does not understand living
God was... quite incapable of dealing with living men, and was only accustomed to communicate
with corpses, or at most with men as they lay asleep (that is, in their dreams).’
The behaviour of God in the matter of the urge to evacuate (or ‘sh--’) rouses him to a specially
high pitch of indignation. The passage is so characteristic that I will quote it in full. But to make it
clear I must first explain that both the miracles and the voices proceed from God, that is, from the
‘Although it will necessitate my touching upon an unsavoury subject, I must devote a few more
words to the question that I have just quoted ("Why don’t you sh--?") on account of the typical
character of the whole business. The need for evacuation, like all else that has to do with my
body, is evoked by a miracle. It is brought about by my faeces being forced forwards (and
sometimes backwards again) in my intestines; and if, owing to there having already been an
evacuation, enough material is not present, then such small remains as there may still be of the
contents of my intestines are smeared over my anal orifice. This occurrence is a miracle
performed by the upper God, and it is repeated several dozens of times at the least every day. It
is associated with an idea which is utterly incomprehensible to human beings and can only be
accounted for by God’s complete ignorance of living man as an organism. According to this idea
"sh--ing" is in a certain sense the final act; that is to say, when once the urge to sh-- has been
miracled up, the aim of destroying the understanding is achieved and a final withdrawal of the
rays becomes possible. To get to the bottom of the origin of this idea, we must suppose, as it
seems to me, that there is a misapprehension in connection with the symbolic meaning of the act
of evacuation, a notion, in fact, that any one who has been in such a relation as I have with
divine rays is to some extent entitled to sh-- upon the whole world.
‘But now what follows reveals the full perfidy! of the policy that has been pursued towards me
Almost every time the need for evacuation was miracled up in me, some other person in my
vicinity was sent (by having his nerves stimulated for that purpose) to the lavatory, in order to
prevent my evacuating. This is a phenomenon which I have observed for years and upon such
countless occasions - thousands of them - and with such regularity, as to exclude any possibility
of its being attributable to chance. And thereupon comes the question: "Why don’t you sh--?" to
which the brilliant repartee is made that I am "so stupid or something". The pen well-nigh shrinks
from recording so monumental a piece of absurdity as that God, blinded by His ignorance of
human nature, can positively go to such lengths as to suppose that there can exist a man too
stupid to do what every animal can do - too stupid to be able to sh--. When, upon the occasion of
such an urge, I actually succeed in evacuating - and as a rule, since I nearly always find the
lavatory engaged, I use a pail for the purpose - the process is always accompanied by the
generation of an exceedingly strong feeling of spiritual voluptuousness. For the relief from the
pressure caused by the presence of the faeces in the intestines produces a sense of intense
well-being in the nerves of voluptuousness; and the same is equally true of making water. For this
reason, even down to the present day, while I am passing stool or making water, all the rays are
always without exception united; for this very reason, whenever I address myself to these natural
functions, an attempt is invariably made, though as a rule in vain, to miracle backwards the urge
to pass stool and to make water.’" ...
Furthermore, this singular God of Schreber’s is incapable of learning anything by experience:
‘Owing to some quality or other inherent in his nature, it seems to be impossible for God to derive
any lessons for the future from the experience thus gained.’ (186.) He can therefore go on
repeating the same tormenting ordeals and miracles and voices, without alteration, year after
year, until He inevitably becomes a laughing-stock to the victim of His persecutions.
‘The consequence is that, now that the miracles have to a great extent lost the power which they
formerly possessed of producing terrifying effects, God strikes me above all, in almost everythin
that happens to me, as being ridiculous or childish. As regards my own behaviour, this ofte
results in my being obliged in self-defence to play the part of a scoffer at God, and even, on
occasion, to scoff at Him aloud."
This critical and rebellious attitude towards God is, however, opposed in Schreber’s mind by an
energetic counter-current, which finds expression in many places: ‘But here again I must most
emphatically declare that this is nothing more than an episode, which will, I hope, terminate at the
latest with my decease, and that the right of scoffing at God belongs in consequence to me
alone and not to other men. For them He remains the almighty creator of Heaven and earth, the
first cause of all things, and the salvation of their future, to whom - not withstanding that a few of
the conventional religious ideas may require revision - worship and the deepest reverence are
Repeated attempts are therefore made to find a justification for God’s behaviour to the patient. In
these attempts, which display as much ingenuity as every other theodicy, the explanation is
based now upon the general nature of souls, and now upon the necessity for self-preservation
under which God lay, and upon the misleading influence of the Flechsig soul (60-1 and 160). I
general, however, the illness is looked upon as a struggle between Schreber the man and God,
in which victory lies with the man, weak though he is...
No attempt at explaining Schreber’s case will have any chance of being correct which does not
take into account these peculiarities in his conception of God, this mixture of reverence and
rebelliousness in his attitude towards Him...
We shall find, indeed, that this ‘close relationship’ is the rock upon which the patient builds his
hopes of an eventual reconciliation with God and of his sufferings being brought to an end. The
rays of God abandon their hostility as soon as they are certain that in becoming absorbed into
his body they will experience spiritual voluptuousness (133); God Himself demands that He shall
be able to find voluptuousness in him (283), and threatens him with the withdrawal of His rays if
he neglects to cultivate voluptuousness and cannot offer God what He demands (320).
This surprising sexualization of the state of heavenly bliss suggests the possibility that Schreber’s
concept of the state of bliss is derived from a condensation of the two principal meanings of the
German word ‘selig’ - namely, ‘dead’ and ‘sensually happy’.! But this instance of sexualization will
also give us occasion to examine the patient’s general attitude to the erotic side of life and to
questions of sexual indulgence. For we psycho-analysts have hitherto supported the view that
the roots of every nervous and mental disorder are chiefly to be found in the patient’s sexual life...
