In his interesting article on William Carlos Williams' "The Use of Force," R. F. Dietrich points out the sexual connotations of the story that "are there because they express the savagery in human nature that, lying so close to the surface, can erupt at any moment in a flow of irrational behavior . . ." (Studies in Short Fiction, Summer 1966). The interpretation of the doctor-child conflict in terms of a sexual encounter does indeed appear to be valid when one considers the sexual overtones of the language of the story as Dietrich does. However, I would like to suggest a further interpretation based upon Freudian theory. I believe that the three sets of characters in "The Use of Force"—the doctor, the parents, and the child—are motivated by the three zones of the human psyche, the ego, the super-ego, and the id, respectively, and I also believe that the doctor, at first governed by the ego, permits his id to dominate him during his encounter with the child.

It is evident that the child, in her unrestrained passion and aggression, is acting entirely according to the dictates of the id, which Freud describes in his New Introductory Lectures on Psychoanalysis as "striving to bring about the satisfaction of the instinctual needs subject to the observance of the pleasure principle." The aim of the id is to seek pleasure and to avoid pain, functioning without regard for the conventional restraints of society or morality, and even without regard for self-preservation. The id, as Freud remarks, "knows no judgements of value: no good and evil, no morality." Mathilda's blind fury and her instinctual, hysterical attack on the doctor, when he moves closer to examine her, indicate that she is completely unconcerned about the doctor either as someone capable of helping her or in his role in society as someone to be respected. Describing her as lunging at him with "one catlike movement" while "both her hands clawed instinctively" for his eyes, the doctor emphasizes Mathilda's instinctual, animal-like aggressiveness, characteristic of an individual governed by the id. In other words, the child appears to be dominated by the id, and reason or conventional morality (the ego and the super-ego) form little part of her psyche.

According to Freud, the instinctual aggressions and passions of the normal adult psyche are regulated and repressed by the reason (the ego) and the conventions of society and morality (the super-ego). As Mathilda's behavior would seem to indicate that she is dominated by the id, the control and repression of her untamed aggression must be supplied from some external source. Freud points out that "young children are amoral and possess no internal inhibitions against their impulses striving for pleasure. The part which is later taken on by the super-ego is played to begin with by an external power, by parental authority." In their physical attempt to hold their daughter still so that the doctor can examine her throat, the parents are, in effect, attempting to repress her passion and aggression. In Freudian terms the super-ego is attempting to repress the id. In regarding the parents as the super-ego, I think it is worth noting that their reaction to Mathilda's behavior is not one of anger, but rather one of extreme embarrassment and mortification. At the child's first attack on the doctor, "both the mother and father almost turned themselves inside out in embarrassment and apology." The father releases her at the critical moment because of his "shame at her behavior and his dread of hurting her." When Mathilda reduces the wooden spatula to splinters, her mother asks her: "Aren't you ashamed to act like that in front of the doctor?" Rather than considering the doctor as one who can help their child, the parents seem to regard him as one socially superior to them because of his professional status. This is why they are embarrassed rather than angered at their child's behavior. And this display of embarrassment on the part of the parents is indicative of the feelings of guilt associated with the super-ego.

Whereas the parents are governed by the super-ego, the doctor, understanding the practical nature of the problem, is governed by the ego, which, Freud says, "stands for reason and good sense." The physician realizes that he "had to have a throat culture for her own protection." He is annoyed with the mother when she refers to him as a nice man. He realizes he has a job to do: "For heaven's sake, I broke in. Don't call me a nice man to her. I'm here to look at her throat on the chance that she might have diphtheria and possibly die of it." This is the reasonableness of the ego opposing the super-ego's concern with social convention.

No change occurs in the behavior of the parents or the child. Throughout the story the parents remain dominated by the super-ego, and Mathilda is governed by the id. But there is a remarkable change in the behavior of the physician. He loses control of himself, or, in Freudian terms, he permits his id to dominate the ego. As he first encounters the patient he behaves with reason and circumspection. He is annoyed at the stupidity of the parents and is determined to obtain the necessary throat culture. After the second fruitless assault, the doctor reasons with himself whether he should continue or try again later. But he realizes the urgency of the situation and tries again to force open the patient's mouth. Up to this point the doctor is controlled by the ego, and even in the motivation for his final forceful attempt to obtain the throat culture he is behaving rationally, for he realizes the necessity of force under the circumstances. But, in the use of force, he loses his ability to reason as he attacks the girl with the same blind fury with which she resists him: "But the worst of it was that I too had got beyond reason. I could have torn the child apart in my own fury and enjoyed it. It was a pleasure to attack her." So in a "final unreasoning assault" the doctor manages to force open Mathilda's mouth and examine her throat. But, in so doing, he loses his ability to reason and permits his passions and aggressions to govern him. The doctor's ego submits to the id as he enjoys the momentary release of instinctual aggression. It should be noticed here, however, that this is not a total domination of the ego. For if the doctor were totally governed by the id, he would have probably merely struck the girl in blind fury. Perhaps it was Williams' intention here to demonstrate the usefulness of force in such a crisis. Without the use of force, it would not have been possible for the doctor to obtain the necessary throat culture. Nevertheless, there is no doubt that the doctor derives pleasure from his attack, even if only for a moment.

According to Freud, in the normal individual the ego acts as a mediator between the id and the super-ego. At the beginning of "The Use of Force" the doctor, governed by the ego, serves as the intermediary between the parents dominated by the super-ego and the child controlled by the id. Thus, as we should expect, the physician is the one who acts with reason and circumspection. But in the process of examining his patient he, too, becomes momentarily unbalanced. Therefore, "The Use of Force" deals not only with the conflict between doctor and patient, but also with the inner conflict between the psychic forces of reason and aggressive passion, between the ego and the id.