On October 13, 1885, the Orient Express, which had then been in operation a scant two years, pulled into the Gare de l’Est in Paris at the end of its long journey from Austria. A bearded 29-year-old man descended from his carriage and joined the crowds moving towards the Boulevard de Strasbourg. Poor but ambitious, he was making one last desperate throw of the dice before facing the grim prospect of exile, perhaps to the United States, a country he regarded as “a hopeless place for science” and one he would later dismiss as “gigantic, but a gigantic mistake.”1
Our weary traveller had trained in medicine in Vienna, where his prior efforts to build an academic career in zoology, then in physiology, and finally in neuro-anatomy had ended in disappointment. Worse yet, he was fleeing a growing controversy provoked by his therapeutic experiments with cocaine, a substance he had claimed was a wonder drug, but one that others found led to addiction, destruction of the personality, and death. His private life was equally messy. Engaged since 1882, he was desperate to marry. Yet it seemed he could do so only by abandoning his scientific ambitions and settling down to a mundane, perhaps maddening, existence as a practicing clinician. At the last, only the forceful intervention of his mentor, Ernst Brücke, had enabled him to secure a small grant to support him for six months in Paris, where he planned to work under the great Jean-Martin Charcot, who was then at the height of his fame.
Even with this prospect in front of him, Sigmund Freud looked at a bleak future, and his first weeks in Paris did little to relieve the gloom. Charcot’s reputation drew would-be neurologists to Paris like iron filings to a magnet, and nothing enabled the young Austrian to stand out from the crowd of professionals jostling for the great man’s attention and favors. Or, rather, nothing did until Freud conceived the idea of putting himself forward as someone who could translate Charcot’s latest lectures into German. Once his offer had been accepted, Freud found himself inside the charmed circle, at least to the extent of being invited to the soirées held on Tuesdays at Charcot’s mansion on the Boulevard Saint-Germain. And Freud was as good as his word. Though by his own admission his spoken French was atrocious, he produced a German translation of the third volume of Charcot’s Leçons sur les maladies du système nerveux that appeared in print even before the French original was published.
The mark of Charcot’s favor made Freud a devoted disciple. Yet even still, his stay in Paris lasted a bare four and a half months. Charcot was ill for some of that time, and Freud also took a two-week vacation at Christmas to spend time with his fiancée, Martha Bernays. Yet the Parisian circus that he experienced at first hand had made a profound impression, entirely reorienting his intellectual horizons. As he wrote to Martha on November 24, within weeks of settling in Paris, “Charcot, who is one of the greatest of physicians and a man whose common sense borders on genius, is simply wrecking all of my aims and opinions. I sometimes come out of his lectures as from out of Notre Dame, with an entirely new idea about perfection.”2 In February of the new year, Freud returned to Vienna with all the enthusiasm of a convert, bent upon enlightening the Viennese medical elite about Charcot’s discoveries concerning hysteria and his use of hypnosis.
Freud seems to have been oblivious to the impression his bumptiousness and his embrace of a French rival would have on his superiors. A lecture before his elders at the Viennese Medical Association was greeted with little enthusiasm. In a forum that was supposed to be devoted to relaying original scientific discoveries of one’s own, Freud proffered only a warmed-over version of what he had observed at the Salpêtrière. His claim that Charcot’s emphasis on male hysteria was novel was roundly dismissed by colleagues, who proceeded to recall their own encounters with male hysterics decades earlier. And, while Charcot’s institutional power and ruthlessness had caused the French medical establishment to drop its long hostility towards hypnosis, no such transformation of attitudes had occurred in the German-speaking world. Theodor Meynert, in particular, a dominant figure in Freud’s world, was scathingly dismissive of hypnosis as nothing more than quackery. Freud’s espousal of the technique did nothing to commend him to his superiors.
