NO PURE SEDUCTION:
ALLEN ESTERSON ON FREUD’S DISPUTED THEORIES, VIEWS AND
METHODS
Allen Esterson
Although some of his theories are still hotly
debated, Sigmund Freud, (May 6, 1856 – September 23, 1939) is
widely regarded as a trailblazer in the realm of psychiatry and
psychology. The Austrian psychiatrist and neurologist, who was
allegedly the first to offer a comprehensive explanation of how
human behavior is determined by the conscious and unconscious
forces, is regarded as the founder of psychoanalysis.
Along with the “talk therapy” that remains the
staple of psychiatric treatment to this day, Freud popularized,
among other notions, such concepts as the psychosexual stages of
development; Oedipus complex; transference; dream symbolism; Ego,
Id and Super-Ego; and the one that has become part of the
colloquial English more than any other psychiatric term – the
Freudian slip.
Q: You’ve written a fair amount on Freud’s
seduction theory. Can you briefly describe what it is?
A: Well, there are actually two versions. One is the traditional
version, based on Freud’s later accounts of an episode from
his early psychoanalytic career. It says that as a result of
numerous reports from his female patients that they had been
sexually abused by their father in childhood, Freud postulated
that hysterical symptoms in adulthood were caused by childhood
sexual abuse. However, the original 1896 seduction theory papers
show that Freud postulated that the precondition for hysteria was
an unconscious memory of sexual excitation in
infancy. (As Peter Swales has pointed out, the theory should
be more accurately described as the "sexual molestation
theory.") In addition, Freud also postulated that for cases
of obssessional neurosis, as well as repressed memories of
passive infantile sexual experiences, there would have to
have been repressed memories of active sexual experiences
around the age of eight (for example, the boy in question had
supposedly sexually molested a younger sister).
Q: Jeffrey Masson’s book "The Assault on
Truth" argued that Freud intentionally suppressed evidence
that his patients were victims of sexual abuse. Yet you issued a
correction to his account by stating that "Masson’s
version of events is erroneous." How so?
A: To fully understand the situation one must go back a few years
before Masson’s book was published in 1984. During the 1970s,
some feminists in the United States became involved with the
issue of the sexual abuse of female children. Dismayed by the
then current psychoanalytic view that many such allegations made
by adult women in therapy were fantasies, one or two academic
feminists traced the origins of this view to Freud’s later
accounts of the seduction theory episode:
"In the period in which the main interest was
directed to discovering infantile traumas, almost all my women
patients told me that they had been seduced by their father. I
was driven to recognize in the end that these reports were untrue
and so came to understand that hysterical symptoms are derived
from fantasies and not from real occurrences." (Freud,
1933)
Using quotations from Freud’s 1896 seduction theory papers
that appeared to support their argument, and showing little
understanding of Freud’s clinical techniques at that time,
some feminist authors now asserted that the female patients in
question had indeed been sexually abused by their father, and
that Freud had retreated from his clinical claims because he was
unable to face up to the notion that fathers sometimes abused
their daughters. Following up an independent interest in
childhood sexual abuse, Jeffrey Masson, in his capacity as
Projects Director of the Freud Archives, also became convinced
that Freud’s original claims in 1896 were true, and held that
the reason for Freud’s repudiation of the seduction theory
was his failure of courage in the face of opposition to his
contentions from his medical colleagues.
In fact, a correction to Masson’s account had already been
articulated in a then little-known article by Frank Cioffi
("Was Freud a Liar?") published a decade earlier. There
were no reports of childhood sexual abuse from the patients in
question; rather, Freud used his newly-developed technique of
analytic interpretation to "reconstruct" supposed
infantile experiences which he had convinced himself were deeply
buried in his patients’ unconscious minds, and used a
coercive clinical procedure to try to induce them to
"reproduce" the purported "sexual scenes":
"Before they come for analysis the patients know nothing
about these scenes... Only the strongest compulsion of the
treatment can induce them to embark on a reproduction of
them," Freud wrote in 1896. Moreover, "they have no
feeling of remembering the scenes" and assured Freud
"emphatically of their unbelief." Explaining his
analytic methodology, Freud stated: "It is exactly like
putting together a child’s picture puzzle; after many
attempts, we become absolutely convinced which piece belongs in
the empty gap..."
