Myths, Damned Myths, and Psychoanalytic Case Histories

Allen Esterson comments on Melvyn Bragg’s radio programme on hysteria, “In Our Time”, broadcast on BBC Radio 4, 22 April 2004.

Melvyn Bragg, presenter of BBC Radio 4’s long-running weekly series “In Our Time”, has an impressive record of encouraging practising scientists to make even abstruse scientific topics accessible to the radio-listening public. But when it comes to Freud and psychoanalysis it’s a different story. Whereas scientists are questioned closely about the origins of the ideas in their field, Bragg’s chosen experts on Freud (ne’er a dissenter among them) are given a free run to propagate their faith to the listeners, and manifest errors and dubious assertions are rarely challenged.

On 22 April 2004 the chosen topic was “hysteria”, and as one might have expected, the programme was predominantly about Freud’s early experiences as a neurological practitioner in Vienna in the 1890s. His guests in the studio were Juliet Mitchell, Professor of Psychoanalysis and Gender Studies at the University of Cambridge; Rachel Bowlby, Professor of English at the University of York, who has written the introduction to the new Penguin translation of Freud and Breuer’s Studies on Hysteria; and Brett Kahr, Senior Clinical Research Fellow in Psychotherapy and Mental Health at the Centre for Child Mental Health in London.

For anyone knowledgeable about the history of psychoanalysis, what immediately came across, aside from the simplistically idealised versions of psychoanalytic history the guests on the programme provided, was the ignorance they displayed on occasion. I’ll run through a few examples.

In the context of the discussion about the relative incidence of male and female hysteria in the late nineteenth century, Brett Kahr stated that Freud “began with a cohort of eighteen hysterical patients, all women” on whom he reported in his 1896 “Aetiology of Hysteria” paper. Of course Freud had treated numerous patients in the years immediately prior to this time, but Kahr’s principal error lies in the fact that six of the patients on whom Freud gave a general report in the paper in question were men (Freud, Standard Edition, vol. 3, pp. 207-208). This is not a trivial mistake, because Kahr was addressing the issue of the preponderance of women among people diagnosed with hysteria at that time.

Juliet Mitchell recounted how Freud came back from his period of study in Paris with the notion that there is such a thing as male hysteria and “got a very poor reception”, as “there was a great denial of male hysteria”. This story, told by Freud in “An Autobiographical Study” (SE 20, p. 15), was long ago shown by the historian of psychology Henri Ellenberger to be completely false. He traced documents pertaining to the meeting in 1886 at which Freud gave his report on male hysteria, and found that Freud’s later account of it was the complete opposite of the truth. Ellenberger reports that, far from rejecting Freud’s views, no one denied the existence of male hysteria. In fact the chairman of the meeting, Bamberger, actually said “All this is very interesting, but I see nothing new in it” (Ellenberger, 1970, p. 441). This complete refutation of the traditional account was published in 1970, more than three decades ago, yet so unaware are Freudians like Mitchell of the critical writings on the early history of psychoanalysis in recent decades, she is still repeating this discredited story! And note that neither of the other guests on the programme pointed out that Mitchell’s account was erroneous, so presumably they too are ignorant of Ellenberger’s exposure of the falsity of Freud’s story in his celebrated volume The Discovery of the Unconscious (1970).

All Bragg’s guests were credulous about the clinical claims of Breuer and, especially, Freud concerning their alleged “cures” in this period. Rachel Bowlby acknowledged that Anna O. spontaneously “talked off her distress” prior to Breuer’s encouraging her to talk freely. But she also said that this process showed “the therapeutic effect that could be got from finding the origins of where her troubles had come from”. Now Albrecht Hirschmüller, Breuer’s biographer, traced the original case notes, and found that this account bears little relation to what actually happened. First, some symptoms partially or wholly disappeared spontaneously. Second, the relief from distress that Bowlby describes did not come initially from “finding the origins” of it. In fact the spontaneous talking that Anna O. did at that stage of the treatment had nothing to do with recollecting distressing incidents, as the traditional account has it, but with the recounting of fantasy stories. Breuer then started to prompt her with phrases designed to set the process going whenever she slipped into one of her recurrent trance-like states. Not one of the guests pointed out a crucial fact about the case, that, contrary to Freud’s later several times claiming that Breuer “restored her to health”, the patient was hospitalized almost immediately after Breuer terminated the treatment, and again some three times in subsequent years, each time with the diagnosis of “hysteria”. All this information is available in Hirschmüller’s The Life and Work of Josef Breuer, available in translation since 1989, and has been reported in several books and articles in the last decade. One would have thought that the fact that the traditional account of the Anna O. case was erroneous in a number of important respects would have been pertinent to the discussion, but listeners would have had no idea that this was the case.

