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From Daniel T. OHara and Gina Masucci MacKenzie’s Introduction to The Interpretation of Dreams

            During the night of July 23–24, 1895, Sigmund Freud (aged thirty-nine) dreamed the dream that came to be known as the “specimen dream” of psychoanalysis, that of Irma’s injection. Freud began the analysis of this much-commented-on dream before either his self-analysis or his book about dreams was fully underway. It occupies the entire second chapter of The Interpretation of Dreams (1900). It is significant, as we will later see, that although the dream occurred fifteen months prior to the death (in October 1896) of his eighty-two-year-old father, Jacob, from heart and bladder failure, its secret core deals with their ambivalent relationship. Although Freud said that the greatest loss a man could suffer in life was the death of his father, this dream helps to explain why that loss may also be a bit of a blessing.

            The dream of Irma’s injection presents a scene in a large hall decorated for the birthday party of Freud’s wife, Martha. As the couple greet guests at the entrance, Freud meets his patient “Irma” (actually a composite of two female patients, Anna Lichtheim and Emma Eckstein, with similar “hysterical” complaints) and some of his medical colleagues, all given pseudonyms: Dr. M., the master diagnostician; Otto, Freud’s needling friend; and another associate, Leopold. As the dream makes clear, hysterical complaints—such as dizziness and breathlessness without exertion, partial paralysis of a limb, abdominal pains not tied to evident gastric obstructions or dietary excesses, loss of voice, and so on—were at the time taken to be the symptoms of what was termed a hysterical neurosis, particularly in women.

            Before he went to bed and had this famous dream, Freud had completed a report for one of these colleagues that justified his treatment for his patient Irma; the report was for the older physician and mentor whom he held in the deepest respect and who appears in the dream as Dr. M. The reason for this sudden bout of conscientious reporting was that earlier that night Otto, a mutual friend and Freud’s contemporary who came to dinner that evening with a cheap gift, a rancid bottle of liqueur, mentioned during casual conversation over cigars that he had just treated Irma for an organic symptom, not a neurotic one. In effect, Otto called into serious question Freud’s psychological diagnosis and therapeutic treatment—the cathartic talking cure for hysterical symptoms (not quite psychoanalysis yet) that he and Josef Breuer had outlined in their controversial Studies on Hysteria (1895). At this point in his career, Freud still held to the seduction theory of the origin of neurosis and to the technique of cathartic discharge as its cure. He came to believe that it is the memory of unconscious fantasies rather than the memory of real events that inaugurates and sustains neurosis, and that reliving traumatic emotion alone, without analytic insight, is not of any permanent help.

            Freud’s Irma dream fantastically supplemented his self-justifying report by showing its dreamer to be correct in his original diagnosis of the psychological rather than the organic nature of Irma’s ailments. It portrays Freud’s friend Otto as a miserly and dangerously bungling fool, his patient Irma as a self-destructively resistant patient who is finally compliant, and the other compliant women in the dream (except his now sixth-time pregnant wife) as dying to have their hysterical secrets also penetrated and cured by this brilliant, if now middle-aged, specialist in nervous diseases, our hero Sigmund Freud.

            The most dramatic moment in the dream comes when Freud and his colleagues examine Irma in the middle of the party. They tap her chest and check her body, whose secrets are all visible for the men to see, as if she were naked. She then obliges them by opening wide her mouth to reveal strange and uncanny structures at once reminiscent of the nasal cavity and of the female genitalia. With the addition of white scabrous patches in her mouth suggesting both discharged sperm and syphilitic infection, Irma’s degradation, one would think, is complete. It is worsened, however, when Otto, who lacks professional conscientiousness, injects Irma’s shoulder with a dirty syringe, causing it to become infected. Despite this, Dr. M. momentarily takes Otto’s side in the dream, and tells the other doctors and Irma not to worry, absurdly enough, as dysentery will soon supervene, and all toxins will thus be expelled. At this point, there appears in the dream the incomplete chemical name and formula for an unknown compound, which are reminiscent of both the main ingredient in the cheap liqueur Otto brought to dinner and of what we now term female hormones, the material trigger of a woman’s sexuality. By the dream’s conclusion, however, the purely physical causes of Irma’s ailments have all been superceded by the psychological cause of repressed sexuality, a “drive,” as Freud will later term it, that exists on the border between nature and culture.

            This dream and its detailed analysis inevitably lead Freud to the conclusion that a dream, any dream, is the disguised “fulfilment of a wish.” To go further, the dream fulfills Freud’s greatest wish: to lay bare the secret of dreams, which is that the mechanism of dreams is wish fulfillment.This dream of Irma’s injection thereby reveals the truth of all dreams by revealing its purely wishful motivation. So certain was Freud of the momentous significance of his discovery about the real meaning of dreams that he immodestly confessed to Wilhelm Fliess—an ear, nose, and throat specialist from Berlin who acted as Freud’s theoretical sounding board and who was given to wild biological speculations—that one day there would be a memorial plaque at the door of the house where he first discovered the secret of dreams. (Freud proved a prophet in this respect).