Among the numerous erroneous elements in Masson’s account of
the episode are the following: He did not register that
Freud’s retrospective accounts of the episode changed each
time he reported it (in accord with his current theoretical
requirements), thereby failing to recognize that the final
account (the traditional story quoted above) was suspect, and
that, more generally, Freud’s accounts of his early
psychoanalytic experiences were highly unreliable, something that
Henri Ellenberger (1970) and Frank Sulloway (1979) had already
amply demonstrated. Additionally, he failed to grasp the nature
of Freud’s clinical procedures at that time, though they were
expressed clearly enough in Studies on Hysteria (1895), as
well as in "The Aetiology of Hysteria" (1896). He
credulously treated Freud’s imaginative analytic
reconstructions (based largely on the symbolic interpretation of
symptoms) of patients’ supposed infantile events as authentic
reports of what the patients had told him; credulously accepted
anything that Freud wrote about the reception to his theory,
disregarding the highly subjective, not to say self-serving,
nature of the words in question, thereby treating Freud’s
distorted views as if they constituted accurate history. Further,
he provided a grossly misleading account of the contemporary
reactions to Freud’s "Aetiology of Hysteria" paper;
proposed a motivation for Freud’s repudiation of his theory
that is demonstrably erroneous; gave an erroneous account of the
prehistory of the seduction theory, thereby disregarding the fact
that, prior to Freud’s announcement of the theory in a letter
to Wilhelm Fliess in October 1895, he had not reported a single
case of sexual abuse in infancy, yet only four months later he
completed the first seduction theory papers in which he claimed
that he had uncovered repressed memories of sexual abuse in
infancy for every single one of his current patients. Moreover,
he failed to note that in the "Aetiology" paper
one-third of the patients were men, that the supposed culprits
covered a wide range of categories, and that fathers were not
mentioned among these; and failed to record Freud’s highly
improbable claim that for all six obsessional patients he had not
only uncovered repressed memories of passive sexual abuse in
infancy, but also repressed memories of active sexual abuse
incidents around the age of eight, conveniently in full accord
with his theory. In short, Masson’s account was tendentiously
selective and misleading, most notably in his quotations from the
"Aetiology" paper which he reported in such a way as to
provide a very plausible story for those readers (almost everyone
at the time) who were unaware of the true nature of Freud’s
clinical claims.
I should add that in his Afterword to the 2003 edition of The
Assault on Truth Masson purports to answer his
non-psychoanalytic critics. However, he fails to address many of
the challenges to his thesis (as expounded above), and those he
does consider are often expressed in his own terms rather than in
those of his more knowledgeable critics, enabling him to come up
with a plausible-sounding response. It would take an essay to
detail the fallacies in Masson’s defence of his thesis, but
it is worth noting that he writes that "Freud had a theory
about incest," thereby demonstrating that he hasn’t even
grasped what the seduction theory was about: he has failed to
register that the identity of the putative abuser was of
no consequence, that an absolutely essential part of the theory
(and the 1896 clinical claims) was that the patients had no
memory of the supposed sexual molestations, and that these
incidents had to have occurred in infancy.
Masson’s credulity towards Freud’s subjective opinions
and rhetorical gestures knows no bounds, as if Freud’s
unreliability, and indeed deviousness, had not been repeatedly
demonstrated in the literature of recent decades. For instance,
he quotes Freud’s demonstrably false 1933 account of the
episode (see above) and asks, "Could anything be
clearer?" On the equally demonstrable contention that Freud
was endeavouring to validate a preconceived theory, his
rebuttal is on the grounds that first, Freud twice said he
had no such preconception, and second, that Freud said he
had a personal disinclination for the notion! Indeed such is
Masson’s extraordinary credulity in quoting Freud’s words
both in his 1984 book and in his 2003 Afterword that one gains
the impression that the critical examinations of Freud’s
historical writings in recent times that have exposed their
self-serving nature, and more generally the laying bare of
Freud’s rhetorical techniques, have completely passed him by.
