The Collected Clinical Works of Alfred Adler, Volume 9 - Case Histories Problems of Neurosis -

311 Pages·2005·1.36 MB·English

by  Adler

The Collected Clinical Works of Alfred Adler Volume 9
Case Histories
Problems of Neurosis
The Case of Mrs. A.
The Case of Miss R.
Alfred Adler
Edited by Henry T. Stein, Ph.D.
Classical Adlerian Translation Project
© 2005 by Henry T. Stein, Ph.D.
All rights reserved under International and Pan-American Copyright
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from the editor. All inquiries should be sent to Henry T. Stein, Ph.D., Classical
Adlerian Translation Project, 2565 Mayflower Lane, Bellingham, WA 98226.
Tel [phone] or e-mail to [email protected] .
Published 2005 by The Classical Adlerian Translation Project.
Printed in the United States of America
0-9715645-9-0
Table of Contents
Editor’s Preface 2005 ............................................................................. iii
Part 1: Problems of Neurosis .................................................................1 Chapter
I: Goals of Superiority.....................................................2 Boy 17: Fear of
Decisions ...............................................3 Man 35: Agoraphobia and Heart
Symptoms ...................5 Man 40: Fear of Heights
..................................................6 Woman 27: Suffering from Obsessions
...........................6 Chapter II: Not Meeting the Problems of
Life............................13 Boy 18: Schizophrenic
...................................................13
Elderly Woman: Depression ..........................................15 Woman 46:
Domination with Depression .....................15
Chapter III: Deficient Social Feeling, Masculine Protest ..........20
Boy with Obsessive Guilt Feelings ................................25
Woman 26: Who Wanted to be a Man ..........................28
Chapter IV: Problems in Love and Marriage .............................31
Man 23: Dominating Through Drinking ........................34
His Wife Takes Morphine .............................................35 Mistress with
Headaches and Palpitations .....................38
Chapter V: Neurotic Style of Life and Psychotherapy ..............42
Boy 15: Believed He Was a Prophet .............................45
Man 40: Clairvoyant and Speechless .............................46
Principles of Psychotherapy ..........................................46 Man 32: Escape
Through Drinking ...............................49
Suicidal Medical Student ...............................................53 Chapter VI: Neurotic
Use of Emotion .......................................55
Man 50: Depressed When All is Well ...........................55
Man 36: Impotence and Polygamous Desires ...............56
Man 50: Beggar as King ................................................58
Man 53: Agoraphobia – Avoidance of People ..............60
Chapter VII: The Family Constellation ....................................63
Position of the First Child ..............................................63
Effects of Dethronement ................................................64 First Child May Keep
Position ......................................65
Attitude of Eldest Toward Authority .............................66
Position of Second Child ...............................................67 Position of Youngest
Child ............................................70 Difficulties of an Only Child
.........................................72
Case of Homosexual Development ...............................73
Importance of Evaluation of Men and Women .............77
i Chapter VIII: Earliest Recollections ..........................................79
Chapter IX: Further Useless Goals of Superiority .....................84
Sadism and Masochism .................................................85 Man 32:
Erythrophobia ..................................................87 Man 45: Swallowing Air
...............................................88
Man 40: Wanting to Marry His Cousin .........................89
Woman 60: Jealousy ......................................................90 Woman: Neurotic
Heart and Jealousy ...........................91
Man 38: Agoraphobia and Fear of Syphilis ...................92
Boy 14: Shirking the Masculine Ideal ...........................92
Woman 20: Masochistic Fantasies ................................93 Chapter X:
Occupational Choices and Sleep Postures ..............96
Body Postures and Sleep Postures ...............................100
Chapter XI: Organ Dialect and Dreams....................................102
Woman 25: Anxiety Neurosis .....................................102 Critical, Compulsive
Housewife ..................................102 Organ Dialect
...............................................................103 A Woman’s Revenge Against Her
Father ...................104
Depression as Safeguard Against Marriage .................106
Sleep and Hypnosis ......................................................106
Antagonism to a Wife Awake and Dreaming ..............109
Part 2: The Case of Mrs. A. ...............................................................112
General Introductory Comments ............................................113
The Case of Mrs. A. ................................................................116
Part 3: The Case of Miss R. ...............................................................141
Preface .....................................................................................142 Chapter I:
Early Childhood ......................................................150
Chapter II: Adolescent Difficulties ..........................................160
Chapter III: The Development of a Neurosis ..........................168
Chapter IV: The Style of Life ..................................................178
Chapter V: The Jealousy Mania ..............................................193
Chapter VI: Sexual Development ............................................200
Chapter VII: The Problem of Love ..........................................213
Chapter VIII: The Shock of Sexual Knowledge ......................228
Chapter IX: The Masculine Protest .........................................244
Chapter X: A Lupus Phobia .....................................................260
Chapter XI: Yes! But-- ............................................................282
Chapter XII: The Goal of Superiority .....................................303
Index ........................................................................................321 Appendix:
“Basic Principles of
Classical Adlerian Psychology” ..............................................339
ii
Editor’s Preface – 2005
Volume nine brings together three of Adler’s books on case histories:
Problems of Neurosis, The Case of Mrs. A., and The Case of Miss R. Although
these books were previously published in English, the text required substantial
editing for readability. Adler’s diagnostic brilliance now shines through without
the distractions of dated terminology and awkward phrasing.
