FREUD’S FOLLOWERS WERE EAGER for more case histories. Freud, who was refining his methods, was content to oblige. But it seems that in the eight years since the failure with Dora, he had not brought an analysis to a successful conclusion. The First International Psychoanalytic Congress was scheduled for April 1908, in Salzburg. It would include figures soon to achieve their own renown: Ernest Jones, from London; Karl Abraham, from Berlin; Sándor Ferenczi, from Budapest; and Jung, from Zurich. Looking for a subject, Freud tried to move along a collaboration with a member of the Wednesday group. Freud had been acting as a coach in an informal treatment that Max Graf was conducting with his young son.
Graf would later become disenchanted with the analytic movement. But in 1908, he and his wife, Freud’s former patient Olga Hönig, were adherents. It was Freud who had encouraged the two to marry. They had a son, Herbert, then almost five years old, and a baby daughter, Hanna. Not long after the birth of his sister, Herbert had developed a fear of horses. He worried that a horse might bite or fall down, anxiety that soon extended to fear of leaving the house.
Graf and Hönig had intended to raise their children according to analytic principles, with sexual openness and little punishment, but Hönig had trouble sticking to the plan. When her son touched his penis, between age three and four, she threatened to have the doctor cut it off.
This story emerged in the course of Graf ’s conversations with Freud, who later wrote up his consultations with Graf as a case study, calling Herbert “Little Hans.” A captivating recital—in the standard English translation, Hans and his father speak with an endearing formality—the Little Hans case is sometimes put forward as evidence of progress in Freud’s approach to treatment. Where he had jumped to conclusions with Dora, Freud now cautioned Graf to listen patiently. But Freud exercised little restraint in his role as adviser. He immediately told Graf to inform his son that the anxiety over horses was nonsense; he feared them because he took such an interest in their widdlers, and he wanted to be taken into his mother’s bed! When the father and son visited him in the office, Freud bragged to young Herbert that long before his birth, he, the doctor, had known that the boy “would be so fond of his mother that he would be bound to be afraid of his father because of it.”
The father was an eager accomplice, jumping to conclusions in accord with his understanding of Freud’s theories. When Herbert discussed concerns over a biting horse, Graf interpreted: “I say, it strikes me that it isn’t a horse you mean, but a widdler, that one mustn’t put one’s hand to.” Quite sensibly, the boy protested, “But a widdler doesn’t bite.” Freud rechanneled the interaction. He believed that horses symbolized the father, who might either attack the son or (since horses might fall over) die.
Throughout the treatment, Graf’s interpretations received a mixed reception. Herbert feared the public baths. Graf drew his son out on the issue, discussing tubs at home and the boy’s hostility to his sister. Graf suggested, “When you were watching Mummy giving Hanna her bath, perhaps you wished she would let go of her so that Hanna should fall in?” Herbert assented, and later the father continued, “And then you’d be alone with Mummy. A good boy doesn’t wish that sort of thing, though.” Showing no sign of deep conflict, Herbert answered: “But he may think it.” A moment later, Herbert insisted, “If he thinks it, it is good all the same, because you can write it to the Professor.” It seems that Herbert was one more patient who knew what pleased the doctor.
The father and son managed to have amusing conversations about urine, excrement, penises, masturbation, and murder. To this day, there is something refreshing about the window the case notes give on topics dear to boys. At the treatment’s end, Herbert was willing to take walks so long as he could stay in sight of the house, maintaining a line of retreat. Graf interpreted this remaining anxiety as a longing for the mother—even though the phobia had extended to walks with the mother.
Freud put great stock in Herbert’s modest progress. It pointed to the possibility of psychoanalysis with children. Although what Herbert admitted to was mostly sibling rivalry that was readily accessible to consciousness, Freud believed that the case confirmed his theory that phobias arise from Oedipal concerns. The boy’s difficulties seemed to Freud to argue for the benefits of sexual enlightenment at an early age—Freud wished the parents had told Herbert about vaginas and copulation. And despite Herbert’s comfort with aggression and his open wish for more intimacy with his mother, Freud used the analysis to advance his views on the malign effects of the “civilized” repression of instincts. Finally, the Little Hans essay is social criticism.
But Freud understood that, as corroboration, the treatment had its weaknesses. He wrote, “It is true that during the analysis Hans had to be told many things that he could not say himself, that he had to be presented with thoughts which he had so far shown no signs of possessing, and that his attention had to be turned in the direction from which his father was expecting something to come. This detracts from the evidential value of the analysis…” Graf and Freud had struggled mightily to demonstrate castration anxiety in a boy who had, in actuality, been threatened by his mother with loss of his penis.
As for the more local causes of Herbert’s anxiety, there were many to consider. Freud mentioned that the boy’s mother had suffered neurosis. Otherwise, the case report depicts a healthy, well-functioning family. But there was a history of suicide in collateral relatives. (Herbert’s sister would commit suicide as well.) Olga Hönig was by her husband’s account a distant and rigid parent. He and she were in conflict from the start of the marriage, and they divorced shortly after the completion of the therapy. (As a matchmaker, Freud seems to have been convincing but otherwise spectacularly inept.) These details Freud omitted. But those he provided also suggest that Herbert was facing difficult transitions. At age three and a half, the sister had arrived. At four, Herbert was moved out of his parents’ room. The family changed apartments. And the mother became pregnant for a third time. As for his particular fears, it turns out that Hans had, in this period, witnessed a carriage accident in which a horse fell down.