Esterson, A. (2002). "The myth of Freud’s ostracism by
the medical community in 1896-1905: Jeffrey Masson’s assault
on truth." History of Psychology, 5 (2): 115-134. http://www.esterson.org/Myth_of_Freuds_ostracism.htm
Q: In 1993, literary critic, Frederick Crews reviewed
several books on Freud for the New York Review of Books,
one of which was yours, Seductive Mirage. That review set
off an incendiary debate on the merits of Freud’s theories
and methods that has come to be characterized as the Freud Wars.
One of the biggest battles waged in this war has centered on the
notion of Freud’s false memories and the Recovered Memory
Movement. Can you briefly explain this dispute?
A: Inherent in the question are two (related) issues, that
concerning Freud’s false memories (or tendentious
misrepresentations -- it is often difficult to disentangle one
from the other) of what actually happened with his patients in
the mid-1890s, and the supposed false memories of his seduction
theory patients. It is in regard to the latter that the
"battle" has raged. The traditional psychoanalytic
story has always been that Freud soon came to realise that many
of the seduction theory patients’ reports of childhood sexual
abuse were fantasies, or in current parlance, false memories.
However, this view involves a misconception about the nature of
Freud’s original clinical claims and the theory they
supposedly vindicated.
On the basis of this misconception, feminists concerned with
women in psychotherapy represented the episode as a kind of
prototype for the Recovered Memory Movement (RMM). Freud had been
right originally, they argued, when he believed the (purported)
reports of paternal childhood sexual abuse. We must take our cue
from this, the argument went, and recognize that just as Freud
found many instances of childhood sexual abuse among his patients
at that time, we have to appreciate just how widespread the
sexual abuse of female children (especially by their father) is
today. In effect, feminist-inspired therapists saw Freud’s
1896 theory of hysteria (as they understood it) as essentially
correct, and became convinced that the task of the therapist was
to uncover memories of sexual abuse using various techniques to
facilitate their recovery.
One of the fruits of this development was the "bible"
of the RMM, The Courage to Heal: A Guide for Women Survivors
of Child Sexual Abuse (1988), by Ellen Bass and Laura Davis.
Bass and Davis propounded the view that almost any somatic or
behavioral symptom could well indicate forgotten childhood sexual
abuse, and this became a commonplace view among recovered memory
therapists, i.e., therapists who saw as their main task the
uncovering of early abuse experiences. Tens (possibly hundreds)
of thousands of women in the United States (almost all
well-educated) took the lesson to heart and came to believe that
the images and putative memories that were induced under
therapeutic procedures designed to uncover presupposed sexual
abuse represented the central reality of their childhoods. This
resulted in the shattering of thousands of families as so-called
"survivors" broke off relations with their parents,
grandparents, and even siblings if the latter were unconvinced by
their stories. (A similar process was to follow in Britain,
albeit on a smaller scale.)
Critics of the RMM pointed out that the kinds of techniques
practised by recovered memory therapists were conducive to the
production of false memories or false beliefs, and that even the
conviction induced by the reading of books like The Courage to
Heal predisposed some women to believe that childhood sexual
abuse was at the root of specific problems (somatic or
behavioral) in their lives. Many such critics saw in Freud’s
candidly expressed mid-1890s coercive procedures parallels with
the burgeoning RMM, while admirers of Freud argued that, on the
contrary, he had been a pioneer in recognizing the occurrence of
false memories. In regard to the latter view, however, there is a
lack of understanding of the nature of what Freud meant when he
decided that the analytically reconstructed "sexual
scenes" from infancy were actually fantasies. In large part
due to Freud’s tendentious ambiguity in his accounts of the
episode, there is a widespread failure to appreciate that the
supposed "fantasies" were not reports given
by the patients to Freud, or accounts the patients
pieced together, as is generally the case with recovered memory
cases in the present era; rather, they were the imaginative
productions of Freud himself. What that episode actually
exemplifies is not the danger of mistaking patients’ false
memories for authentic events, but that of taking internal
properties of a reconstruction, such as supposed symbolic
relationships with symptoms and self-consistency within a
narrative largely fashioned by Freud himself (i.e., his jigsaw
puzzle argument cited above), to be a demonstration of its
validity.