Adler takes us on a fascinating journey of life style analysis through
progressive levels of understanding. In Problems of Neurosis, he offers us vivid
thumbnail sketches of thirty-three cases, spanning the symptoms of depression,
obsession, compulsion, alcoholism, schizophrenia, clairvoyance, agoraphobia,
impotence, sadism, masochism, and jealousy. He also discusses the general
topics of family constellation, earliest recollections, body postures, sleep
postures, organ dialect, and hypnosis.
In The Case of Mrs. A., Adler takes us further into a single style of life.
Working from the notes presented by another physician, he spontaneously
comments on each segment of information offered to him. Using the diagnostic
common in medicine, he gathers data, makes conjectures, then tests them until
he establishes a coherent theme. He even ventures to predict the consequences of
behavioral patterns. In a presentation of modest length, he achieves his goal of
clearly illustrating the unity of a style of life.
The Case of Miss R . takes us into deeper waters. In the mid1920’s, a
journalist presented The Diary of Claire Macht to Adler. After studying the
material, he offered his comments in a series of eight presentations to an
Individual Psychology Association. Originally titled The Technique of Individual
Psychology, Volume 1: The Art of Reading a Life-and-Case History, it was first
issued in Germany, then translated into English and published in 1929. In her
autobiographical narrative, a young working-class woman recalls her sexual
awakening in early twentieth-century Vienna with striking candor No doubt
shocking to a reader in the 1920’s, the sexually explicit material is commonplace
in psychological literature today. However, Adler’s artful construction of a
unified psychological portrait is compelling to follow, similar to watching an
artist like Rembrandt at work. He weaves early family influences and social
conditions into a unique tapestry.
iii
Volume nine is a “must read” for anyone interested in the art of life style
analysis. His remarkable theory springs to life in this series of richly varied case
histories.
For readers unfamiliar with Adler’s ideas, a brief overview, titled “Basic
Principles of Classical Adlerian Psychology,” is included in the appendix. Other
comprehensive articles, titled “Classical Adlerian Theory and Practice” and “A
Psychology of Democracy” have been published in Volumes 1 & 2 of The
Collected Clinical Works of Alfred Adler. A deeper appreciation of the
development of Adler’s theory can be achieved by studying Volumes 1-8.
iv Part 1
1 2
Problems of Neurosis
A Book of Case Histories
1 First published in 1929 by Routleldge & Kegan Paul, Ltd., London.
Edited by P. Mairet.
2 Additional editing by Henry T. Stein, Ph.D., 2005.
Chapter I Goals of Superiority
The problem of every neurosis is, for the patient, the difficult maintenance
of a style of acting, thinking and perceiving which distorts and denies the
demands of reality. Usually, only when this way of life has become arduous to
the verge of breakdown is the case brought to the physician, whose task is to find
the right method for its correction. Therefore, the common problem of both
patient and physician, and the basis of their cooperation, is to understand the
nature of the patient’s mistakes. This understanding demands not only an
accurate outline of his significant history, but also a perception of the dynamic
unity of that history as a continual striving toward an implied conception of
superiority.
As the work of Individual Psychologists has abundantly proved, an
individual goal of superiority is the determining factor in every neurosis, but the
goal itself always originates in, and is strictly conditioned by the actual
experiences of inferiority. The physician’s first line of approach is to identify the
real causes of the feelings of inferiority, which the patient disguises from himself
in various degrees and in his individual manner. Since the feeling of inferiority is
generally regarded as a sign of weakness and as something shameful, he
naturally has a strong tendency to conceal it. Indeed, the effort of concealment
may be so great that the person himself ceases to be aware of his inferiority as
such, being entirely preoccupied with the consequences of the feeling and with
all the objective details that serve its concealment. So efficiently may an
individual train his whole mentality for this task that the entire current of his
psychic life flowing ceaselessly from below to above--that is, from the feeling of
inferiority to that of superiority-occurs automatically and escapes his own notice.
It is not surprising, therefore, that we often receive a negative reply when
we ask a person whether he has a feeling of inferiority. It is better not to press
the point, but to observe his mental and psychic movements, in which the
attitude and individual aim can always be discerned. In this way we soon
perceive a greater or lesser degree of the feeling of inferiority in everyone,
together with a compensatory striving toward a goal of superiority. Such a
universal feeling is not in itself indictable; its meaning and value depend entirely
on how it is used. The most important discovery of Individual Psychology is that
the inferiority may be used as a stimulus to continue on the useful side of life.
