Freud, p.31
Freud, page 31
Unbeknownst to most Freudians, however, this hole in the record was filled in 1986 by an admirable feat of independent scholarship, Peter J. Swales’s long essay “Freud, His Teacher, and the Birth of Psychoanalysis.” Swales’s immediate purpose was to identify and characterize one of Freud’s anonymous early patients—the very patient, in fact, who had accompanied him to consult with Bernheim in Nancy. But what the historian discovered in the process was nothing less than the source of fundamental convictions to which Freud would cling for the next fifty years.
Several passages in Freud’s contributions to Studies on Hysteria, the book that he and Breuer would jointly issue in 1895, hint that someone whose case history he didn’t feel at liberty to set forth—he called her “Frau Cäcilie M.”—had actually been his most informative patient and the main influence on the book itself. Although he knew her better than any of the four women whose stories he would tell in greater detail, “personal considerations” required that she be kept in the background. Freud would say enough, however, to indicate that she had understood her own hysteria in novel terms that he found compelling. And in private he was more emphatic. If you knew her, he wrote to Wilhelm Fliess in 1897, “you would not doubt for a moment that only this woman could have been my teacher (meine Lehrmeisterin).”13
Swales found that this was Anna von Lieben, the immensely rich baroness who joined another baroness, Fanny Moser (“Frau Emmy von N.”), as the most important of Freud’s early patients. She was the Hauptklientin whom he couldn’t allow to “get well in [his] absence.” Her husband’s fee payments were the principal basis of Freud’s economy in a period, 1887 to 1893, when he was risking insolvency in order to make himself thoroughly presentable as a “society doctor.”* Even so, in this instance the benefit to his wallet was secondary to decisive intellectual stimulation.
Born the Baroness Anna von Todesco, the daughter of a banker and, from 1871, the wife of another banker, Anna was related, through intermarriages, to three other great Jewish families in the Coterie: the houses of Gomperz, Auspitz, and Wertheimstein. She had divided much of her time between a grand rural villa and the Viennese palace into which her parents had moved when she was about fifteen. Then Anna’s mother had hosted glittering soirées attended by such luminaries as Brahms, Liszt, and Johann Strauss. After 1888, the extended Lieben family relinquished the palace but occupied a whole urban apartment building.
The Coterie was a hub of eccentricity and nervous illness, including psychoses that required institutionalization. For originality, oddness, and imperiousness of behavior, however, no one could match Anna von Lieben. A melancholy, introspective poet, a portrait painter, and a musician, she was also gifted at chess, which she enjoyed playing against two opponents at once. Upon her command, shopkeepers would reopen after closing time so she could ransack their shelves in one glorious burst of spending. She was as nocturnal as a raccoon. A chess professional was stationed outside her bedroom in readiness for impromptu games that could last until dawn. In the eyes of the young Hugo von Hofmannsthal, she was “half crazy.”14
Lieben had long been obese. Outside her hearing, Freud expressed himself rudely about her weight. She was der Koloß, “the colossus” or “the hulk.”15 When she was staying at the sumptuous Villa Todesco in Hinterbrühl, south of Vienna, she required that lamb cutlets be delivered from the city each morning in time for her favorite breakfast. Now and then, though, she would consign herself to a slimming spa or try a diet consisting entirely of champagne and caviar. But because ambulation was difficult for her, she passed most of her waking hours reclining on a divan—the serendipitous inspiration, it has been surmised, for her young physician’s couch therapy.