Contrary to what generally happens in recovered memory therapy,
Freud’s seduction theory patients were not easily won over,
if at all, to the belief that they had been sexually abused in
early childhood. (Freud himself made this clear, and in fact used
this as evidence that his theory was correct, since he
would anticipate there would be strong resistance to the
uncovering of deeply repressed memories.) And, as Crews has
pointed out, despite appreciable differences with psychoanalytic
formulations, the RMM is indebted to Freud’s post-seduction
theory to the extent that there is a core of shared assumptions.
These include that human beings are predisposed to repress early
experiences of a sexual nature, that such unconscious memories
lead to the occurrence of psychological disturbances in
adulthood, that these repressed memories remain essentially
unchanged beyond conscious awareness and can be retrieved by
appropriate techniques decades later, that knowledge of
occurrences in early childhood can be obtained from the analysis
of dreams, that both somatic and behavioral symptoms may be
symbolic representations of early traumas, and that it is
essential to uncover and work through repressed material from
childhood if current emotional problems are to be resolved.
Q: Why do you think there is so much importance placed on
setting Freud "straight" rather than on concentrating
on what’s taking place now in psychoanalytic thinking?
Indeed, Marcia Cavell has argued that "It is as foolish to
try to "analyze" Freud sixty years after his death
without taking account of what has happened in psychoanalytic
thinking in the meantime, as it would be to appraise Darwin
without locating him in post-Darwinian evolutionary
biology." Do you agree?
A: There is a misconception among admirers of Freud that the
critical literature of recent decades has been about criticizing
Freud’s theories -- as if that had not been adequately
undertaken by previous generations of critics -- whereas the bulk
of it has been about setting the historical record straight (as
well as providing previously unrecognized instances of
Freud’s misrepresentations of his clinical experiences) in a
social context in which mythological notions about Freud and his
work have had wide currency. My impression is that few of
Freud’s defenders have actually read the books giving
detailed evaluations of his work, but rely instead on reading
commentators who expound what are essentially summaries of the
critiques, so that they have only a sketchy notion of what the
issues are actually about. This is exemplified by Cavell’s
proposed analogy with Darwin, as if the issue is purely to do
with some erroneous notions propounded by Freud, rather than with
the whole basis of his theoretical postulations, the means by
which he purportedly validated them, and his frequent lapses from
probity in pursuance of persuading people (including himself!) of
the validity of his contentions.
If one is to rebut Cavell’s contention in a single sentence,
one can simply point out that the essential elements of
Darwin’s theory remain central to modern biology, whereas
Freud’s fundamental proposition that he had discovered a
unique technique that reliably enabled him to uncover the
contents of his patients’ unconscious minds is without
foundation. As Clark Glymour has observed in relation to
Freud’s first exposition of psychoanalysis, written
immediately following his recognition that the seduction theory
was erroneous:
"Freud had many scientifically honorable courses
of action available to him.... He did none of these things, or
others one might conceive. Instead he published The
Interpretation of Dreams to justify by rhetorical devices the
very methods he had every reason to distrust.... At the turn of
the century Freud once and for all made his decision as to
whether to think critically, rigorously, honestly, and publicly
about the reliability of his methods. The Interpretation of
Dreams was his answer to the public, and, perhaps, to
himself."
This echoes Cioffi’s words in the same context a decade
earlier: "Freud could not bring himself to recognize the
reasoning by which he had persuaded himself of the authenticity
of the seductions, because it was the same sort of reasoning
which, for the rest of his career, he was to employ in his
reconstruction of infantile fantasy life and of the content of
the unconscious in general." ("Was Freud a Liar?,"
1974)
Q: Has progress been made in the field of psychoanalysis
since Freud?