Making matters worse, over the last half of the 1880s, Charcot’s claims about hypnosis and its relationship to hysteria were coming under sustained assault even in France. To be sure, the attacks came from the periphery, from the provincial city of Nancy in eastern France, and the Napoleon of the neuroses must have felt they posed little threat to his entrenched authority. But Charcot’s claims that only a minority of people, those who were afflicted with an inherited neuropathic taint, were vulnerable to hypnosis, and that the hypnotized passed through a regular series of predictable stages were weakened to the point of collapse by Bernheim’s repeated demonstrations that neither was empirically so. Validation of the upstart Frenchman’s claims by others made a mockery of Charcot’s assertions, a viewpoint that was embraced even in Paris following the great man’s death in 1892. For many, the upshot was a renewed conviction that hypnosis was the product of “mere” suggestion (rather than, as Charcot had argued, a primarily physiological process), and thus a species of self-delusion, charlatanry, and fraud. The spread of such views may well have prompted Freud to reconsider his own therapeutic investment in hypnosis, a technique he had never truly mastered, and one that by the mid-1890s he would largely abandon.
Freud’s return to Vienna and to clinical practice brought his long engagement to a close. Marriage, however, soon brought a parade of children, six of them by 1896, adding substantially to his financial burdens. His private practice in these years was devoted to neurological patients, particularly children with cerebral palsy, but custom was slow to arrive. Such as they were, his clients included a number of cases of indeterminate, “functional” origin, “hysterics,” albeit not necessarily of the dramatic sort he had seen in Paris. It was a pattern familiar to many an aspiring neurologist on both sides of the Atlantic, for whom hysterics were an indispensable source of income. These he treated with the standard weapons in the neurologist’s repertoire: massage, hydrotherapeutics, electricity, and the rest cure.
In Freud’s tenuous circumstances, an important source of patient referrals was a fellow physician many years his senior, Josef Breuer, a colleague Freud had first encountered in Brücke’s laboratory. Breuer had developed a large and lucrative practice among Vienna’s Jewish haute bourgeoisie, a clientele that made him a wealthy man. As his workload grew, he referred some of the overflow to Freud. Periodically, he also relieved the younger man’s financial worries with small loans, and the two men grew personally close.
As long ago as 1880, Breuer had treated one particularly remarkable case of hysteria, Bertha Pappenheim, a woman who would become famous to posterity as Anna O. It was a treatment that continued till June of 1882. Bertha/Anna’s disturbances were legion. They had surfaced after the sheltered young woman had spent many months nursing her dying father. Her symptoms were dramatic: trance-like states, hallucinations, spasms of coughing, sleeplessness, a refusal to eat or drink, a rigid paralysis of the extremities on the right side of her body, severely disturbed vision, outbreaks of uncontrollable anger, a failure to recognize those around her, and finally a failure of language—first a deterioration of her German, and then an inability to speak or comprehend anything but English, her native language remaining unintelligible to her for eighteen months. Breuer’s treatment of her involved frequent and prolonged encounters on a regular basis. According to his account, he eventually found that, by talking with her about her symptoms and, more importantly, by tracing them back to traumatic scenes in her past, they could be made to disappear, the catharsis proving profoundly therapeutic. It was the patient herself who dubbed this “the talking cure.”
Such “cures,” Breuer acknowledged, required exhaustive (and exhausting) efforts. Bertha/Anna had a remarkable memory, which proved a double-edged sword. Tackling her hearing difficulties alone required sifting, in reverse chronological order, through 303 separate instances when these dysfunctions had materialized. On and on the process went, till the final recalcitrant symptoms—a paralysis of her right arm and her inability to speak her native language—were relieved when she recalled hallucinating about a black snake poised to strike the bed-ridden father she was tending to, and being unable to move her arm until it occurred to her to recite a prayer in English. The event recalled, the paralysis abruptly vanished, and she was once more able to converse in German.
These dramatic events were frequently the object of Breuer and Freud’s conversations, beginning in November 1882. Subsequent scholarship has demolished Breuer’s assertions that Bertha/Anna was cured by his ministrations. On the contrary, not long after Breuer abruptly ceased treating her, she was institutionalized by her family at the Sanatorium Bellevue in Kreuzlingen, Switzerland, where she remained for more than three and a half months, still exhibiting a multitude of hysterical symptoms, as well as being addicted to morphine (an aspect of Breuer’s treatment of her he never acknowledged in print). Freud himself would eventually claim, in a conversation with his disciple Ernest Jones, that Breuer’s therapeutic efforts were terminated abruptly when he discovered that his patient harbored erotic longings for her therapist, longings that expressed themselves in the form of a phantom pregnancy. But this story, too, we now know was fictitious. Instead, Bertha/Anna was re-institutionalized on at least three more occasions in the 1880s, and continued for years after her alleged cure to experience hallucinations and to manifest the whole panoply of her hysterical symptoms, till she finally “recovered” in the early 1890s, a decade after she had ceased being Breuer’s patient.