Freud’s account of Little Hans’s phobia was taken at face value for decades, not least because once Freudian psychology gained acceptance, the premises of the analysis seemed obvious. Boys fear castration, desire their mothers, hate their fathers—and this complex is so important that it will stand at the root of any symptoms that appear early in life, or indeed at almost any age.
Coming across an account of a parallel case today, an observer might say that in response to intense attention from his father, and with the passage of time, a vulnerable five-year-old became less handicapped by his agoraphobia. The mother’s coldness, the parents’ eroding marriage, and the arrival of siblings would seem adequate causes for the anxiety. This sort of change in explanation is often called reductionism, but here what has been simplified is a viewpoint whose details are implausible and unnecessary.
The Graf collaboration progressed more slowly than Freud had expected—it would conclude just after the congress. So Freud turned quickly to assemble his thoughts on a recent analysis. The patient was Ernst Lanzer, whom Freud called the “Rat Man.”
Lanzer was a young soldier afflicted with obsessive thoughts that had worsened after his father’s death, when Lanzer was nineteen. He was twenty-nine when he first visited Freud, in October 1907. Aware of Freud’s theories, Lanzer arrived prepared to discuss sex. He liked that Freud’s technique of word association resembled the workings of his own mind under the compulsion of the obsessions.
Lanzer had recently experienced an acute exacerbation of his symptoms after an encounter with a sadistic officer. Lanzer opposed corporal punishment. The officer favored it. Arguing his case, the officer described “a specially horrible punishment used in the East.” A bucket is applied to a man’s rear end, and a hungry rat is placed inside; the rat eats into the man’s anus. Who turned fiction into fact is unknown, but the story is identical to one found in a popular pornographic book published in 1899. Lanzer imagined the procedure being performed on his future wife or his father—thoughts that Lanzer tried to undo through engaging in compulsive rituals.
After taking a history, Freud concluded that Lanzer had suffered obsessive-compulsive disorder since age six. Lanzer had been raised by a domineering, obsessional mother and a violent father. The father, also a military man, beat his son from an early age and threatened him with death or castration for naughtiness. As a three-year-old, Lanzer had turned for comfort to an older sister who engaged him in sex play. This sister died before Lanzer was four. During her terminal illness, Lanzer resisted the father in the course of a beating. The beatings then stopped, perhaps because Lanzer became docile—in his own view, a coward.
As with so many of Freud’s cases, when presented in outline, this one sounds straightforward. A young man who has experienced mental illness since early childhood suffers an exacerbation first upon the death of his father and again after contact with a man who resembles the father in his cruelty. There were other stresses as well, including one common in Freud’s cases, a mésalliance, or love interest across class lines.
But Freud’s approach was to use the details of the obsessions to elucidate the workings of the mind. Lanzer, in his obsessing, produced a wealth of material. Freud picked out a single theme stemming from a single incident as the underlying cause of the illness.
Freud speculated that as Lanzer was turning six, he must have masturbated in shameful fashion and been punished by his father. This interference led to Oedipal rage—repressed aggression by Lanzer against his father. In a therapy filled with recollections, this choice of a signal event was an odd one. Lanzer could remember no such experience, though he was quite open to confession. For instance, he recalled that his mother had interfered with his habit of pulling back the covers to observe a sister’s body while she slept.
Looking for causes of Lanzer’s mental illness, Freud minimized the direct effects of stressors such as the sister’s death and the father’s rage. Freud went so far as to praise the father, calling him “a most excellent man” with a “straightforward soldierly manner,…a hearty sense of humor and kindly tolerance toward his fellow-men.” Freud continued: “That he could be hasty and violent was certainly not inconsistent with his other qualities but was rather a necessary complement to them.” In Freud’s account, it is Lanzer who is aggressive.
With the Oedipus complex as an organizing principle, Freud approached Lanzer’s symptoms, particularly the fears related to rats, as if they were riddles or word puzzles. The climax was an extended riff on rat, or Ratte. Freud connected the word to Spielratte (slang for a gambler, in reference to a behavior of Lanzer’s father), raten (or installment payments, another link to money, a typical concern of obsessives), and hieraten (to marry). Freud went on to connect rats to children—as a child, Lanzer had been punished for biting—so again what was at issue was Lanzer’s own aggression. The rat torture story was agitating for Lanzer because it “fanned into a flame all his prematurely suppressed impulses of cruelty, egoistic and sexual alike.”
Throughout the treatment, Freud worked to overcome what he saw as Lanzer’s resistance to self-awareness. Lanzer had a compulsion about money (he paid Freud in clean bills) but none about sex (he enjoyed fingering the privates of young ladies, a habit that began in childhood with governesses). Freud concluded that the money obsession was a displacement of inapparent sexual disgust. Similarly, over the patient’s objections, Freud insisted that the basis of the obsessions in adulthood was a further conflict with the father (as he had experienced after his death) over Lanzer’s choice of a fiancée. Lanzer’s version was that he was ambivalent about his fiancée because she was infertile and he loved children.