Boy 17: Fear of Decisions
These general observations clearly apply to the case of a seventeen-year-old
boy, the second child in the family, who was brought to me because he suffered
from anxiety, and became extremely angry when confronted with difficulties. He
also had stomach trouble and diarrhea when he went mountaineering, a sport
which he sometimes shared with his comrades. His mother was intelligent and
liked him, but apparently preferred his elder brother who gave her less trouble.
This elder brother was much stronger, taller, and a good sportsman. The father
was a capable man and the patient esteemed him highly.
This boy was afraid of making any decisions because his feeling of
inferiority was too great for him to trust himself. He was unwilling, however, to
admit that this feeling was due to any cause within his control. He insisted that
he was born such as he was and his nature was not his responsibility.
The patient’s attitude toward life was one of hesitation. When confronted
with problems he created difficulties, but though he thus “slowed down,” he did
not stop altogether. He was a good pupil at school, but in constant fear of losing
even this advantage, and he could not decide at all what to do upon leaving high
school. He made no friends, did not like girls, and was afraid of sexual
experiences. He believed some of his difficulties resulted from masturbation and
nocturnal emissions. This behavior shows typical indecision and lack of
confidence in regard to the three problems of life: friendship, occupation, and
love. The response to all three problems was evaded or postponed. He disguised
his sense of general inadequacy by making various causes responsible, thus
reassuring and convincing himself of worth. It is notable, however, that the
patient went on in spite of difficulties. He studied well, and he climbed
mountains, which by the way, is a common activity of people who feel
overburdened with life, to give themselves feelings of superiority. To review and
emphasize the difficulties of life from the viewpoint of a superior feeling is the
next best thing to being able to boast that one has overcome them. It was in order
to escape from the consciousness of his inferiority feeling that this patient
blamed his weakness on natural difficulties and masturbation, and especially on
inherited deficiencies.
The theory of heredity must never be emphasized in education or in the
theory and practice of psychology. Except in cases of congenital mental
retardation, everyone can do everything necessary. This is not, of course, to deny
the differences of inherited physical and mental capacities, but what counts is the
use we make of them. Only in this way do we see the enormous significance of
education. Correct education develops the individual, with all his inherited
abilities and disabilities. With courage and training, disabilities may be so
compensated that they even become great abilities. When correctly encountered,
a disability becomes the stimulus for higher achievement. We are no longer
surprised to find that those who have attained remarkable successes in life have
often been handicapped in the beginning with disabilities and great feelings of
inferiority. On the other hand, we find that a person who believes himself the
victim of inherited deficiencies and disabilities, lessens his efforts with a feeling
of hopelessness, thus permanently hindering his development.
Teachers exaggerate the harmfulness of hereditary factors to excuse the
inefficiency of their own methods. It is interesting to read in Einhardt’s
biography of Charlemagne that this great Emperor could learn neither reading
nor writing, from sheer lack of talent for such things. Now, with the proper
development of educational methods, no normal child finds these tasks beyond
him. This and many other examples show that whenever authors, teachers or
parents fail to find a method to correct errors by education, they blame the
child’s inherited deficiencies. This superstition is one of the greatest difficulties
and the most commonly encountered in education and in handling “problem
children,” not to mention the treatment of criminals, neurotics, and psychotics.
Yet for the treatment of these conditions, the only reasonable assumption is the
one made by Individual Psychology: that everyone is equal to his lifetask. This
does not mean that the results are or can be equal, for of course, we must
consider inequalities of training, method, and above all the degree of courage
shown.
To return to the case in question, the ability of this boy’s father was an
additional reason for his feeling that he could not make good in life. It is well
known that the children of great men are often unsuccessful; they feel incapable
of ever attaining positions as high as their fathers held, and therefore do not
seriously attempt anything at all. In the case of this patient, the high
achievements of his elder brother also lengthened his distance from the goal of
superiority in the family circle. He felt himself hopelessly surpassed. The
neurosis which he developed was a protection from the painful consciousness of
this inferiority. It was the adoption of an attitude which signified to him: “If I
were not anxious, if I were not ill, I would be able to do as well as the others. If
my life were not full of terrible difficulties, I would be the first.” With this
attitude, a person can still feel superior, for the evaluation of his worth and value
is placed beyond proof, in the realm of possibilities. His chief occupation in life
is to look for difficulties, to find means of increasing them, or at least of
increasing his own sense of their gravity. He carefully collects and exhibits the
most ordinary difficulties of life, common to everybody. He does this more to
impress himself than others, but naturally other people take his burdens into
account and do not expect so much of him. Any success he may have, moreover,
is magnified by this heavily-advertised handicap, so that it becomes his most