The discussion of Freud’s early patients was marred by the extraordinary credulity with which Freud’s claims were treated. Kahr reported how Freud found that his female patients’ somatic symptoms almost invariably originated from sexual experiences. This is the psychoanalytic fairy tale version of events. In fact Freud started with the preconception (stated explicitly in an article he wrote for an encyclopaedia as early as 1888 [SE 1, p. 51]) that sexuality was always an important factor in hysterical symptoms, and such was his interpretative and reconstructive technique, he invariably ‘found’ what he was looking for. So, as Bowlby pointed out, in Studies on Hysteria (1895), Freud reported very few cases of sexual abuse (notably two incidents of attempted assault in teenage). Yet a year later, in accord with the seduction theory he had arrived at on largely theoretical grounds in early October 1895, he was claiming that he had analytically uncovered unconscious memories of sexual abuse in infancy in one hundred percent of his patients.

It was evident that Bragg was slightly disconcerted when Bowlby said that there was very little on sexual abuse in the cases histories in Studies on Hysteria, since he no doubt had in mind the well-known ‘fact’ that most of Freud’s early female patients reported having been sexually abused in early childhood. What a pity the source of Bragg’s puzzlement was not explored, as it would have directed attention to the fact that Freud’s technique of analytic reconstruction and the symbolic interpretation of symptoms always enabled him to ‘find’ whatever his current theory required.

What are the facts about Freud’s supposed childhood sexual abuse cases in this period? In his paper on “Phobias and Obsessions”, published early in 1895, Freud did not report having uncovered a single case of sexual abuse at the root of some eleven patients’ symptoms (and it should be noted obsessional neurosis was as much part of the later seduction theory as hysteria, with six such cases reported in the 1896 papers). And, as already noted, sexual abuse played little role in the cases in Studies on Hysteria (1895). Yet a year later Freud announced that he had uncovered unconscious memories of sexual abuse in infancy for every one of his current patients diagnosed as “hysterical” or “obsessional”. How does one account for this apparent anomaly? In early October 1895 Freud reported to Wilhelm Fliess his exciting new theory, that the “solution” to the aetiology of hysteria and obsessional neuroses was that these patients had unconscious memories of sexual abuse in infancy. Within a mere four months he had completed two papers (one for a French journal) in which he claimed to have corroborated his theory for 13 patients diagnosed as hysterical, and six cases of obsessional neurosis (which patients, incidentally, supposedly also had repressed a memory of an active sexual abuse of an infant sister from around the age of eight). (SE 3, pp. 152, 155-156, 164, 168-169) In other words, a very short time after arriving at his new theory Freud analytically ‘uncovered’ the evidence to confirm it, demonstrating that his analytic technique of interpretation and reconstruction enabled him to ‘corroborate’ whatever theory he currently held. So what about the “cures” he had claimed in Studies on Hysteria? He is now saying (1896) that patients can’t be cured of their major hysterical symptoms unless the crucial infantile traumas are uncovered and abreacted, which calls into question all his earlier claims of therapeutic efficacy. The received account of psychoanalytic history is replete with anomalies such as these, but like members of a true-believing sect, the guests in the studio talked knowingly about such events, seemingly unaware of such blatant inconsistencies.