15. Breuer’s patient “Anna O.,” or Bertha Pappenheim (1859–1936) as seen in 1882. This photograph was taken at the Sanatorium Bellevue at Kreuzlingen, where she was confined as a mental patient. In later life, Pappenheim became a prominent social worker, author, and feminist, no thanks to the talking cure she helped to invent.
All these revelations about Anna O.’s true history were to remain hidden, however, for nearly a century. The myth of her cure through talk therapy would in the meantime circulate and recirculate, and come to form the foundation of a radically novel approach to the treatment and understanding of hysteria. Three years after his return from Paris, Freud himself began employing hypnosis and the cathartic method on a series of his own female patients, beginning with a patient he referred to only as Frau Emmy von N., moving then to Fräulein Elizabeth von R. (his first full-length analysis of hysteria), and then to the cases of Miss Lucy R., Katherina, and Frau Cäcilie M. (about the last of whom he generally sustained a discreet silence, no doubt because of her elevated social status). Like Breuer, he asserted that the process produced results:
we found, to our great surprise at first, that each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which it was provoked and in arousing its accompanying affect, and when the patient had described that event in the greatest possible detail and had put the affect into words.3
At length, and primarily at Freud’s insistence, the two men’s shared experiences prompted them to write a joint monograph on hysteria. A preliminary communication on the subject appeared in 1893, and was followed by the publication two years later of their book Studies on Hysteria, to which Freud contributed four lengthy discussions of patients he had treated. To great dramatic effect, a handful of case reports (Anna O. first amongst them) was used to legitimate their theory and treatment. Freud, in particular, wrote his account in the form of a series of psychologically charged vignettes that read, in his own words, “like short stories and that, as one might say, … lack the serious stamp of science”—a discomforting reality that he explained away with the consoling thought that “the nature of the subject is responsible for this, rather than any preference of my own.”4 “Hysterics,” Breuer and Freud concluded, “suffer mainly from reminiscences,”5 memories that lingered in repressed form in the unconscious, only to return to the surface with a vengeance years later in the disguised form of symptoms.
Charcot’s patients had been drawn in substantial numbers from the ranks of the poor, and his etiological account of the origins of hysteria had placed a correspondingly heavy emphasis on degeneration as the source of their troubles. Freud’s and Breuer’s patients, by contrast, were privileged and affluent, ill-disposed to being told that they were biologically inferior. Small wonder that Freud warned of the need to abandon “the theoretical prejudice that we are dealing with the abnormal brains of dégénérés and déséquilibrés.”6 Like Cheyne before them, Breuer and Freud emphasized that hysteria was rather a sign of superiority, the province of the educated, the successful, the well-to-do, the desired, and the desirable. “Hysteria of the severest kind,” Freud insisted, “can exist in conjunction with gifts of the richest and most original kind.”7
It was, as the obese diet doctor had discovered more than a century and a half earlier, a formula that flattered the sensibilities of the hysterical, and did much to increase the clientele of the medics espousing it—which was fortunate, since self-evidently only the rich could afford to indulge in so intensive and extensive a therapy. Frau Cäcilie M., for instance, was twice blessed: born a baroness, and married into still another fortune, this querulous hypochondriac spent the last thirty-three years of her life making various doctors dance to her tunes. For six years, Freud was summoned for daily or twice-daily consultations about her moodiness and hallucinations, obsessions and torments, irritations and anxieties, pains that prevented her walking, and various hysterical conversions that transmuted past experiences into present physical ailments through symbolic association, all of which he sought to trace back to their original traumas—a process that appeared to produce the most intense sufferings in his hypersensitive patient; and a steady stream of fees into the needy Freud’s pocket.
