SECTION TWO
The Individual: Therapy and Theory

THERAPY

Like many doctors, writers, and philosophers working at the end of the nineteenth century, Freud grew increasingly interested in the unconscious. He took the unconscious to be a dimension of human life at once inaccessible and important as a source of thoughts and actions. In his efforts to decipher the meanings of hysterical symptoms and other neglected mental phenomena that seemed beyond conscious control (such as dreams and slips of the tongue), Freud moved further away from his neurological training. Committed to the idea that apparently meaningless behaviors actually expressed unconscious conflict, he developed techniques for determining what the behaviors might mean. This section -- divided into six parts -- introduces us to some of Freud's most famous patients and the key concepts with which he tried to make sense of their symptoms and their lives.

Anna O -- Hypnosis to Free Association

Freud's interest in what lay beyond conscious life and in hypnotism and hysteria led him to study with the famous neurologist Jean-Martin Charcot of the Salpêtrière Hospital in Paris. When Freud returned to Vienna, he began using hypnosis, massage, and pressure on the head to get patients to dredge up thoughts related to their symptoms. Only later did he ask them to say whatever crossed their minds. This he called "free association," what the patient "Anna O." had already described as the "talking cure."

Neurology and Hypnosis When Freud went to Paris in 1885 to study with Jean-Martin Charcot, the neurologist had already shifted his own focus from neuropathology to problems of hysteria, hypnotism, and suggestion. Charcot documented the stages of hysteria with photography. This practice was suspect, however, since patients tended to perform for the camera and doctors to record the most photogenic. Freud, too, would devote himself to the study of hysteria but tried to avoid provoking symptoms from patients eager to perform.

Freud's translation of Charcot's lectures into German Holograph manuscript, 1886 Manuscript Division Library of Congress (35)

Images of hysterics under hypnosis at Salpêtrière, from D.M. Bourneville and P. Régnard. [ Upper Left, Upper Right, Lower Left, Lower Right ] Photographic Iconography of Salpêtrière. Paris: 1876-1880 Copyprint General Collections (29)

I felt no particular partiality for the position and activity of a physician in those early years, nor, by the way, later. Rather, I was moved by a sort of greed for knowledge. -- Sigmund Freud, 1925

Hippolyte Bernheim. On Suggestion and Its Curative Effect. Leipzig: 1888 Rare Book & Special Collection Division Library of Congress (30) Hippolyte Bernheim Picture postcard, n.d. Prints & Photographs Division Library of Congress (31)

Suggestion and hypnosis Hippolyte Bernheim, a rival of Charcot's, was convinced that hysteria was the product of suggestion and could be treated through hypnosis. Freud supported Bernheim's attempt to make hypnosis and suggestion legitimate subjects for scientific inquiry, and to develop them as therapeutic devices.

But this procedure of free association and so on is queer, because Freud never shows how we know where to stop -- here is the right solution. -- Ludwig Wittgenstein, 1942

Anna O. and Free Association Freud was impressed by what he heard from his colleague Josef Breuer about one of his patients, Bertha Pappenheim (1859–1936), called Anna O. in the case history. By describing her traumatic experiences and feelings about them to Breuer she seemed to get some relief from debilitating symptoms such as partial paralysis and hallucinations. Although Breuer's treatment was not nearly as successful as he and Freud claimed, Pappenheim eventually overcame her symptoms to become an innovative social worker and a leader of the women's movement in Germany.

Bertha Pappenheim [Anna O.], ca. 1880 Copyprint (38)

Bertha Pappenheim. The Tragic Moment: Three Vignettes. Frankfurt am Main: 1913 [ book cover | title page ] General Collections Library of Congress (39A)
Bertha Pappenheim. Battles: Six Tales. [ book cover | title page] Frankfurt am Main: 1916 General Collections Library of Congress (39B)

The hysterical attack corresponds to a memory from a patient's life. -- Sigmund Freud, 1895

Sigmund Freud and Josef Breuer. Studies on Hysteria. Vienna: 1895 Rare Book & Special Collections Division Library of Congress (36A)

Studies on Hysteria -- First edition This joint publication of Freud's and Breuer's lays out their theory of hysteria, describing how the hysteric experiences the illness and sometimes overcomes it by gaining insight into how it came about. In the draft of "Architecture of Hysteria," Freud tries to sort through the relation of fantasies to accurate memories of traumatic events.

