The second case is that of a patient who, as a child, had some convulsive attacks.  She was therefore considered delicate and was thoroughly spoiled.  When nearly thirty she lived through a sexual experience which caused extreme anxiety; she broke down and was admitted to an asylum.  After admission she looked across the dormitory and saw a head appearing above the bed-clothes, the hair of which had been cut short for hygienic reasons.  With a memory of her sexual indiscretion still vivid in her mind she jumped to the conclusion that she was in a place where men and women were crowded together in the same room.  She got out of bed, refused to return to it, fought against the nurses and was transferred to a single room, with the mattress on the floor and the window shuttered.  She wondered where she was and came to the conclusion that she was in a horse-box.  Then arose a feeling of terror that she would be at the disposal of the grooms when they returned from work.  The sound of heavy footsteps of the patients passing along the corridor to the tea-room suggested that the grooms were returning and that her room would soon be invaded.  The feeling of terror increased and she tried to hide in the corner, drawing the mattress and clothes over her.  And so on.

Months later when I had my first interview with her, her sole remark during the hour was “How can I speak in a place like this?” This was repeated almost without intermission throughout the hour.  It formed a good example of the origin of the process of perseveration, a process frequently adopted by the patient to guard against the disclosure of a troublesome secret.

If we attempt to trace out some of the mechanisms employed in these two cases we shall see that in response to definite stimuli each reacted in a manner which cannot be considered abnormal in kind.  It was normal reaction for the child to be distressed at being separated from her mother in such a way, to be frightened by being left in the graveyard alone, or at the threat of her being carried away by a “bogey-man” if she dared to mention anything of the clandestine meetings to her mother.  It was not very abnormal that after her sexual experience the other patient while still in a confused state caused by the intense emotional condition of anxiety, should, on seeing a head with the hair cropped short, jump to the conclusion that there was a man in a bed in the same ward with herself, or that she should feel frightened and wish to leave the room.

The mental activity in each case depended on mental content, that is, memory of past experiences with their intense emotional states which acted as the driving force and also made the recall of the experience go extremely easy.  The further developments after being placed in the single room with mattresses on the floor and the window shuttered were rationalizations also based on mental content, i.e., on the memory of rooms somewhat similar to that in which she found