Freud - Complete Works (15 page)

Studies On Hysteria

69

  
May 17
. - She had a very
good night. In the bran bath which she had to-day, she gave some
screams because she took the bran for worms. I heard this from the
nurse. She herself was reluctant to tell me about it. She was
almost exaggeratedly cheerful, but she kept interrupting herself
with cries of ‘ugh!’ and made faces expressive of
terror. She also stammered more than she has for the last few days.
She told me she had dreamt last night that she was walking on a lot
of leeches. The night before she had had horrible dreams. She had
had to lay out a number of dead people and put them in coffins, but
would not put the lids on. (Obviously, a recollection of her
husband.) She told me further that in the course of her life she
had had a large number of adventures with animals. The worst had
been with a bat which had got caught in her wardrobe, so that she
had rushed out of the room without any clothes on. To cure her of
this fear her brother had given her a lovely brooch in the form of
a bat; but she had never been able to wear it.

   Under hypnosis she explained that
her fear of worms came from her having once been given a present of
a pretty pin cushion; but next morning, when she wanted to use it,
a lot of little worms had crept out of it, because it had been
filled with bran which was not quite dry. (A hallucination? Perhaps
a fact.) I asked her to tell me some more animal stories. Once, she
said, when she had been walking with her husband in a park in St.
Petersburg, the whole path leading to a pond had been covered with
toads, so that they had had to turn back. There had been times when
she had been unable to hold out her hand to anyone, for fear of its
turning into a dreadful animal, as had so often happened. I tried
to free her from her fear of animals by going through them one by
one and asking her if she was afraid of them. In the case of some
of them she answered ‘no’; in the case of others,
‘I mustn’t be afraid of them.’¹ I asked her
why she had stammered and jerked about so much yesterday. She
replied that she always did this when she was very
frightened.² - But why
had
she been so frightened
yesterday? - Because all kinds of oppressive thoughts had come into
her head in the garden: in particular, how she could prevent
something from heaping up again inside her after her treatment had
come to an end. I repeated the three reasons for feeling reassured
which I had already given her: (1) that she had become altogether
healthier and more capable of resistance, (2) that she would get
the habit of telling her thoughts to someone she was on close terms
with, and (3) she would henceforth regard as indifferent a whole
number of things which had hitherto weighed upon her. She went on
to say that she had been worried as well because she had not
thanked me for my visiting her late in the day; and she was afraid
that I would lose patience with her on account of her recent
relapse. She had been very much upset and alarmed because the house
physician had asked a gentleman in the garden whether he was now
able to face his operation. His wife had been sitting beside him,
and she (the patient) could not help thinking that this might be
the poor man’s last evening. - After this last piece of
information her depression seemed to be cleared up.³

  
Evening
. - She was very
cheerful and contented. The hypnosis produced nothing whatever. I
devoted myself to dealing with her muscular pains and to restoring
sensibility in her right leg. This was very easily accomplished in
hypnosis, but her restored sensibility was in part lost again when
she woke up. Before I left her she expressed her astonishment that
it was such a long time since she had had any neck-cramps, though
they usually came on before every thunderstorm.

  
¹
The procedure I was following here can
scarcely be regarded as a good one: none of it was carried out
exhaustively enough.

  
²
Her stammering and clacking were not
completely relieved after they had been traced back to the two
initial traumas, though from then on the two symptoms were
strikingly improved. The patient herself explained the
incompleteness of the success as follows. She had got into the
habit of stammering and clacking whenever she was frightened, so
that in the end these symptoms had come to be attached not solely
to the initial traumas but to a long chain of memories associated
with them, which I had omitted to wipe out. This is a state of
things which arises quite often and which always limits the beauty
and completeness of the therapeutic outcome of the cathartic
procedure.

  
³
It was here that I learnt for the first
time, what was confirmed on countless later occasions, that when
one is resolving a current hysterical delirium, the patient’s
communications are given in a reverse chronological order,
beginning with the most recent and least important impressions and
connections of thought and only at the end reaching the primary
impression, which is in all probability the most important one
causally.