A: In the sense that the more outlandish Freudian notions were
gradually jettisoned by many psychoanalysts once dissenters like
Karen Horney developed their own theoretical structures in the
1930s, one can say there has been progress. But one must also
consider the question of what is meant by psychoanalysis
nowadays, given that the discipline has become so dispersed and
diluted. Commentators favorable to psychoanalysis argue that the
current situation illustrates the fruitful developments that have
occurred since Freud’s day. More perceptive, I think, is the
view expressed by Alan A. Stone, in a Keynote Address to the
American Academy of Psychoanalysis in 1995. Repudiating the view
that the work of psychoanalytic theorists over the previous
century was analogous to the construction of a great conceptual
cathedral, Stone stated:
"Unfortunately I and many others in my
generation have lost that sense of conviction and with it the
feeling that we are part of a collective enterprise. To us, the
maxim about dwarfs standing on giants seems untrue or at least
inapplicable to psychoanalysis. Those who stand on Freud’s
shoulders have not seen further, they have only seen differently
and often they have seen less. Rather than building a cathedral,
psychoanalysts have built their own churches. Consider from this
perspective the two great women, Anna Freud and Melanie Klein,
who dominated psychoanalysis after Freud’s death. Each of
them thought she was standing on Freud’s shoulders and
extending his true vision. And their adherents certainly believed
they were building Freud’s cathedral and they accommodated
both their psychoanalytic practice and thinking accordingly.
Today, at least in my opinion, and I am not entirely alone in
thinking this, neither Anna Freud’s Ego Psychology nor
Melanie Klein’s Object Relations Theory seem like systematic
advances on Freud’s ideas. Rather they seem like divergent
schools of thought, no closer to Freud than Karen Horney who
rebelled against Freudian orthodoxy."
Treating the same issue from a more theoretical perspective, in
1993 Morris Eagle, former President of the Division of
Psychoanalysis of the American Psychological Association, arrived
at the following conclusion concerning modern developments in
psychoanalytic theory and practice:
"I believe that after examining the different
variants of so-called contemporary psychoanalytic theory... one
must conclude that the theoretical formulations and claims that
constitute contemporary psychoanalytic theory are on no firmer
epistemological grounds than the central formulations and claims
of Freudian theory... There is no evidence that contemporary
psychoanalytic theories have remedied the epistemological and
methodological difficulties that are associated with Freudian
theory."
Q: Almost every element of Freud’s views was
contested during his lifetime. How did Freud handle such
criticism?
A: One needs to appreciate that Freud was utterly convinced that
he had discovered an epoch-making technique for accessing the
contents of the unconscious, and equally convinced that the
fruits of his technique constituted truths about human beings on
which he was the supreme authority. That being the case, he had
to explain why numerous experienced psychologists and
practitioners in related fields were, in varying degrees,
sceptical about his psychoanalytic contentions and supposed
discoveries. His favored explanation was that their objections
were actually rationalizations that masked their unconscious
resistance to psychological truths that they were unable to
confront, and since analytic theory predicted that there would be
strong resistance on the part of patients to the retrieving of
unwelcome repressed ideas, he treated people’s
"resistances" to psychoanalysis "as actual
evidence in favour of the correctness of its assertions"
(1913). In similar vein, in relation to opposition from his
contemporaries to his ideas, he wrote in 1914 that
"psychoanalytic theory enabled me to understand this... as a
necessary consequence of fundamental analytical
premises."Applying the same notion to opposition from
"scientific opponents of psychoanalysis", he averred
that this was "a manifestation of the same resistance which
I had to struggle against in individual patients" (1933). In
short, the refrain that he never tired of repeating was that
society "disputes the truths of psychoanalysis with logical
and factual arguments; but these arise from emotional sources and
it maintains these objections as prejudices, against every
attempt to counter them" (1916).
Of course, he also occasionally provided more direct responses to
specific criticisms, in the course of which he frequently made
use of rhetorical devices, at which he was a master. For
instance, his response sometimes implicitly assumes the point at
issue and only has the appearance of being an answer to
the objection. In such cases, the weakness of his argument may be
camouflaged by the buttressing of his case by his citing supposed
analogies, though the only legitimate use of an analogy is to
clarify a point being made, not to provide evidence for
its validity. The reader is also likely to be inundated with
repetitions of the procedure he is defending, the purpose
of which is to induce a sense of conviction rather than to
persuade by force of argument. Despite his not having adequately
addressed the criticism in question, his presentational skills
are so brilliant that he generally manages to convey the
impression that he has done so, and he proceeds as if the
criticism has been decisively rebutted.
