Phyllis Greenacre (1894-1989), who later became president of the American Psychoanalytic Association, wrote an article in which she contrasted Freud's and Janet's views of obsessional illness. The 1923 article also discussed her ideas about obsessive-compulsive symptoms.
While these [obsessive-compulsive] conditions have been variously described and named, the two most important conceptions dealing with the underlying mechanism, are those of Janet and Freud. Janet includes in his group conditions which lack obsessions, compulsions, and phobias, but are characterized by the predominance of indecision, unreality feelings, and a multiplicity of symptoms arising from feelings of somatic [of or relating to the body] insufficiency. As the basis of the disorder he emphasizes the asthenia, weakness, or "lowering of psychological tension." The Freudian concept on the other hand, brings to the fore the forced or compulsive character of the symptoms which are explained as "symbolic reactivations of childhood self-reproaches for sexual performances or tendencies." According to this concept, the indecision resulting from an obsession or phobia is really due to the early exaggerated divorce between hate and love so that the conflict and antagonism between the two dominates the most important reactions. The psychasthenia of Janet's concept seems to me to give an incomplete picture or notion of the extraordinary energy and tension which is met in the obsessive-compulsive conditions and especially in the panic tantrums which arise from them.
...[These conditions] are most apt to develop in people with fairly definite social awareness, coupled with an acute sense of limitation or inferiority, the latter having either a personal or a situational origin. Very rarely, however, [is] there any intellectual inferiority.... The compulsive-obsessive person is pre-eminently conventional in his aspirations: the approved standards of religion, law, etiquette, and even education are the ends of his strivings and the measure of his achievement....
[One mechanism by which obsessive-compulsive symptoms are created] consists in the substitution of a symbolic object or ritual for the original desire/fear situation. It serves [the purpose] to the patient of eliminating the fundamental and intolerable conflict and replacing it with something apparently innocuous which bears the brunt of the conflict, a scape-goat to carry the sins into the wilderness. One of the most common forms of symbol substitution of this type occurs in the germ phobias where the germs stand as symbols of sexual uncleanliness in masturbation. Hand-washing becomes a cleansing then for sex activity or even sexual thoughts. The number rituals appear usually to be of this sort.
Thus one of our patients [quoting here from a case history], a young woman of 28, avoided the number 3 because it was a symbol to her of three parts of the male genitalia about which she had a much delayed and intensified curiosity. At the same time she suffered from a far reaching tuberculosis phobia, had hand washing compulsions; and an extreme fear of blood which she identified in her childhood ruminations with seminal fluid [semen].
In this mechanism with the projection of the conflict onto neutral symbolic topics which are then avoided, the distortion is the most far reaching, and the process is more likely to involve a number of objects, one being substituted for another, until all connection with the original disrupting situation is lost.
NOTE: Greenacre's use of "obsessive-compulsive" in this 1923 article is one of the first appearances in print of that hyphenated term.
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