Studies On Hysteria

70

  
May 18
. - She had slept
last night better than she had for years. But after her bath she
complained of cold at the back of her neck, tightness and pains in
the face, hands and feet. Her features were strained and her hands
clenched. The hypnosis brought out no psychical content underlying
her neck-cramp. I improved it by massage after she had woken
up.¹

  
¹
Her astonishment the evening before at its
being so long since she had had a neck-cramp was thus a premonition
of an approaching condition which was already in preparation at the
time and was perceived in the unconscious. This curious kind of
premonition occurred regularly in the case already mentioned of
Frau Cäcilie M. If, for instance, while she was in the best of
health, she said to me, ‘It’s a long time since
I’ve been frightened of witches at night’, or,
‘how glad I am that I’ve not had pains in my eyes for
such a long time’, I could feel sure that the following night
a severe onset of her fear of witches would be making extra work
for her nurse or that her next attack of pains in the eyes was on
the point of beginning. On each occasion what was already present
as a finished product in the unconscious was beginning to show
through indistinctly. This idea, which emerged as a sudden notion,
was worked over by the unsuspecting ‘official’
consciousness (to use Charcot’s term) into a feeling of
satisfaction, which swiftly and invariably turned out to be
unjustified. Frau Cäcilie, who was a highly intelligent woman,
to whom I am indebted for much help in gaining an understanding of
hysterical symptoms, herself pointed out to me that events of this
kind may have given rise to superstitions about the danger of being
boastful or of anticipating evils. We must not vaunt our happiness
on the one hand, nor, on the other, must we talk of the worst or it
will happen. The fact is that we do not boast of our happiness
until unhappiness is in the offing, and we become aware of our
anticipation in the form of a boast, because in such cases the
subject-matter of what we are recollecting emerges before the
feeling that belongs to it - that is to say, because an agreeable
contrasting idea is present in consciousness.

Studies On Hysteria

71

   I hope that this extract from the
history of the first three weeks of the treatment will be enough to
give a clear picture of the patient’s state, of the character
of my therapeutic efforts and of the measure of their success. I
shall now proceed to amplify the case history.

   The delirium which I have last
described was also the last considerable disturbance in Frau Emmy
von N.’s condition. Since I did not take the initiative in
looking for the symptoms and their basis, but waited for something
to come up in the patient or for her to tell me some thought that
was causing her anxiety, her hypnoses soon ceased to produce
material. I therefore made use of them principally for the purpose
of giving her maxims which were to remain constantly present in her
mind and to protect her from relapsing into similar conditions when
she had got home. At that time I was completely under the sway of
Bernheim’s book on suggestion and I anticipated more results
from such didactic measures than I should to-day. My
patient’s condition improved so rapidly, that she soon
assured me she had not felt so well since her husband’s
death. After a treatment lasting in all for seven weeks I allowed
her to return to her home on the Baltic.

   It was not I but Dr. Breuer who
received news of her about seven months later. Her health had
continued good for several months but had then broken down again as
a result of a fresh psychical shock. Her elder daughter, during
their first stay in Vienna, had already followed her mother in
developing neck-cramps and mild hysterical states; but in
particular, she had suffered from pains in walking owing to a
retroverted uterus. On my advice she had gone for treatment to Dr.
N., one of our most distinguished gynaecologists, who had put her
uterus right by massage, and she had remained free from trouble for
several months. Her trouble recurred, however, while they were at
home, and her mother called in a gynaecologist from the
neighbouring University town. He prescribed a combined local and
general treatment for the girl, which, however, brought on a severe
nervous illness (she was seventeen at the time). It is probable
that this was already an indication of her pathological disposition
which was to manifest itself a year later in a character-change.
Her mother, who had handed the girl over to the doctors with her
usual mixture of docility and mistrust, was overcome by the most
violent self-reproaches after the unfortunate outcome of the
treatment. A train of thought which I have not investigated brought
her to the conclusion that Dr. N. and I were together responsible
for the girl’s illness because we had made light of her
serious condition. By an act of will as it were, she undid the
effects of my treatment and promptly, relapsed into the states from
which I had freed her. A distinguished physician in her
neighbourhood, to whom she went for advice, and Dr. Breuer, who was
in correspondence with her, succeeded in convincing her of the
innocence of the two targets of her accusations; but even after
this was cleared up, the aversion to me which she formed at the
time was left over as a hysterical residue, and she declared that
it was impossible for her to take up her treatment with me again.
On the advice of the same medical authority she turned for help to
a Sanatorium in North Germany. At Breuer’s desire I explained
to the physician in charge the modifications of hypnotic therapy
which I had found effective in her case.