If I had to sum up the essence of Freud’s mode of dealing
with criticisms of his ideas or scepticism about his supposed
clinical findings, I would say it is encompassed in this
statement which prefaced his last major work, An Outline of
Psychoanalysis: "The teachings of psychoanalysis are
based on an incalculable number of observations and experiences,
and only someone who has repeated those observations on himself
and on others is in a position to arrive at a judgement of
them." In other words, only someone who has accepted the
premises of psychoanalysis (since this is necessary to make the
required "observations") is able to make a just
evaluation of it.
Q: Breuer’s seminal case study - the story of Anna O.
- continues to be a source of fascination for many, even though a
century or so has passed. Freud, who never treated her, mentions
her more often than any of his own patients. What is it about
this case study that has captivated so many?
A: The interest in "Anna O." (Bertha Pappenheim), who
was treated by his colleague Josef Breuer in 1880-1882, stems
from the fact that Freud several times alluded to the clinical
procedure used by Breuer as the basis on which he was to develop
his own psychoanalytic theory and practice.
Precisely what happened with Breuer’s patient has long been
the subject of debate and disagreement. There are two main
sources for the crucial information - Breuer’s case history
published (partly from memory) in Studies on Hysteria in
1895, some thirteen years after the treatment was completed in
June 1882, and Breuer’s original report written in July 1882.
The latter is augmented by letters written by Breuer and two
doctors at the Bellevue sanatorium where Pappenheim resided for
several months from July 1882, plus some relevant letters written
by the patient and her mother.
Breuer reports that from the summer of 1880 through to the end of
November, when he was called in on account of a cough that he
quickly diagnosed as hysterical, Pappenheim had developed a
number of transitory symptoms while nursing her father, who was
suffering from a tuberculosis-related pulmonary abscess. She fell
into states of absence, hallucinated, developed visual
disorders, right-sided limb contractures, and other symptoms.
Soon after being called in, Breuer had little hesitation in
deciding that she was experiencing a hysterical illness.
During the following months, when she became bedridden,
Pappenheim exhibited more visual disorders, paralysis of the
anterior neck muscles, and more severe right-sided contractures
and anaesthesias that later affected the left-sided extremities.
The patient also suffered from extreme distress and agitation,
and the loss of her native German language, though she was able
to communicate in English, and occasionally in French or Italian.
There was then a period during which some of these symptoms
spontaneously diminished, or even disappeared. Following the
death of her father in April 1881, there was an exacerbation of
some of the visual disorders and of her states of absence,
with accompanying hallucinations. Later on, her recurring
disturbed mental states were found to ease temporarily after she
recounted fantasy stories while in evening states of
absence. Breuer recorded that by the summer of 1881, the
illness had passed its winter peak, and several somatic symptoms
had either considerably diminished or vanished. The remaining
part of his original report mainly deals with minor symptoms that
resulted from day-to-day "annoyances" and disappeared
when the incidents were later recounted. Unfortunately, the
report only goes up to the December 1881.
The story of Pappenheim’s recovery that became part of
psychoanalytic mythology as told by Freud, was that during the
last six months of the treatment the patient was led to trace
back to the emotional experiences that had occasioned the onset
of her symptoms, and as a result of their cathartic expression
they disappeared and the patient was brought back to health:
"[Breuer] was able with the help of hypnosis to
study and restore to health a highly-gifted girl who suffered
from hysteria... Breuer was able to establish that all her
symptoms were related to [the period when she was nursing her
dying father] and could be explained by it... The therapeutic
procedure adopted by Breuer was to induce the patient, under
hypnosis, to remember the forgotten traumas and to react with
them with powerful expressions of effect." (Freud,
1924)
However, the discovery of Breuer’s original 1882 report by
Henri Ellenberger in the early 1970s showed that, at the very
least, this was a gross oversimplification of the story. As noted
above, during the course of the illness there was spontaneous
remission of some symptoms. Again, as the original report stopped
at the end of 1881, for the crucial period of the last six months
during which the cure was accomplished, we have only Breuer’s
less reliable case history published some thirteen years later,
written up partly from memory. Then there is the fact that the
crucial recollections occurred in states of auto-hypnosis into
which Pappenheim slipped in the evenings, and that Breuer’s
published report of the final six months was heavily dependent on
what his patient told him in this hypnotic state, including his
account of the onset of the symptoms. (As Breuer records in his
original report, Pappenheim only knew of this first period of her
illness from what he was to tell her later; he, in turn, had
heard it from the patient while she was in a trance-like state.)
