Vertigo has no clear narrative sequence, presenting its plot line through stream-of-consciousness, structured like the talking cure. Episodes are strung together as Scottie himself discovers and makes sense of the events. After he witnesses Madeleine's death, the movie is seen through his perspective, and events are revealed to the audience as they would be to a therapist. This structure validates the concept of therapy in everyday life.
The film explores obsession. In the beginning of the film, Kim Novak plays a woman obsessed with the spirit of a dead ancestor. After her supposed death, Scottie becomes obsessed with the image of her. His libidinal energy is invested so heavily in the remembrance of Madeleine, that Scottie cannot love Judy the way she begs to be loved. This inability references Freud's belief in the economics of love, which work on a scarcity principle.
Related to Scottie's obsession is the phallocentric gaze of the camera, seen through Scottie's eyes. The clearest example of this Freudian subtext of latent sexuality is the Coit Tower, a recurrent phallus, standing proud against the San Francisco skyline. When Scottie has the naked Madeleine in his bed, the Tower is visible through his apartment window. It is Scottie's insignia, and Madeleine uses it to navigate by, saying, "it led me straight to you." Whenever Madeleine is lost to him, Coit vanishes. When she re-enters his life, the Tower reappears. The film's twin climaxes take place in the equally phallic church tower of San Juan Batiste. Hemingway wrote about penile tumescence, "to a man in that portentous state, all objects look different. They are... more mysterious, and vaguely blurred." Thus, when Scottie follows Madeleine into the graveyard, the scene is shot in soft focus, and when Judy's transformation at the salon is complete, she walks towards him in an eerie green mist. The film validates latent sexuality in its main focus on obsessive love.
The film also destabilizes the conception of identity in a typically Freudian way. It is a study of flawed characters. Judy is not really Madeleine and yet once she is made over, she is not truly Judy either. Freud's works destabilized people by telling them they did not know who they really were and that there were unconscious functions that motivated them that they couldn't control.
Finally, Scottie believes in the power of psychology to release a person's guilt or fear. He tells Madeleine, "once you see the house you will remember when you saw it before and it will destroy your dream." Later, he drives Judy to the crime scene, saying "there is one final thing I have to do and then I will be free of the past." He has an energetic belief in the release of dreams once they are recalled. Because of time constraints, Hitchcock condenses the psychoanalytic process, but the guilt, longing and melancholy pervading the story reveal the serious, transformative power of Scottie's illness.
Despite the insertion and validation of many Freudian concepts, Vertigo reveals the main failing of psychoanalysis. It cannot remedy love. Circular symbolism links Scottie to his love of Judy/ Madeleine in both her life and demise. This circular imagery opening the film symbolizes Scottie's vertigo, also appearing in Carlotta's hair in the painting, again in Madeleine's hair, the bouquet of flowers suggests the pattern, and the story itself is circular in structure. Every event that happened in the first half of the film repeats in the second, including the death of his love. The locations of the movie follow this pattern, twice spiraling outward from the heart of San Francisco. Characters come full circle with their tragic destinies. Scottie follows Madeleine the night after he rescues her, through the same San Francisco streets, baffled as she leads him to his own house, to himself. Judy's death may symbolize Scottie's own (emotional) death. This connection is clear in Scottie's dream when he looks down at Madeleine's grave and sees his own face spiraling, showing that when he lost her, he lost himself.
One thing often overlooked is the emotional heights that Scottie is more afraid to fall from than tangible heights. When he does fall in love, and realizes to what depths he's been tricked, he growls "you shouldn't have been that sentimental" presumably about Judy's necklace, but really about his own reconstructed fantasy of Madeleine. As they climb the stairs, Scottie overcomes his fear of heights and confronts his emotional downfall, in the form of Judy, the personification of both his previous weaknesses.
Vertigo is about wanting to achieve the ultimate love, and never having love turn out the way we want it to. As we watch Judy refuse to become Madeleine, Hitchcock prompts us to confront our own fixations with superficiality. However, it is not a movie about voyeurism, but rather crafting and molding people to resemble our fantasies, seizing back control from a world which has gone mad. Hitchcock is rare in seeing that psychology is not always the answer to people's problems. He respected the profession and premised many of his films on Freudian concepts, but he also held a pessimistic view of humanity. One psychologist, no matter how knowledgeable, cannot cure the basic troubles of man namely, love and loss.