Studies On Hysteria

72

   This attempted transfer failed
completely. From the very first she seems to have been at
cross-purposes with the doctor. She exhausted herself in resisting
whatever was done for her. She went downhill, lost sleep and
appetite, and only recovered after a woman friend of hers who
visited her in the Sanatorium in effect secretly abducted her and
looked after her in her house. A short time afterwards, exactly a
year after her first meeting with me, she was again in Vienna and
put herself once more into my hands.

   I found her much better than I
had expected from the accounts I had received by letter. She could
get about and was free from anxiety; much of what I had
accomplished the year before was still maintained. Her chief
complaint was of frequent states of confusion - ‘storms in
her head’ as she called them. Besides this she suffered from
sleeplessness, and was often in tears for hours at a time. She felt
sad at one particular time of day (five o’clock). This was
the regular hour at which, during the winter, she had been able to
visit her daughter in the nursing home. She stammered and clacked a
great deal and kept rubbing her hands together as though she was in
a rage, and when I asked her if she saw a great many animals, she
only replied: ‘Oh keep still!’

   At my first attempt to induce
hypnosis she clenched her fists and exclaimed: ‘I won’t
be given any antipyrin injections; I would rather have my pains! I
don’t like Dr. R.; he is antipathetic to me.’ I
perceived that she was involved in the memory of being hypnotized
in the sanatorium, and she calmed down as soon as I brought her
back to the present situation.

Studies On Hysteria

73

   At the very beginning of the
treatment I had an instructive experience. I had asked her how long
she had had a recurrence of the stammering, and she had
hesitatingly answered (under hypnosis) that it was ever since a
shock she had at D--- during the winter. A waiter at the hotel in
which she was staying had concealed himself in her bedroom. In the
darkness, she said, she had taken the object for an overcoat and
put out her hand to take hold of it; and the man had suddenly
‘shot up into the air’. I took this memory-picture
away, and in fact from that time on she ceased to stammer
noticeably either in hypnosis or in waking life. I cannot remember
what it was that led me to test the success of my suggestion, but
when I returned the same evening I asked her in an apparently
innocent voice how I could manage to fasten the door when I went
away (while she was lying asleep) so that no one could slip into
the room. To my astonishment she gave a violent start and began
grinding her teeth and rubbing her hands. She indicated that she
had had a severe shock of that kind at D---, but could not be
persuaded to tell me the story. I observed that she had in mind the
same story which she had told me that morning during the hypnosis
and which I thought I had wiped out. In her next hypnosis she told
me the story in greater detail and more truthfully. In her
excitement she had been walking up and down the passage and found
the door of her maid’s bed room open. She had tried to go in
and sit down. Her maid had stood in the way, but she refused to be
stopped and walked in, and then caught sight of the dark object
against the wall which turned out to be a man. It was evidently the
erotic factor in this little adventure which had caused her to give
an untrue account of it. This taught me that an incomplete story
under hypnosis produces no therapeutic effect. I accustomed myself
to regarding as incomplete any story that brought about no
improvement, and I gradually came to be able to read from
patients’ faces whether they might not be concealing an
essential part of their confessions.