Towards the end of the discussion, when Kahr was claiming to have uncovered early childhood sexual abuse in one of his patients that he directly associated with symptoms that developed in adulthood, Bragg asked if it was exceptional to find “such a direct link”. Kahr replied “Not at all. I want to resurrect the early trauma model of hysteria”, at which point Bragg made the comment “like the masturbating foot in one of Freud’s early [cases]”, in response to which Juliet Mitchell interjected “that’s right”. But what are the circumstances of this assertion of Freud’s to which Bragg alluded? It comes in “The Aetiology of Hysteria” (SE 3, p. 215), where Freud writes: “Thus, in one of my cases the circumstances that the child was required to stimulate the genitals of a grown-up woman with his foot was enough to fixate his neurotic attention for years on his legs and to their function, and finally to produce a hysterical paraplegia.” I’ll leave aside the question of how, even if we assume the incident occurred as Freud states, he could possibly have ascertained with such certitude that this was the cause of paralysis of the legs decades later. But what evidence do we have that the incident occurred at all? Although in the 1896 seduction theory papers Freud twice said (or directly implied) that he would be providing the “actual material” of the cases he was writing about, he never did so; in other words, everything that people take as given from these papers of 1896 depends entirely on taking Freud’s claims on faith. But the situation is worse than that (for those who do so). None of the participants raised the issue of Freud’s clinical technique that led to his ‘findings’ at that time. Let me give a couple of quotes from the introductory pages to “The Aetiology of Hysteria” (1896). Freud introduced his account of his clinical methodology with analogies, one of which was that his procedure was comparable to that of “a forensic physician [who] can arrive at the cause of an injury, even if he has to do without any information from the injured person” (SE 3, p. 192, my emphasis). Then, after providing the analogy of the “deciphering and translating” of meagre archaeological remains of a building to reconstruct what the original building must have looked like, Freud wrote: “If we try, in an approximately similar way, to induce the symptoms of a hysteria to make themselves heard as witnesses to the history of the origin of the illness, we must take our start from Josef Breuer’s momentous discovery: the symptoms of hysteria…are determined by certain experiences of the patient’s which have operated in a traumatic fashion and which are being introduced in his psychical life in the form of mnemic symbols (pp. 192-193, Freud’s italics).

What do these statements of Freud’s reveal? One, that a central part of his clinical procedure involved the symbolic interpretation of patients’ symptoms to analytically reconstruct the supposed unconscious ideas or memories that lie at the root of the symptoms. Two, that as a generality, Freud arrived at his analytic reconstructions while having “to do without any [direct] information” from the patient. It is in this light that one should consider the “masturbating foot” assertion. There is not one jot of evidence that such an experience actually occurred in the infancy of one of Freud’s patients. (Recall that in the paper in question Freud is writing of unconscious memories of infantile sexual abuse.) Yet such was the level of discourse among the participants in this programme, highly doubtful claims like the “masturbating foot” episode were taken as historical fact without demur; in fact with eager assent in the case of Mitchell.

One fact not brought out in the discussion is that in his 1896 “Aetiology of Hysteria” paper Freud reported that the sexual abuse material he had uncovered in all his patients occurred in “the earliest childhood” (SE 3, p. 202), namely, in “the third or fourth, or even the second year of life” (p. 212). In other words, Freud was claiming to have uncovered unconscious memories (“with our patients, those [sexual abuse] memories are never conscious” [p. 211]) of sexual abuse from the ages of one, two and three. Were anyone to make such claims nowadays, they would be treated with considerable reserve, not to say great scepticism. Yet the guests in the studio discussed such ‘findings’ of Freud’s with no mention whatsoever of any of the facts I documented above. In other words, they treated these purported historical events not unlike the manner in which fundamentalist Christians take as given the stories of the miracles of Jesus.

To get some idea of the mythological world inhabited by the participants in this programme, here is Kahr’s description of how Freud’s “cohort” of seduction theory patients typically produced the material Freud adduced. According to Kahr, Freud “let them into his consulting room, lie down on a couch, put their feet up, and have a conversation”. Compare this with how Freud himself described how he obtained the preconceived infantile “sexual scenes” that he “warned” the patients they would “reproduce” during the application of his “pressure procedure”: “Only the strongest compulsion of the treatment can induce [the patients] to embark on a reproduction of them”. Moreover, “they have no feeling of remembering the scenes” and “assure me emphatically of their unbelief.” (SE 3, p. 204.) Not quite the cosy picture painted by Kahr of Freud’s women patients stretching out on his couch and freely recounting their childhood experiences.

Kahr said of a schizophrenic patient he had once treated that “in psychotherapy we were able to discover that he had had a fellatio trauma as a young boy and that an elder male member [of the family] had orally assaulted him.” It is extraordinary that none of the participants raised the crucial issue of what it means when Kahr confidently tells us that “in psychotherapy we were able to discover” a trauma from the early childhood of a patient. Has it not been all too apparent in recent times that, at the very least, many such ‘discoveries’ are highly dubious? How is it that, although the apparent recovering in therapy of memories of sexual abuse from childhood has been a contentious issue on the very forefront of debates in psychotherapeutic circles, and highlighted in newspaper articles, not one of the participants felt the need to enquire further of Kahr on this point?