In her adolescence Anna had contracted an unspecified “female illness,” to which she soon began adding other debilities. One of them, according to Freud, may have been organic in nature: a facial neuralgia. But when the pain subsided under apparent hypnosis, he began to suspect a psychogenic cause.16 Other woes, ranging from trivial to grave, struck him as pointing less ambiguously to psychological distress. Anna was easily upset by small annoyances; she had long felt misunderstood by family members who considered her a malingerer; she was given to Weltschmerz; and she would fall into states of weakness and confusion, requiring a sympathetic doctor to rally her back to normal awareness. With one major exception that we will discuss, this seems to have been all that was wrong with Lieben when Freud took over her case, which he would nevertheless characterize as “my most severe and instructive” one.17
Lieben obtained some relief through the sifting of her memories. That she, not Freud, took the lead in that process is indicated not only by his tribute to her pedagogical role but also by the fact that, through many years of valetudinarianism, she had believed in both traumatic memory and the conversion of ideas into symptoms. She was a connoisseur of grievances, big and small, and had amassed such a store of them in her journals that it was easy for her to coordinate symptoms with memories. Thus she put her therapist on the path of “reading back” from the coded language of a symptom to the nature of the supposed experience lying behind it.
But that was just one of the lessons Anna von Lieben would teach her trusting doctor. Here are the others:
• Pathogenic moral shocks. Charcot regarded his lower-class patients at the Salpêtrière as simpletons who could experience fear but not moral reflection or even shame. Lieben and her kind, however, were brought up to cultivate refined feeling, purity of thought, and correct behavior. Lieben believed, and so Freud came to accept, that the nervous systems of proper ladies could be disrupted by just about anything—including their own unruly desires—that offended their high ideals. Anna’s model of neurosogenesis through disgust and self-reproach had a measure of verisimilitude in her rarefied milieu. Freud, however, would claim it to be the rule for the human mind in general.
• Metaphors as pathogens. A theory of symbolization was already implicit in the idea of somatic conversion, but Lieben possessed a more radical notion that she had apparently been pursuing for years. The mind’s hysteria-generating faculty, she believed, could forge a symptom from a figure of speech that had once come to mind at a stressful moment. Psychoneurotic symptoms, then, were charades, and by guessing which metaphor was being mimed, the patient or her doctor could coax remembrance of the traumatic event back into consciousness.
Studies on Hysteria contains a number of quaint examples from Anna/“Cäcilie’s” case and others. Why did Cäcilie feel a pain in her heel? Not because she was vastly overweight or because she may have had plantar fasciitis, but because she had once feared that she might not “find herself on a right footing” with certain strangers.18 Why did she experience a neuralgic pain in her cheek? Because an insult from her husband had felt “like a slap in the face.”19 Such glib exercises, accepted by Freud without hesitation, would endear him to science-envying littérateurs; but he was flouting all that he had learned in medical school about attribution of causes and aligning himself with the most fanciful diagnosticians of the Middle Ages.
• Dream interpretation. Anna’s favorite uncle, Theodor Gomperz, was an authority on dreams and their significance in tribal societies. Whether or not he influenced her, it is certain that she kept a record of her dreams and their supposed messages. One journal entry was headed “Traumesdeutung,” or dream meaning, closely anticipating the title of Freud’s magnum opus. Although Freud was already interested in dreams, Lieben’s affinity for symbolic translation probably colored her own view of them, and therefore Freud’s.
• Sex. From adolescence onward, Anna keenly felt the absence of fulfillment in love. During the entirety of her work with Freud, she kept a therapeutic journal that was later destroyed by a son-in-law on the grounds that “it was full of private and indecent things, even perhaps outright obscenities.”20 Her married sex life, such as it was (she had five children), had ended, and her husband had openly taken a mistress. Momentously for Freud’s development, Lieben ascribed her nervous state to sexual frustration. She believed, moreover, that certain behaviors could be understood as surreptitious expressions of desire. One of her poems, for example, suggests that women smoke as a substitute for being kissed. Here Freud, as a reader, was being tutored in the implacability and deviousness of the sex instinct.
• Layered memories. A letter from Breuer to Forel in 1907 disclosed that Lieben, under prodding from Freud, had kept retrieving ever earlier memories until she was drawing material from her putatively forgotten childhood. This had been exciting to Breuer and Freud alike, and it led Freud to one of his most doctrinaire ideas: that a trauma in adolescence or thereafter always reactivates a much earlier one that wasn’t understood as threatening at the time.