Before his illness Senatspräsident Schreber had been a man of strict morals: ‘Few people’, he
declares, and I see no reason to doubt his assertion, ‘can have been brought up upon such stric
moral principles as I was, and few people, all through their lives, can have exercised (especially in
sexual matters) a self-restraint conforming so closely to those principles as I may say of myself
that I have done.’ (281.) After the severe spiritual struggle, of which the phenomena of his illness
were the outward signs, his attitude towards the erotic side of life was altered. He had come to
see that the cultivation of voluptuousness was incumbent upon him as a duty, and that it was
only by discharging this duty that he could end the grave conflict which had broken out within him
- or, as he thought, about him. Voluptuousness, so the voices assured him, had become ‘Godfearing’
and he could only regret that he was not able to devote himself to its cultivation the
whole day long." (285.)
Such then, was the result of the changes produced in Schreber by his illness, as we find them
expressed in the two main features of his delusional system. Before it he had been inclined to
sexual asceticism and had been a doubter in regard to God; while after it he was a believer in
God and a devotee of voluptuousness. But just as his re-conquered belief in God was of a
peculiar kind, so too the sexual enjoyment which he had won for himself was of a most unusual
character. It was not the sexual liberty of a man, but the sexual feelings of a woman. He took up
a feminine attitude towards God; he felt that he was God’s wife
No other part of his delusions is treated by the patient so exhaustively, one might almost say so
insistently, as his alleged transformation into a woman. The nerves absorbed by him have, so he
says, assumed in his body the character of female nerves of voluptuousness, and have given to
his body a more or less female stamp, and more particularly to his skin a softness peculiar to the
female sex (87). If he presses lightly with his fingers upon any part of his body, he can feel these
nerves, under the surface of the skin, as a tissue of a thread-like or stringy texture; they are
especially present in the region of the chest, where, in a woman, her breasts would be. ‘By
applying pressure to this tissue, I am able to evoke a sensation of voluptuousness such as
women experience, and especially in I think of something feminine at the same time.’ (277.) He
knows with certainty that this tissue was originally nothing else than nerves of God, which could
hardly have lost the character of nerves merely through having passed over into his body (279).
By means of what he calls ‘drawing’ (that is, by calling up visual images) he is able to give both
himself and the rays an impression that his body is fitted out with female breasts and genitals: ‘It
has become so much a habit with me to draw female buttocks on to my body - honi soit qui mal y
pense - that I do it almost involuntarily every time I stoop.’ (233.) He is ‘bold enough to assert that
anyone who should happen to see me before the mirror with the upper portion of my torso bared
- especially if the illusion is assisted by my wearing a little feminine finery - would receive an
unmistakable impression of a female bust’. (280.) He calls for a medical examination, in order to
establish the fact that his whole body has nerves of voluptuousness dispersed over it from head
to foot, a state of things which is only to be found, in his opinion, in the female body, whereas, in
the male, to the best of his knowledge, nerves of voluptuousness exist only in the sexual organs
and their immediate vicinity (274). The spiritual voluptuousness which has been developed owing
to this accumulation of nerves in his body is so intense that it only requires a slight effort of his
imagination (especially when he is lying in bed) to procure him a feeling of sensual well-being that
affords a tolerably clear adumbration of the sexual pleasure enjoyed by a woman during
‘Something occurred in my own body similar to the conception of Jesus Christ in an immaculate virgin, that
is, in a woman who had never had intercourse with a man. On two separate occasions (and while I was still
in Professor Flechsig’s institution) I have possessed female genitals, though somewhat imperfectly
developed ones, and have felt a stirring in my body, such as would arise from the quickening of a human
embryo. Nerves of God corresponding to male semen had, by a divine miracle, been projected into my body,
and impregnation had thus taken place.’ (Introduction, 4.)
If we now recall the dream which the patient had during the incubation period of his illness,
before he had moved to Dresden, it will become clear beyond a doubt that his delusion of being
transformed into a woman was nothing else than a realization of the content of that dream. At
that time he had rebelled against the dream with masculine indignation, and in the same way he
began by striving against its fulfilment in his illness and looked upon his transformation into
woman as a disgrace with which he was threatened with hostile intention. But there came a time
(it was in November, 1895) when he began to reconcile himself to the transformation and bring it
into harmony with the higher purposes of God: ‘Since then, and with a full consciousness of what
I did, I have inscribed upon my banner the cultivation of femaleness.’ (177-8.) ...
‘On the other hand, God demands a constant state of enjoyment, such as would be in keeping
with the conditions of existence imposed upon souls by the Order of Things; and it is my duty to
provide Him with this . . . in the shape of the greatest possible generation of spiritual
voluptuousness. And if, in this process, a little sensual pleasure falls to my share, I feel justified in
accepting it as some slight compensation for the inordinate measure of suffering and privatio
that has been mine for so many past years . . .’ (283.)
‘. . . I think I may even venture to advance the view based upon impressions I have received, tha
God would never take any steps towards effecting a withdrawal - the first result of which is
invariably to alter my physical condition markedly for the worse - but would quietly an
permanently yield to my powers of attraction, if it were possible for me always to be playing the
part of a woman lying in my own amorous embraces, always to be casting my looks upon female
forms, always to be gazing at pictures of women, and so on.’ (284-5.) In Schreber’s system the
two principal elements of his delusions (his transformation into a woman and his favoured relation
to God) are linked in his assumption of a feminine attitude towards God. It will be an unavoidable
part of our task to show that there is an essential genetic relation between these two elements.
Otherwise our attempts at elucidating Schreber’s delusions will leave us in the absurd position
described in Kant’s famous simile in the Critique of Pure Reason - we shall be like a man holding
a sieve under a he-goat while some one else milks it.