Kahr talked with sublime confidence about what Freud “found” in his patients, and about what he himself had “discovered” to be at the root of his patients’ symptoms. Unfortunately no one pointed out that psychoanalysts almost invariably find that the causes of symptoms of their patients are in accord with their preconceptions (in line with whatever psychoanalytic school their ideas are associated with). And when in the course of time some claims cease to be fashionable (or are subsequently explicitly renounced), there is never any explanation of how they came to be analytically ‘confirmed’ in the first place.

One of the most revealing moments in the programme came when the case of Elisabeth von R., from Studies on Hysteria, was discussed. Here is Kahr’s account: “Elisabeth von R. had a huge passion for her brother-in-law but that couldn’t be expressed, and she developed all kinds of symptoms as a result, and when Freud eventually got her to put these frustrated desires into words, into language, the symptoms began to abate.” What are the facts. There is no good evidence that Elisabeth had any amorous feelings towards her brother-in-law, let alone a “huge passion”. Not even Freud suggested that any symptoms other than her intermittent leg pains were related to the feelings he surmised that Elisabeth had for her brother-in-law. And far from putting her (supposed) desires into words, it is evident from the case history that it was Freud who expressed the idea he had surmised to be the “solution” for which he was looking: “She cried aloud when I put the situation [i.e., his own surmise] before her with the words: ‘So for a long time you had been in love with your brother-in-law’.” Nowhere does Freud write that Elisabeth accepted his explanation, or that she put this particular idea into words, though there are tendentiously and artfully composed passages that insinuate that this was the case. (Later in life Elisabeth told her daughter of the “young bearded nerve specialist” who had “tried to persuade me that I was in love with my brother-in-law, but that wasn’t really so.”) Nor is there serious evidence that the leg pains abated as a result of Freud’s confronting her with his “solution” and the discussions in the sessions that followed. All Freud says about her symptoms at this point is, “This process of abreaction certainly did her much good”, with no mention of her leg pains having abated. Some weeks after the termination of the treatment Elisabeth’s mother reported she was suffering from “severe pains once more”. Whatever her subsequent progress, which remained vague in Freud’s account, there is no evidence that Freud’s confronting her with his belief that she was unconsciously in love with her brother-in-law had any effect whatsoever on her intermittent leg pains. (SE 2, pp. 157-160) What is evident here is something I have found repeatedly in reading the literature on Freud, that one cannot trust the accounts of his clinical experiences provided by psychoanalysts and other commentators sympathetic to Freud. (Incidentally, one cannot trust Freud’s own accounts either. In an allusion to Elisabeth von R. in an earlier paper he referred to another young man “who had made a slight erotic impression” on her. In the case history in Studies this was sexed up considerably, and Freud wrote there of the “hopes” that Elisabeth attached to her relationship with the young man, that she was “firmly determined to wait for him”, of the “blissful state of mind” she experienced in his company, and of the “hurt” she felt whenever she thought of him after he moved out of her life [SE 3, p. 48; SE 2, pp. 145, 146].)

The unreliability of psychoanalysts’ accounts is illustrated again by Mitchell’s contribution immediately after the discussion of Elisabeth von R. She mentioned “Katharina”, a young woman with whom Freud had a lengthy conversation one afternoon when he was on holiday in the mountains. According to Mitchell, “her sister is having an affair with her father, and she’s jealous.” This is an extraordinary report on this “case”. The facts, as reported by Freud, are that Katharina told Freud of an occasion when she had come across her father in bed with her older sister, and that he had made a drunken sexual advance towards her [Katharina] when she was fourteen. Nowhere in the case history is there any suggestion that Katharina was jealous of her sister’s sexual relationship with her father. A clue to the anomaly lies in the subject of Mitchell’s latest theorising. Her most recent book is called Siblings, in which she advances the view that sibling rivalry must be considered alongside the traditional Oedipus complex. Evidently she has superimposed her own ideas onto the Katharina case, and has decided that Freud missed that Katharina was jealous of her sister’s relationship with the father. Let me run that one by again. The unique contribution to the psychoanalytic understanding of this case by Juliet Mitchell, Professor of Psychoanalysis and Gender Studies at the University of Cambridge, is that Katharina was jealous of her sister’s incestuous relationship with her drunken father. Leaving aside the enormity of the implications of this ‘insight’, not only do we have commentators presenting tendentious accounts of Freud’s already tendentious reporting of his cases: beyond that Mitchell has imposed her own interpretation of a case in such assured terms that listeners almost certainly would assume she was reporting factual information that is to be found in the original case history. To the (adapted) adage that there are lies, damned lies, and psychoanalytic case histories must be added a fourth category: psychoanalysts’ reports of Freud’s case histories.