• Free association. Citing a 1921 statement by A. A. Brill, Swales maintains that Freud learned his free association technique, whereby the client is encouraged to say whatever comes into her mind, in sessions with the voluble Lieben after their joint visit to Nancy in 1889. There are grounds for believing that Brill’s information was conveyed to him by Freud. To be sure, Freud’s distant recollections were error prone; and free association isn’t mentioned in the Studies, published two years after Lieben’s treatment ended. Nevertheless, we can surmise that Anna, with her own habit of seeking causal links through symbolic clues, influenced Freud in this respect as well.
We can see why Freud was so grateful to Anna von Lieben. At the same time, it is dumbfounding that root principles of his science may have been derived from a database consisting of one patient’s musings about her history. Delboeuf had warned that therapeutic schools get born when physicians judge their first patient to be representative and then read the same traits into all of the others.21 Not even Delboeuf, however, could have envisioned that a doctor would adopt a patient’s own hunches wholesale without exercising critical judgment and would then pretend that he had been gradually drawn toward the same conclusions by impartial study of many other cases.
3. DRAMA SCHOOL
From the scattered passages about “Frau Cäcilie M.” in Studies on Hysteria it is hard to discern what Freud had hoped to accomplish, therapeutically, with Anna von Lieben. Indirect evidence, however, tells us that at some early point in the treatment, he began attempting the memory extirpation that had been commended by both Delboeuf and Janet. In July 1889, writing to his sister-in-law Minna Bernays during his stay in Nancy, he remarked that she could grasp his way of treating Lieben if she were to read Edward Bellamy’s novel of 1880, Dr. Heidenhoff’s Process. In Bellamy’s plot, a woman suffering from melancholia and hysteria is cured by an electrical machine that erases her traumatic memories as she concentrates on them. Freud possessed no such machine, but his hypnotherapy, though clumsy enough to warrant his seeking remedial instruction from Bernheim, was apparently directed to the same end.22
Freud’s idea of ultimate symptom removal, however, corresponded neither to Bellamy’s science-fiction notion nor to the serious proposals of Janet and Delboeuf. For those two authors, a traumatic memory was the sole irritant behind a given hysterical symptom. To efface the memory, then, would be equivalent to dissolving a kidney stone or an embolism; nothing further would remain to be done. But for Freud, the toxic element in hysteria was the panic-driven emotion that the traumatized patient had never allowed herself to feel. It constituted a repressed “quantity of affect” that would have to be coaxed forth in therapy and reattached to the now consciously remembered experience.
Years earlier, in 1880–82, just such a regimen had been practiced with a young Viennese woman, Bertha Pappenheim, by Freud’s older friend and confidant Josef Breuer. Working more as partners than as physician and obedient patient—indeed, it was Pappenheim who took the initiative—the two parties had developed a routine whereby Pappenheim lived through past incidents, some of which may have been pathogenic; and her suffering had appeared to dwindle during that phase of her treatment.
Breuer and Freud had been discussing Pappenheim’s therapy off and on since at least October 1882, shortly after Breuer disengaged himself from active involvement in her case.23 Their dialogue had evidently become more intense after Freud’s return from Paris in the spring of 1886. On Charcot’s authority he had accepted a traumatic account of hysteria formation that must have looked at least somewhat compatible with the Pappenheim case as he understood it from Breuer. No doubt Breuer and Freud, who each exchanged letters with Charcot at the time, were reassessing Pappenheim’s hysteria from a Charcotian point of view.
Once Freud’s general practice began narrowing to the psychoneuroses, Breuer’s experience with Pappenheim became still more interesting to him. The proof can be found in his 1888 essay “Hysteria,” where, while admitting that conventional treatments were yielding hit-or-miss results, he briefly and enigmatically endorsed another approach. Hypnotic suggestion, he wrote,
is even more effective if we adopt a method first practiced by Josef Breuer in Vienna and lead the patient under hypnosis back to the psychical prehistory of the ailment and compel him to acknowledge the psychical occasion on which the disorder in question originated. This method of treatment is new, but it produces successful cures which cannot otherwise be achieved.24
That statement curiously failed to mention what was distinctive in “the Breuer method,” as Freud would later call it. Readers of the 1895 Studies on Hysteria would learn, however, that Breuer had aimed at catharsis, or the purgative discharge of obstructed affect, a consummation occurring because a restored memory had been reunited with feelings that the hysteric-in-the-making had been too frightened or ashamed to express at the time. For both the early Breuer and the early Freud, catharsis figured as a therapeutically provoked means of abreaction, the healthful release of affect that normally allows even a trying experience to be “worn away” without pathological consequences.