By the time their book appeared, it seems that Freud was already falling out with Breuer, and he subsequently claimed that he had already largely lost his faith in the hypnotic and cathartic techniques their writings recommended. Hysteria, Freud had concluded, would not yield so readily to the recapitulation of the past. Cathartic sessions might indeed relieve some hysterical symptoms, but the relief they supplied was only temporary. A more complex approach to the underlying trauma was required, and it was one that Freud now moved to develop.
16. Sigmund Freud (1856–1939) in 1891, four years before the appearance of Studies on Hysteria. (Wellcome Library, London)
There was the question, of course, of the nature of that trauma. Both men claimed to emphasize the psychological in their accounts. Breuer, indeed, promised: “In what follows, little mention will be made of the brain and none whatever of molecules. Psychical processes will be dealt with in the language of psychology.”8 In reality, however, he does no such thing. His text instead emphasizes “intracerebral excitations,” and, in drawing parallels between the nervous system and electrical installations, he implicitly engages in a reductionism with which Freud would already have been familiar. Charcot, too, in his later years, had increasingly acknowledged the psychological, and had then sought to square his use of such language with his somatic account of hysteria by implying that all things psychological were in reality no more than the surface manifestations of underlying neurological events, what Hughlings Jackson referred to as psychophysical parallelism.
Freud in private was wrestling with this vexed question. He saw that Charcot and Breuer had “solved” this problem by word magic, and that more than vague gestures towards psychophysical parallelism would be required to provide an adequate translation of events at one level into the mechanisms operative at another. But his “project for a scientific psychology,” to which he devoted endless hours before and after the publication of Studies on Hysteria, and the occasion of multiple written but unpublished drafts, became for him a biological blind alley. At length he set the enterprise to one side as insoluble, indeed itself “a kind of madness.” As he confessed in a letter to the Berlin general practitioner Wilhelm Fliess, in November 1895, “I no longer understand the state of mind in which I hatched the psychology.”9 A chemical or physiological account of mental phenomena might ultimately be discovered, but not by him.
Meantime, his case reports about the women he had treated for hysteria had unabashedly stressed the psychological. That provided much of their contemporary and their lasting appeal to a broader audience than his fellow specialists. So did a series of as yet only tantalizing hints of the sexual etiology of hysterical symptoms, for this was a doctrine concerning which Freud himself remained somewhat unsure at this stage. His patients’ symptoms, it seemed, were defenses against “strangulated affect”10 that they had somehow sought to suppress, but the nature of those murdered memories, and quite how their repression contributed to the psychopathology of these hysterical women, were yet to be fully worked out. Past events were bound up with undischarged emotions or affect, and years later those stored-up emotions produced pathologies, pathologies that might be alleviated by reliving (or “abreacting”) the original experience—but only if the patient’s mysterious “amnesia” for the precipitating event could somehow be overcome.
One way of overcoming that unwillingness or inability to cooperate with treatment was to utilize hypnosis. An alternative, with which Freud briefly flirted, was to find ways to make his patients “concentrate,” perhaps by applying physical pressure to the forehead. Still another, and this was the approach that ultimately came to dominate and form the very center of psychoanalytic practice, was to allow the patient to “free associate,” to speak freely whatever manifested itself in his or her consciousness, and thereby, over time and inadvertently, as it were, to reveal what lay beneath the surface, locked away in unconscious levels of mental activity by what he postulated was a vigilant internal censor. For “free” associations eventually ran up against internally generated roadblocks, forms of repression through which the conscious mind kept secrets from itself, but at the price of converting what it repressed into symptoms. Freud’s task, as he saw it, was to comprehend the basis of these internal psychological conflicts, to pry open the patient’s defenses, to make the unconscious conscious. Or, rather, to guide the patient to accomplish these tasks, thereby achieving a lasting rearrangement of his or her mental furniture.
By the early 1890s, Breuer had abandoned hysteria as a focus of his practice and as an intellectual puzzle. He acknowledged when the second edition of their monograph was issued in 1908 that, since its first appearance, “I … have had no active dealings with the subject; I have had no part in its important development and I could add nothing fresh to what was written in 1895.”11 The time-consuming nature of the cathartic treatment was simply incompatible with the nature of his general practice, which in any event amply sufficed to secure for him a lucrative living.
