Rat Man: A Case of 'Obsessional Neurosis'

Case study of Sigmund Freud's client Rat Man (Ernst Lanzer),

whose obsessive thoughts helped Freud to develop his theories.

Ernst Lanzer, born in Vienna in 1878 suffered from "obsessional

neurosis," an illness that featured having thoughts so persistent and
uncomfortable that he would cut his own throat with a razor just to get
them to stop. After suffering for it throughout his childhood, in 1907 he
went to visit Freud. Lanzer noted that hydrotherapy, or therapy using
bathing helped relieve the symptoms, but he also noted that a relationship
with someone at the bath house could've been what actually helped. Rat
Man claimed to have obsessive thoughts randomly and wouldn't go away
unless he harmed himself to distract the mind. These thoughts usually
involving harm to those close to him.

The name Rat man came from a particular experience Lanzer

described which perfectly illustrates his condition. While serving in the
military he learned of a form of punishment involving putting a bucket of
live rats on a person's stomach and the rats would try to dig their way
through the stomach to escape the bucket. After hearing of this, the
thought of it happening to a friend or family member could not escape his
mind. One day, Rat Man had ordered a new pair of glasses which needed
to be paid for upon pick up. Rat Man quickly learned that his glasses had
been paid for and the one who paid for them was the man who taught him
the rat punishment. The man wanted this money paid back to him and Rat
Man convinced himself that he had personally pay the man back or the he
would perform the rat torture on his friends or family.

Rat Man claimed to have become sexually aware at a young age. He

had such inappropriate desires that he became embarassed and felt
ashamed. He also was very afraid of his parents learning of his thoughts
so he began to feel guilt taking control over him. However, after multiple
months of psychotherapy, Rat Man became aware of how irrational his
thoughts were and he became well enough to end his sessions.

The case of a patient’s obsessive thoughts inspired Sigmund Freud to

share his observations in the 1909 case study Notes upon a Case of
Obsessional Neurosis.1 Referring to the man using the pseudonym ‘Rat
Man’, Freud describes in depth how persistent, obsessive thoughts led
him to irrational, compulsive behavior, such as cutting his own throat
with a razor blade. He investigated the cause of Rat Man’s ‘obsessional
neurosis’, which he attributed to events which had occurred early in the
patient’s childhood but that had a lasting effect on his present state.

There is some debate as to the real identity of Rat Man - he has been
variously identified as a man named Paul Lorenz, but is more generally
accepted to have been Ernst Lanzer, who was born in Vienna in 1878 and
attended university, training as a lawyer.

He suffered for many years with his problem before seeking professional
help.

In 1907, having read with interest numerous works of Freud and been
impressed by his discussion of “curious verbal associations”, Rat Man
finally approached the psychoanalyst. Freud noted that it was usual for
patients to have suffered for some time before consulting a doctor, by
which time the symptoms had become more noticeable. Rat Man claimed
that hydrotherapy, a popular activity at the time which involved bathing,
had helped with the problem, but that his relations with a person at the
baths, rather than the ‘therapy’ itself, had likely been of help.

Rat Man complained of obsessive thoughts which would surface for no

apparent reason in his mind. These thoughts, often of misfortune
occurring to a relative or someone close to him, would persist until he
took a particular irrational action to placate the risk.

Freud described the man’s case as a “moderately severe” of “obsessional

neurosis” and found his problems more difficult to comprehend than
those of his clients with hysteria, such as the oft-quoted case of Anna O.

During his sessions with Freud, which lasted at least 6 months, the man
recounted numerous events that had occurred in his life from his
childhood up to those which were troubling him at present. Freud also
engaged his patient in free association - revealing everything that entered
his mind without filtering ideas which he would otherwise repress. By
gaining an insight into the man’s stream of consciousness, Freud hoped
to identify any signs which suggested the repression of traumatic events
or feelings in the man’s subconscious.
The main subject of Rat Man’s obsessive thoughts was the irrational fear
of the death of his father. He felt that by carrying out an action, however,
bizarre, he could prevent such an event occurring.

A situation which demonstrated Rat Man’s worries, and later helped him
to earn his pseudonym from Freud, occurred during military service. He
worked with a lieutenant who was known to have a sadistic streak and to
be defender of corporal punishment. In an anxious state, Rat Man told
Freud how one day, the lieutenant relayed to him a particularly cruel form
of punishment, which involved placing a container of live rats on a
person who was laid down. The rats would seek to escape confinement by
digging through the victim. This idea, however repulsive to him, then
became the subject of his obsessive thoughts and he began to fear it
happening to his partner or his father. Once the idea had entered his mind,
the man was unable to placate the irrational fear of this happening to a
friend or relative.

The irrationality of Rat Man’s fears was further demonstrated when he

lost his pince-nez (bifocals) and placed an order for a new pair to be sent
through the post. His retelling to Freud was complex and caused some
degree of confusion. To summarize, the person collecting the parcel from
the post office was expected to pay for it. Rat Man’s colleague informed
him that another lieutenant had paid the fee for him, and that he should
pay him back. After learning this, Rat Man irrationally convinced himself
that he must personally pay back the lieutenant otherwise his friend or
relative would receive the torture involving the rats.

To resolve his fears, Rat Man would normally carry out an action to
prevent them (as he feared) from happening. However, the lieutenant
declined to take the money, saying that he had not paid the fee at the post
office. Fearing that not paying him the money would result in the torture,
he formulated a complex plan involving him, the lieutenant and a
colleague travelling to the post office and carrying out a chain of
transactions which would mean that he could pay the lieutenant and
prevent harm to his father or partner.

Although Rat Man’s solution was difficult to understand, his colleagues

eventually travelled to the post office in order to put their friend at ease.
Causes

During his sessions with Rat Man, Freud looked at his client’s history,
investigating events which took place during his childhood, with a view
that they may have been at the root of his obsessive thoughts.

Rat Man described becoming sexually aware at an early age and recalled
a desire to see women whom he knew naked. According to
Freud’s psychodynamic theory of wish fulfillment, the early development
of this desire originated from the man’s id, a component of the psyche
which influences us from birth, prior to the ego and superego developing,
which temper the desires of the id. As the superego began to exercise
influence over his thoughts, Rat Man felt guilt at having experienced
such unacceptable desires and this conflict between the id and the ego
lead to the wish being repressed later in life. He also recalled to Freud
having experienced a fear of his parents knowing his thoughts, reflecting
the discomfort he felt at having held such wishes.

Freud emphasized that repressed thoughts are not simply forgotten: they
lose their “affective cathexis” but retain their “ideational content” in the
conscious. When an irrational fear a rises, Freud believed that this content
must be substituted for something else - in the case of Rat Man, irrational
compulsions to prevent anxious thoughts being realised.

The man realised the irrationality of his fears of misfortune occurring to

his father, but this did not prevent the obsessive thoughts from affecting
him. Freud noted that he experienced these thoughts from childhood and
even for years after the death of his father from emphysema, whose final
day he had not witnessed, adding to Rat Man’s irrational sense of guilt.