Anna O.'s illness was the desperate struggle of an unsatisfied young woman who found no outlets for her physical and mental energies, nor for her idealistic strivings. -- Henri F. Ellenberger, 1972

Portrait of Josef Breuer Oil painting, 1880s Manuscript Division Library of Congress (36)

"Architecture of Hysteria" Holograph manuscript, 1897 Manuscript Division Library of Congress (37)

Rather than continuing her [Anna O.'s] role as a passive hysterical patient, through her writing she became one who controlled her own cure. -- Elaine Showalter, 1993

Abandoning Hypnosis and Suggestion With hypnotic suggestion, a doctor commanded patients to stop having symptoms. With free association, the analyst intended to create conditions in which patients could grasp the significance of their symptoms and thereby free themselves from illness. But how free was free association? Did psychoanalysts still make use of suggestive powers -- like hypnotists or Charcot's photographers -- even when they no longer gave overt commands to their patients?

"Five Lectures on Psycho-Analysis" Holograph manuscript, 1910 Manuscript Division Library of Congress (33)

No evidence shows that only the patient's unconscious ideas guide the trains of associations in psychoanalytic treatment . . . -- Malcolm Macmillan, 1991

Rat Man, Wolf Man -- Interpretation

For Freud, interpretation was necessary to give meaning to the apparently random thoughts of free association. Freud's focus was on reading the obscure language of the unconscious, and he developed techniques of interpretation in order to do so. In the cases of patients known as Rat Man and Wolf Man, he wove together elaborate stories, explanations, and speculations to make sense out of constellations of symptoms that seemed impossibly puzzling. These case histories, written for colleagues, read like detective novels in which the analyst deciphers the significance of symptoms as if they are clues.

"Rat Man [Ernst Lanzer] Process Notes" Holograph manuscript, 1909 Manuscript Division Library of Congress (40) "Notes Upon a Case of Obsessional Neurosis" Holograph case history, 1909 Manuscript Division, Library of Congress (41)

Rat Man In the case history known as "The Rat Man," Freud tells the story of Ernst Lanzer (1878 1914), a young lawyer plagued by powerful obsessions involving rats, torture, and punishment. Lanzer's obsessive acts and thoughts were traced to his deep ambivalence about sexuality and about his father. These symptoms expressed his ambivalence even as they covered it up. Freud's original process notes from this case are the most complete that still exist. He worked his raw materials into a publishable form that would serve the purposes of his theory, sometimes exaggerating the beneficial effects of the treatment and even its duration.

The Case of the Wolf Man In the case history known as "The Wolf Man," Sergei Pankejeff (1887 1979), a wealthy Russian aristocrat, is described as suffering from debilitating compulsions and fears resulting from his sexual development having gone awry at an early age. Freud focused Pankejeff's attention on a childhood dream which seemed to encapsulate his early traumas and current fears: a dream of wolves perched in a tree outside his open bedroom window. Doctor and patient sought to determine the wish that the dream disguised.

with sister Anna, ca. 1894 with family in Odessa, n.d. self-portrait watercolor, ca. 1919 with wife Therese, ca. 1910 Images of Sergei Pankejeff Sergei Pankejeff Papers Manuscript Division Library of Congress (45, 46, 47, 48)

"Constructions in Analysis" Holograph manuscript, 1938 Manuscript Division Library of Congress (42) Freud in a chair next to his analytic couch in an unidentified summer residence, 1932 Sigmund Freud-Museum Vienna (C)

Constructions in Analysis Throughout his career Freud often considered what it was that made an analytic interpretation effective, and how it might be proven true. How were the interventions of the analyst different from the suggestions of a hypnotist? In this essay from very late in his life, Freud returned to the question of the influence of the analyst and how interpretation, construction, memory, and insight might be related to one another.

Freud has a peculiar tendency to smuggle sexual significance into all possible and impossible dream contents. -- Zeitschrift für Psychologie, 1901

I must therefore content myself with bringing forward fragmentary portions, which the reader can put together into a living whole. -- Sigmund Freud, 1937

Dora and H.D. -- Transference

Freud used the concepts of "transference" and "counter-transference" to refer to the strong emotions projected by the patient onto the doctor and the doctor onto the patient. A transference -- such as treating an analyst like one's father -- might promote therapeutic work, but Freud was also aware that this could distort a patient's (and an analyst's) perspective. Given that an analysis might seem successful entirely because it felt that way, Freud (and his critics) wanted to know how to determine if it had in fact produced true insight. This influence of patient-doctor emotions on analysis plays a central role in two cases. One came at the beginning of Freud's analytic career (the case of Ida Bauer, whom Freud called "Dora") and another at the end (the case of poet Hilda Doolittle, who called herself "H.D.").