For Freud, by contrast, circumstances were quite otherwise. He had already, in his own words,
abandoned the treatment of organic nervous diseases, but that was of little importance. For on the one hand the prospects in the treatment of such disorders were in any case never promising, while on the other hand, in the private practice of a physician working in a large town, the quantity of such patients was nothing compared to the crowds of neurotics …12
In the last half of the 1890s and a for a few years beyond, hysteria continued to be a focus, indeed had come to dominate, both his clinical practice and his intellectual horizons. His thinking on the subject, and his modes of dealing with his patients, had begun to move in very different directions, and had formed the basis for the construction of a new theory of mind, one that extended to encompass the “normal” as well as the pathological. Simultaneously, they constituted the occasion for developing a new technology of treatment.
To argue that hysteria was at root a psychological, not a physical, disorder was a risky move. As Freud would acknowledge in the opening lecture he delivered in America on psychoanalysis in 1909, the doctor
does not have the same sympathy for the former as for the latter … all his knowledge—his training in anatomy, in physiology, and in pathology—leaves him in the lurch when he is confronted with hysterical phenomena … So it comes about that hysterical patients forfeit his sympathy. He regards them as people who are transgressing the laws of science—like heretics in the eyes of the orthodox. He attributes every kind of wickedness to them, accuses them of exaggeration, of deliberate deceit, of malingering. And he punishes them by withdrawing his interest from them.13
It was an abdication of clinical responsibility that Freud would refuse, and an intellectual stance he would repudiate. For him, human psychology was as rule-governed, as deterministic, as the functioning of the human organism, and therefore it followed that to explain hysteria along psychological lines was not in any way to imply that the disorder was under the volitional control of those who suffered from it. Talk of malingering, of deception, of manipulation came only from people “unaccustomed to reckoning with a strict and universal application of determinism to mental life.”14
In 1896, the year after Studies in Hysteria had appeared in print, Freud published three papers outlining a theory that traced the disease to a different sort of repressed memory, a remembrance of sexual seduction or abuse in infancy. Breuer had recognized that there was frequently a sexual component in cases of hysteria. Freud, however, was now asserting something much stronger: that sexual trauma was always and everywhere the root cause of the disorder. Here was “the key that unlocks everything.”15 If reflex theories had linked hysteria to female reproductive organs, Freud’s psychological theories now traced it back to repressed memories of sexual molestation and incestuous assaults as a child. Sex and psychopathology remained inextricably bound up with each other, but now in novel forms.
Even the prominent Viennese sexologist Richard von Krafft-Ebbing, recently installed in Meynert’s chair at the University of Vienna and the most powerful psychiatrist in Vienna, thought this a bit much, openly dismissing Freud’s theory as “a scientific fairy-tale.”16 And, within a year, Freud was off on another tack: the repressed “memories” of childhood seduction were fantasies, not real events. The florid bodily symptoms of his hysterical patients were the somatic conversions of psychological distress, and reading those symptoms, exploring their roots, required the construction of a whole new theory of the human mind. It was an exploratory trip in which hypnosis was of very little use. Instead, the patient’s free associations, alongside dreams and slips of the tongue, were to provide, in the hands of Freud and his followers, a new guide to the complexity of the territory.
Only a handful of people have followed the renegade Freudian analyst and Sanskrit scholar Jeffrey Moussaieff Masson in seeing Freud’s abandonment of seduction theory as a form of intellectual cowardice or bad faith. For most, whether drawn from the dwindling ranks of the Freudian true believers or from those who regard psychoanalysis as an interesting and curious, if dated and superseded, historical phenomenon, Freud’s own reasons for discarding his belief in the literal truth of most accounts of childhood sexual abuse have been seen as plausible. His treatments based on this theory had almost universally failed, and he had discovered no sure way to distinguish between memories of “real” abuse and fantasies. If that were not bad enough, the sheer number of hysterics flocking to him for treatment seemed to imply that, if hysteria was the product of prior assault, an extraordinarily high number of fathers were pedophiles, a claim he found increasingly implausible. Adding to his discomfort on the latter score was the fact that he himself had suffered from a hysterical breakdown in the late 1990s, following the death of his father on October 23, 1896. He was depressed, riven with self-doubts, and obsessively preoccupied with thoughts of his own premature death; he experienced regular gastric upsets and convinced himself that he was suffering from cardiac problems. Some of his siblings also manifested hysterical symptoms. Did that mean that his father was a child abuser? That, for Freud, was going too far. Instead, by analyzing himself and his dreams, and setting those experiences alongside what he learned from other patients, he moved towards a wholly psychological account of the origins of hysteria.
