[1] To protect the anonymity of patients, psychoanalytic case studies usually withheld or disguised the names of the individuals concerned (Anna O., Little Hans, Wolf Man, Dora, etc.).
Freud encouraged Lanzer to discuss details of his sex life (such as his first efforts at masturbation at age 20) and focused on a number of verbal associations with the word "Ratten" ("rats").
Freud was led to publish the Rat Man case history because he was feeling pressured to show the world that psychoanalysis could achieve successful therapeutic results.
The patient presented with obsessional thoughts and with behaviors that he felt compelled to carry out,[8] which had been precipitated by the loss/replacement of his pince-nez and the problem of paying for them, combined with the impact of a story he heard from a fellow officer about a torture wherein rats would eat their way into the anal cavity of the victim.
[10] Freud theorized that these obsessive ideas and similar thoughts were produced by conflicts consisting of the combination of loving and aggressive impulses relating to the people concerned – what Eugen Bleuler later called ambivalence.
[13] In addition, the symptoms were believed to keep the patient from needing to make difficult decisions in his current life, and to ward off the anxiety that would be involved in experiencing the angry and aggressive impulses directly.
The patient's older sister and father had died, and these losses were considered, along with his suicidal thoughts and his tendency, to form part of the tissue of phantasies, verbal associations and symbolic meanings in which he was trapped.
[16] A number of significant discrepancies between the published case history and Freud's process notes, which were discovered among his papers after his death, have been pointed out by Patrick Mahony.
According to Mahony, who is an analyst and sympathetic to the general goals of psychoanalysis, Freud's published case history is "muddled" and "inconsistent" on various matters of fact and also exhibits "glaring" omissions of information.
"[17] Jacques Lacan built his early structuralist theory around the Rat Man case, in particular the polarity of father–rich wife/son–poor wife as an intergenerational force creating the individual neurosis.
[26] In a letter Freud wrote to Jung, shortly after publication of the case study, he claimed of the Rat Man that "he is facing life with courage and ability.