Following Ellenberger, it has become the received view that,
after Pappenheim’s transfer to a sanatorium in the summer of
1882 with only a short break at the end of Breuer’s
treatment, she retained a considerable number of the symptoms
designated as "hysterical". However, as Richard Skues
has pointed out, most of the symptoms listed by Breuer were not
in evidence in the sanatorium report on the patient, though she
did still retain the tendency to cease to be able to communicate
in German in the evenings, to slip into trance-like states of
absence, and was subject to hallucinations. In addition,
she continued to experience severe facial neuralgia, for which
she had been treated with high doses of morphine for some months
to the extent that she had become addicted. She had also been
treated with high doses of the narcotic chloral hydrate for an
unknown period of time, and had to be weaned off the drug.
Finally, it was discovered by Albrecht Hirschmüller that
Pappenheim spent periods in another sanatorium on three occasions
between 1883 and 1887, each time with a diagnosis of
"hysteria," with an official description of
"somatic illness".
That Pappenheim was free of the majority of her somatic symptoms
at the end of Breuer’s treatment is a separate issue from
whether she was "cured" as a result of the procedures
described in the 1895 case history, and as subsequently recounted
by Freud. Malcolm Macmillan has noted that in the original report
and in the purely descriptive parts of the later case history,
Breuer wrote of symptoms being talked away rather than there
being a cathartic discharge of emotion. In a detailed examination
of the issues that revolve around the case, Richard Webster has
also noted some significant differences between the original
report and the case history published in Studies on Hysteria (a
joint venture to which Breuer had agreed only very reluctantly).
The (whole or partial) spontaneous remission of some symptoms
during the period that Breuer was tending the patient raises
questions about the traditional psychoanalytic account. Breuer
himself acknowledged that "As regards the symptoms
disappearing after being ’talked away’, I cannot use this
as evidence; it may very well be explained by suggestion."
Though he went on to argue against this possibility, three
reviewers of Studies on Hysteria at the time remarked on
the unreliability of material obtained from a patient under
hypnosis, and the possibility that the claimed therapeutic
successes may have owed much to suggestion. On the other hand,
several authors have argued for a predominantly organic illness,
especially as Pappenheim’s symptomatology had much in common
with neurological disorders such as those associated with
epileptic seizures. However, the difficulties of retrospective
diagnosis are considerable, and no consensus about
Pappenheim’s illness has emerged.
No discussion of the significance of the case for psychoanalysis
can omit Freud’s postscript to the story. While it was
claimed that Breuer had achieved a remarkable cure, there
remained the fact that there is nothing pertaining to sexuality
in his account of the case. In other words, it lacked a crucial
ingredient that Freud insisted was always present at the core of
patients’ symptoms (an issue that was a major factor in his
ending his friendship with Breuer not long after the publication
of Studies on Hysteria). He resolved this problem by
hinting at an "untoward event" that supposedly led to
Breuer’s breaking off the treatment prematurely, and wrote in
terms that gave readers the impression of his having good
evidence to support such an incident having occurred, pointing to
the existence of a strong transference between patient and
physician. Privately, he told of Breuer being confronted one day
with Pappenheim supposedly experiencing a "phantom
pregnancy," causing him such a shock that took flight from
the sexual implications. Though through much of the twentieth
century this account achieved wide currency, it is now generally
recognized as a story Freud self-servingly reconstructed to
explain away the absence of sexual elements in Breuer’s
account of his "cure" of Anna O.