It was an account that placed fantasy at the root of neurosis, and elaborated a complex model of just how aspects of child development that were supposed to correspond to a universal human nature might under certain conditions provoke hysteria and other forms of psychopathology. That model took a decade and more to develop (and would continue to be modified and tweaked thereafter), but, with the publication of Three Essays on the Theory of Sexuality in 1905, its central elements became clear. The central psychological underpinning for all humans was the libido, the energy that was supplied by unconscious sexual drives. “It is the sexual function,” he announced, “that I look upon as the foundation of hysteria and of the psychoneuroses in general.”17 All sorts of psychological conflicts and discomforts flowed from that fundamental reality.
The Freudian unconscious was a fearful place, one made and generally marred from the outset by the looming presence of parental figures in the newborn’s mental universe. So, far from being a haven from a heartless world, the family was the arena for a host of frightful and dangerous psychodramas that populated that unconscious, fomented its repressions, and created its psychopathologies. As the infant struggled to grow up, and the child to mature, the perils of Oedipal conflicts awaited, and too often wreaked havoc. Forced to repress unacceptable desires, and to deny their fantasies, or to drive them underground, children were riven with psychical conflict. Cravings and suppressions, a search for substitute satisfactions, false forgetting, the constraints of “civilized” morality—in all these respects and more the conflict between Eros and Psyche created a minefield from which few emerged unscathed and unscarred.
If hysteria became just one among many forms of psycho-pathology Freud and his growing band of followers sought to explain and treat, it nonetheless deserves much of the credit (or blame) for the birth of psychoanalysis, a set of doctrines and practices that would prove of growing significance in the twentieth century—indeed, one that would come to dominate American psychiatry for a quarter of a century and more in the years immediately following the Second World War. And yet the ranks of the classic hysterics, both the sorts of patients Freud had observed at the Salpêtrière, and those he and Breuer had jointly written about, mysteriously seemed to thin out by the end of the nineteenth century, or soon thereafter. One more famous hysterical patient came Freud’s way, however, in October 1900, at a time when clients were particularly thin on the ground: Ida Bauer, a woman known to posterity as “Dora.” Dora’s case would allow Freud to incorporate dream analysis into his discussion of hysteria, and it would prompt him to write still another novelistic case history of a young woman afflicted with a protean array of symptoms, the Fragment of a Case of Hysteria.
Dora arrived on Freud’s doorstep at her father’s insistence. The perversity of that action would become fully apparent only as the case unfolded, and would almost be matched, one might conclude, by the nature of the treatment and the interpretations of her “illness” that Freud sought to provide. Ostensibly, the 17-year-old Dora’s encounter with Freud was provoked by her parents’ discovery of a suicide note in her room. That gesture followed two years of depression and difficulty eating, and repeated quarrels with both her mother and her father. On one occasion, these had provoked convulsions and a fainting fit, about which she professed to be amnesiac. Over a period lasting several years, from the age of 13, she had spoken of fatigue and difficulties in concentrating, and her social contacts had steadily diminished. Even before these symptoms surfaced, she had suffered from migraines, had developed a persistent cough, and had periodically lost her voice. Electrotherapy and hydro-therapy had been tried, but with little success.
“Dora’s” father, Philipp Bauer, was already on friendly terms with Freud, who had treated him in years past for tertiary syphilis, so his referral of his daughter for treatment of her “hysterical” symptoms was apparently unsurprising. But once Freud began his “talking cure” a rather more sinister story began to emerge. A prosperous textile manufacturer, Philipp had moved to Meran (now Merano) in the Alps as part of his treatment for tuberculosis. Here, he and his wife became acquainted with the K.’s, a younger family residing in the neighborhood. When syphilis complicated his tuberculosis, Frau K. became his nurse. Soon, the two were lovers, and Frau K. broke off sexual relations with her husband. In turn, Herr K. began to pay close attention to young Dora. One day, he arranged to meet her (together with his wife) at a church. Dora arrived to find he was alone. He drew the shutters on the windows, pulled her to him, and attempted to kiss her. She responded by slapping him and running away. Two summers later, when she was 15, Herr K. renewed his attentions, propositioning her sexually, and remarking “You know I get nothing out of my wife.” Again, she ran from the scene. That afternoon, waking from a nap, she found Herr K. standing at her bedside. When she informed her mother and then her father of these episodes, she was treated as though she were delusionary. Repeatedly, she begged her father to break off relations with the K.’s, only to be ignored, till the truth finally dawned on her: “she had been handed over to Herr K. as the price for his tolerating the relations between her father and his wife.”18 Hence her unremitting depression.