Breuer’s conception hadn’t arisen from his practice but from a scholarly book that, although largely neglected when it was first published in 1857, caused a sensation when its second edition appeared in 1880.25 Oddly enough, the author was the uncle of the future Martha Freud, the classicist Jacob Bernays. It was a treatise on Aristotle’s own theory of catharsis, whereby the viewers of a stage tragedy were said to be purged of pity and terror by empathizing with the dramatic representation of those emotions. Bernays’s volume was all the rage in the Coterie, to which both Breuer and the intellectually avid Pappenheim belonged.
Bernays’s interpretation of a few cryptic lines in Aristotle’s Poetics was debatable.26 Even more so was his attempt to transfer the theory from a theatrical to a therapeutic context. And more problematic still was the idea that “catharsis” really accounted for any perceived progress within the convoluted Pappenheim case, to which we will soon be returning in detail. It is certain, nevertheless, that Breuer and Pappenheim thought they were following the Aristotle-cum-Bernays prescription. Freudian theory about the necessary release of pent-up feelings in psychotherapy can be traced, then, not to clinical victories by himself or others but to a brief cultural fad in 1880.
Whatever their origin, it must be understood that Freud’s premises, from the end of the 1880s into the early twentieth century, inclined him to regard a patient’s emotional agitation as a sign that repressed traumatic memories were being reluctantly dragged closer to the surface of consciousness. Thus he was pleased whenever he could discompose a patient; and if her symptoms then became more numerous and severe, so much the better. This was the opposite of the psychotherapeutic ethos as it was generally regarded at the time. But Freud was adamant, for he conceived of the clinical encounter as an attempt not to assuage the client’s present state but to flush out her demons and subdue them.
It makes sense, then, that Anna von Lieben’s symptoms worsened in the fall of 1888, a year or so after Freud had begun treating her through attempted hypnotism. Then she developed what he called “a really surprising wealth of hysterical attacks,” including “hallucinations, pains, spasms[,] and long declaratory speeches.”27 The last of those manifestations may have been modeled on attitudes passionelles, the fourth and most ludicrous phase of Salpêtrière-style grande hystérie, about which Anna could have heard either from Freud or from Charcot in person—for she had already voyaged to Paris for at least one consultation with the lionized Frenchman.
Lieben’s case also began to acquire an eerie similarity to Pappenheim’s a decade earlier. The women were personally acquainted; Breuer was the family physician to both; and Freud, as we will see, was then urging Breuer to turn Pappenheim’s alleged “cathartic cure” into a showpiece of therapeutic efficacy. In these circumstances, Lieben had all the inspiration she needed to reprise the symptoms of Breuer’s early patient. And she did, matching not only Pappenheim’s dissociated monologues but also her hallucinations and aphasia in her native language.
Freud and Lieben were caught up in an iatrogenic tango whose dips and bends grew more extreme. He couldn’t afford to reflect that he might be part of her problem instead of its solution. He even failed to register the significance of a crucial fact that he would innocently pass along to readers of the Studies. Once he had begun soliciting Anna’s traumatic memories, they were “accompanied by the acutest suffering and by the return of all the symptoms she had ever had”; but when questioned by a different therapist, “she would tell him her story quite calmly.”28 Freud himself, then, was nudging Anna to act out, and the supposedly repressed and terrifying recollections that he elicited lost their affective charge when he wasn’t on hand to cue them.
3. THE CABINET OF DR. FREUD