Dora -- A Botched Case Ida Bauer (1882-1945), the patient Freud wrote about as "Dora," was sent to him in 1900 suffering from so-called "hysterical" symptoms: a nervous cough, depression, and unsociability. The teenager had been resisting the advances of a family friend -- the husband of a woman with whom Dora's father was having an affair. Rather than interpreting what these hysterical symptoms meant to Dora, Freud insisted that they must have the significance that his theory of the sexual roots of hysteria required. Dora rejected Freud and his ideas and left the treatment.

Ida Bauer [Dora] and her brother Otto, 1890 Copyprint Verein für Geschichte der Arbeiterbewegung Vienna (50) Fragment of an Analysis of a Case of Hysteria Vienna: 1905 Rare Book & Special Collections Division Library of Congress (51) Letter from Freud to Wilhelm Fliess on Dora case Holograph letter, October 14, 1900 Manuscript Division Library of Congress (53)

"Introductory Lectures on Psychoanalysis -- Transference" Holograph manuscript, 1916 1917 Manuscript Division Library of Congress (51B)

Introductory Lectures In the winter terms of 1915-1916 and 1916-1917, Freud gave lectures on psychoanalysis to general audiences of men and women at the University of Vienna. In the lecture on transference he gave an elementary account of how the emotions of patients led them during therapy to repeat patterns from their earliest relationships. The goal of treatment was to make the patient aware of this repetition, bringing to consciousness what had been unconscious.

Indeed, analysis does not set out to prevent pathological reactions, but should give the patient's ego freedom to decide one way or another. -- Sigmund Freud, 1923

H.D. -- An Archaeology of Spirit In 1933 Freud began treating the poet H.D.(1886-1961), who came to him, she said, "to fortify and equip myself to face the war when it came." They shared a passion for archaeology and mythology. For both, Athena, the goddess of wisdom and warfare, carried special significance.

Hilda Doolittle. Tribute to Freud. New York: 1956 Holograph letter, October 14, 1900 Rare Book & Special Collections Division Library of Congress (54) Letter from H.D. to Freud Holograph letter, 1939 Manuscript Division Library of Congress (58)

Once the patient is free of the last authority, the therapist, he has achieved the only possible and real freedom; he is himself alone -- however diminished that self may be. -- Philipp Rieff, 1979

"Remembering, Repeating, and Working Through" Holograph manuscript, 1914 Manuscript Division Library of Congress (52A) Sigmund and Anna Freud on holiday in the Dolomites, Italy, 1913. Sigmund Freud Collection Prints and Photographs Division Library of Congress (A)

From Acting Out to Recollection One of Freud's "Papers on Technique," this 1914 essay describes how making the repetition of childhood patterns visible in the transference can lead a person to self- awareness through recollection. It is by "working through" repetition, not just condemning it, that analysis aims to make the past something one can live with rather than something one is imprisoned in.

take my hands in your hands, teach me to remember, teach me not to remember. -- H.D., 1961

Ends of Analysis In 1937 Freud asked what it meant for an analysis to reach its end. The patient and analyst could decide to stop meeting, but did that mean there were no unconscious conflicts left to discover? In this pessimistic essay, Freud emphasizes again that unconscious conflicts will remain (even after a successful analysis) and may cause significant disturbances.

"Analysis Terminable and Interminable" Holograph manuscript, 1937 Manuscript Division Library of Congress (58B)

No psychoanalyst goes further than his own complexes and internal resistances permit. -- Sigmund Freud, 1910

It is the body of Dora which speaks pain, desire, speaks a force divided and contained. -- Hélène Cixous, 1976

PART 1 - PART 2

HOME - Exhibition Overview & Dates - Object Checklist - Public Programs - Credits
SECTIONS: 1. Formative Years - 2. The Individual: Therapy and Theory
3. From the Individual to Society

Exhibitions Home Page - Library of Congress Home Page

Library of Congress
Contact Us ( April 2, 2007 )