17. “Dora” (Ida Bauer) (1882–1945) with her brother Otto, aged 8 and 9 respectively. Her presentation as a sexual prize to Herr K., and her subsequent encounter with Freud, were still a few years away. (Verein für Geschichte der Arbeiterbewegung)
Such, however, was not Freud’s interpretation of her problems. Relentlessly, he pressed upon the abused adolescent an alternative view of her sufferings. Her disgust at Herr K.’s attempted kiss disguised the fact that she really wanted to be kissed. Her reaction, when surely she secretly welcomed such advances, reflected her repression of her real wishes, and signaled that she was “entirely and completely hysterical.” A dream she reported of her father rescuing her from a burning house, the same house where Herr K. had tried to seduce her, was in reality a disguised acknowledgment of the flames of sexual desire, while other aspects of the dream showed that she masturbated, and had fantasies of oral sex with her father. As evidence, he pointed to her nervous habit of playing with her purse, opening it, sticking a finger into it, and then closing it. Surely the symbolic significance of what she was up to was obvious. And so forth. Repeatedly, Freud invoked his authority as her therapist in an attempt to browbeat an anguished adolescent whose father had offered her up as a sexual prize to the middle-aged man he was cuckolding.
Three months after she had reluctantly undertaken treatment with Freud, Dora abruptly broke off her analysis in anger and disgust, and flounced out of his consulting rooms. Who can blame her? In Erik Erikson’s words, “Dora had been traumatized, and Freud retraumatized her.” Her treatment at his hands, Erikson concluded, “is one of the great psychotherapeutic disasters; one of the most remarkable exhibitions of a clinician’s published rejection of his patient; spectacular, though tragic, evidence of sexual abuse of a young girl, and her own analyst’s exoneration of that abuse; an eminent case of forced associations, forced remembering, and perhaps several forced dreams.”19 As a parting shot, when he published the case, Freud suggested that she harbored bisexual longings towards Frau K., the remaining adult in her circle, to whom Dora had turned in her distress.
Perhaps Dora should have been grateful, though. At least she was not seduced by her therapist (though Freud had suggested to her, on the basis of still another of her dreams, that she must want to kiss him, since he was an avid smoker, like both her father and Herr K.). From Ernest Jones fleeing London in the wake of sexual scandal and allegations of child abuse, through Jung’s seduction of the disturbed Sabina Spielrein (not the last of his predatory affairs with patients), and Sándor Ferenczi’s affair with both Gizella Pallos and her daughter Elma (both of whom had been his analysands), not to mention the wilder escapades of such people as Wilhelm Reich and Otto Gross, the roll of sexual dishonor among psychoanalysts is long. The joining of sex, hysteria, and psychoanalysis occurred, it would seem, on many levels.
Dora’s departure from Freud’s couch broadly coincided with a shift in the focus of much of his clinical activity toward other forms of neurosis. More generally, the sorts of dramatic somatization that were so notable a feature of the fin-de-siècle landscape seem somehow to have disappeared, or at least vanished from view. When hysteria once more appeared in dramatic guise on the historical stage, its victims would be men, not women, and they would number in the tens of thousands, perhaps even the hundreds of thousands. These psychically wounded souls would remain anonymous for the most part, not the individualized, identifiable cases of a Freud or a Charcot. But much of their suffering, too, would come to be viewed through a psychological lens. Sometimes that interpretation would allow a certain sympathy for their condition. More often, it would provoke the veiled hostility and sadism toward them that had characterized many previous medical responses to hysteria. For what could be more unmanly and contemptible than a male hysteric?