What was especially interesting about Mitchell’s saying that Katharina was jealous of her sister’s having an incestuous “affair” with her father is that no one in the studio reacted to it in any way. At such moments it’s almost as if they realise at some level that the subject matter of their discourse exists in some kind of parallel universe. No doubt Mitchell would explain that the jealousy she imputes to Katharina was based on unconscious Oedipal desires that we all have well below the level of our awareness. In her discussion of the Oedipus complex she spoke of “the massive societal taboo on incest at the foundation of society itself. So there’s always a prohibited sexuality in us somewhere.” Shades of Freud’s description of the unconscious as a seething mass of repressed desires, “by preference [for] incestuous objects”, namely, “a man’s mother and sister, a woman’s father and brothers… These censored wishes appear to rise out of positive Hell.” (“Introductory Lectures on Psychoanalysis”, SE 15, pp. 142-143) You should keep such Freudian accounts in mind next time you read some neuroscientist insisting that current research confirms Freud’s theory of the unconscious.

Other items in the programme relating to Mitchell include that she said in relation to the lifelong paralysis of the legs of Alice James, sister of Henry and William, that “it had no organic basis whatsoever”. How can Mitchell possibly know this is the case, and that there were not organic causes of the paralysis which doctors at that time could not identify? Again, Mitchell alluded, with evident approval, to Freud’s psycho-historical analysis of Dostoevsky, but failed to mention that it was fatally undermined in an Appendix devoted to Freud’s paper in Joseph Frank’s book Dostoevsky: The Seeds of Revolt, 1821-1849.

Another point on which listeners were misled is the false impression given, especially by Kahr, that Breuer and Freud were lone pioneers in treating patients with supposed hysterical symptoms by psychological means. In fact other physicians around that period, for instance Benedikt, Féré and Janet, were treating somatic symptoms they regarded as hysterical by their own form of psychotherapy prior to Freud.

That should be enough to demonstrate the extraordinarily circumscribed and misleading nature of what should have been a wide-ranging discussion of the whole idea of hysteria as understood as a clinical entity, including the doubts many people have expressed about the validity of its diagnosis in a high proportion of cases. But, it has to be said, this is par for the course as far as Bragg’s treatment of Freud is concerned. One has only to recall his radio programme on Freud some years ago as part of his series on “The Great Scientists”, a programme replete with inaccuracies on a similar scale. (See On Giants’ Shoulders, M. Bragg, 1998.) To take one example, Bragg discussed Freud’s early interest in hysteria that followed his attending Charcot’s lectures in Paris in 1886, and introduced Susan Greenfield, Professor of Pharmacology at Oxford University, “a neurologist with a special interest in Freud”, to take the historical story further. This is how Greenfield did so:

Initially, he thought hysteria was due to a specific cause, a specific idea, but he gradually realised that, under hypnosis, some of the things his patients were telling him were actual fantasies, they were not real facts. He, himself, when he underwent analysis, realised that this Oedipus complex that he had identified was in fact identifiable in himself, even though it had no immediate cause — there was no history in his childhood of his mother seducing him — but nonetheless he had it. And that made him realise that these seeming-fantasies were part and parcel of the human mind and therefore one did not just have an abnormal cause, one simple cause like something terrible happening to you, a very clear-cut thing happening to you that caused a neurosis, but it was rather more complex than that. (On Giants’ Shoulders, pp. 220-221)

It would take several pages to disentangle all the errors and confusions in this one short passage, but it is immediately evident that it is incoherent. One has the impression that Greenfield was informed she would be asked about this period in Freud’s early psychoanalytic career, so she mugged it up from a psychoanalytic source and regurgitated it as best she could. What she produced would be unacceptably inadequate from a student, let alone from an Oxford professor. But Bragg was content to treat her utterly confused account as if (a) it made sense, and (b) it was historically accurate, neither of which is the case. So what was Greenfield doing on the “Great Scientists” programme on Freud, when it was immediately evident that her knowledge of his clinical experiences and of his writings was minimal? I think there is no doubt that she was chosen (along with Oliver Sacks, who thinks that Freud’s adventures in the underworld of the unconscious are analogous to Darwin’s voyage to the Galapagos Islands [p. 233]) to buttress the contention that Freud was a scientist. This is perhaps the most fundamental of Melvyn Bragg’s many delusions about Freud and psychoanalysis — the beginnings of which he dubbed, poetically, “the golden dawn”.

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