Freud put the case material to multiple uses, reinforcing a hodgepodge of pet theories. For instance, he equated rats burrowing into the anus with children coming out, and then attributed to Lanzer the fantasy that men can bear babies, a reference to Fliess’s concept of universal bisexuality. But the heart of the story was the rat obsession and its roots in the postulated early conflict with the father over masturbation. For Freud, the validity of his interpretations was apparent in the clinical outcome, “the complete restoration of the patient’s personality.”
Freud’s report played to great acclaim at the congress. It demonstrated the subtlety of the therapeutic process, in which the analyst’s genius overcomes the deviousness of the patient’s unconscious. Never had there been a bravura performance like the unraveling of rat associations, all connected to the postulated Oedipal drama. The Rat Man case took place of pride in the repertoire. It is the treatment Freud discussed most often, a complete analysis resulting in complete recovery.
Today, the case’s status is linked to another unique feature. It was Freud’s habit, once he had published a case, to destroy all related clinical files. For unknown reasons, Freud’s daily notes on the work with Lanzer survived.
The notes give a window on Freud’s behavior in the consulting room. Instead of waiting for Lanzer to associate to material, Freud would create links and then supply them. Referring to roundworms, Freud noted: “If the rat is a worm, it is also a penis. I decided to tell him this.” Nor was this sort of intrusion the only deviation from the neutral analytic posture that Freud recommended. When Lanzer looked hungry, Freud invited him to join the family at dinner, with the result that Lanzer had complicated fantasies about Freud’s mother, wife, and daughter, who prepared and served the meal.
More importantly, the file shows how Freud translated clinical material into case histories. His approach was more literary than scientific. Freud altered the sequence of events to enhance drama and to make it appear that his theories arose from the material rather than the reverse. Freud was not beyond creating a symptom where one was needed. He withheld information about Lanzer’s mother. Never mind the dead father’s postulated opposition to the love match; the mother had favored another woman for her son. And Freud added time both to minor events within the treatment and to the analysis as a whole, so that it looked as if discoveries had emerged gradually and as if the therapy had been more extensive than was the case. The distortions are not very substantial. Still, the published Rat Man report is best read as an account of what Freud believed an analysis should look like.
And as usual, it appears that the outcome was less definitive than Freud indicated. Historians have found that Lanzer’s employment pattern remained spotty after treatment. A letter from Freud to Jung suggests ongoing trouble in Lanzer’s life. No long-term follow-up was possible. Lanzer died in 1914, at the start of World War I.
Lanzer did have a response to psychoanalysis—the most favorable of any patient whose treatment Freud reported in detail. Lanzer married his fiancée and finished his course of study. His anxiety over the rat story diminished. The reason for the improvement is unclear. Lanzer never embraced the core formulation, that he had been caught masturbating, but he seemed to enjoy the work with Freud.
Psychotherapy research conducted in the second half of the twentieth century speaks to the power of “nonspecific effects,” benefits unrelated to the theory or particular methods that distinguish a school of treatment. Effective therapies offer support, provide a project shared between doctor and patient, and encourage positive expectations. Freud’s work with Lanzer was especially rich in nonspecific factors. Freud liked Lanzer. He dropped him a friendly postcard during a brief absence. He spoke well of him to others. Freud and Lanzer were similar—obsessional, verbal, modern in their approach to sexuality. The two formed a mutual admiration society, each receiving affirmation in what today would be called an “alter ego transference.” The analysis allowed Lanzer to discuss his symptoms and feelings in a setting that normalized them, as ordinary aspects of human experience. Freud calmed Lanzer down, freeing him to act.
Freud’s work with patients is consistent. He has little use for obvious stressors or even for concrete external reality, like the actual stumble of a horse. Consistently, Freud enforces interpretations about the Oedipus complex. The important associations to the material are not the patient’s but Freud’s. But because his own imagination is so fertile, Freud makes his patients out to be compelling creatures, with creative subterranean layers of mind. And his readings of family life have the paradoxical effect of normalizing strange and, by our standards, abusive behavior, by subordinating it to the (allegedly) more important aggression that arises from within the child and settles in his unconscious mind.
The implicit message in the case histories is that we are all perverse, in our fashion. Nothing we report is likely to surprise. Our drives will always be more extreme than our experiences. To hear Freud tell it, the army officer’s sadistic conceit is child’s play compared to what lies latent in the Rat Man’s fertile brain—or rather, sadism is child’s play. There is, in Freud’s acceptance of Lanzer in particular, a liberating embrace of strangeness. If Freud’s therapies are solipsistic—if he seems scarcely to venture outside his own mind—still he is fully accepting of his patients and their families. Accepting and analyzing the violent and the depraved, along with the incidental and the absurd, these histories contain permission for a century’s worth of rebellious creativity. It is a short step to an embrace of the perverse and the sadistic as proper subjects for art, a short step from Little Hans and the Rat Man to Henry Miller and Luis Buñuel.