Freud - Complete Works (16 page)

   The work that I had to do with
her this time consisted in dealing in hypnosis with the
disagreeable impressions she had received during her
daughter’s treatment and during her own stay in the
sanatorium. She was full of suppressed anger with the physician who
had compelled her under hypnosis to spell out the word
‘t . . . o . . . a . . . d’
and she made me promise never to make her say it. In this
connection I ventured upon a practical joke in one of my
suggestions to her. This was the only abuse of hypnosis - and a
fairly innocent one at that - of which I have to plead guilty with
this patient. I assured her that her stay in the sanatorium at
‘-
tal
’ [-’vale’] would become so
remote to her that she would not even be able to recall its name
and that whenever she wanted to refer to it she would hesitate
between ‘-
berg
’ [‘-hill’],
‘-
tal
’, ‘-
wald
’
[‘-wood’] and so on. This duly happened and presently
the only remaining sign of her speech-inhibition was her
uncertainty over this name. Eventually, following a remark by Dr.
Breuer, I relieved her of this compulsive paramnesia.

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74

   I had a longer struggle with what
she described as ‘the storms in her head’ than with the
residues of these experiences. When I first saw her in one of these
states she was lying on the sofa with her features distorted and
her whole body unceasingly restless. She kept on pressing her hands
to her forehead and calling out in yearning and helpless tones the
name ‘Emmy’, which was her elder daughter’s as
well as her own. Under hypnosis she informed me that this state was
a repetition of the many fits of despair by which she had been
overcome during her daughter’s treatment, when, after she had
spent hours in trying to discover some means of correcting its bad
effects, no way out presented itself. When, at such a time, she
felt her thoughts becoming confused, she made it a practice to call
out her daughter’s name, so that it might help her back to
clear-headedness. For, during the period when her daughter’s
illness was imposing fresh duties on her and she felt that her own
nervous condition was once again gaining strength over her, she had
determined that whatever had to do with the girl must be kept free
from confusion, however chaotic everything else in her head
was.

   In the course of a few weeks we
were able to dispose of these memories too and Frau Emmy remained
under my observation for some time longer, feeling perfectly well.
At the very end of her stay something happened which I shall
describe in detail, since it throws the strongest light on the
patient’s character and the manner in which her states came
about.

   I called on her one day at
lunch-time and surprised her in the act of throwing something
wrapped up in paper into the garden, where it was caught by the
children of the house-porter. In reply to my question, she admitted
that it was her (dry) pudding, and that this went the same way
every day. This led me to investigate what remained of the other
courses and I found that there was more than half left on the
plates. When I asked her why she ate so little she answered that
she was not in the habit of eating more and that it would be bad
for her if she did; she had the same constitution as her late
father, who had also been a small eater. When I enquired what she
drank she told me she could only tolerate thick fluids, such as
milk, coffee or cocoa; if she ever drank water or minerals it
ruined her digestion. This bore all the signs of a neurotic choice.
I took a specimen of her urine and found it was highly concentrated
and overcharged with urates.

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75

   I therefore thought it advisable
to recommend her to drink more and decided also to increase the
amount of her food. It is true that she did not look at all
noticeably thin but I nevertheless thought it worth while to aim at
feeding her up a little. When on my next visit I ordered her some
alkaline water and forbade her usual way of dealing with her
pudding, she showed considerable agitation. ‘I’II do it
because you ask me to,’ she said, ‘but I can tell you
in advance that it will turn out badly, because it is contrary to
my nature, and it was the same with my father.’ When I asked
her under hypnosis why it was that she could not eat more or drink
any water, she answered in a rather sullen tone: ‘I
don’t know.’ Next day the nurse reported that she had
eaten the whole of her helpings and had drunk a glass of the
alkaline water. But I found Frau Emmy herself lying in a profoundly
depressed state and in a very ungracious mood. She complained of
having very violent gastric pains. ‘I told you what would
happen,’ she said. ‘We have sacrificed all the
successful results that we have been struggling for so long.
I’ve ruined my digestion, as always happens if I eat more or
drink water, and I have to starve myself entirely for five days to
a week before I can tolerate anything.’ I assured her that
there was no need to starve herself and that it was impossible to
ruin one’s digestion in that way: her pains were only due to
the anxiety over eating and drinking. It was clear that this
explanation of mine made not the slightest impression on her. For
when, soon afterwards, I tried to put her to sleep, for the first
time I failed to bring about hypnosis; and the furious look she
cast at me convinced me that she was in open rebellion and that the
situation was very grave. I gave up trying to hypnotize her, and
announced that I would give her twenty-four hours to think things
over and accept the view that her gastric pains came only from her
fear. At the end of this time I would ask her whether she was still
of the opinion that her digestion could be ruined for a week by
drinking a glass of mineral water and eating a modest meal; if she
said yes, I would ask her to leave. This little scene was in very
sharp contrast to our normal relations, which were most
friendly.

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76

   I found her twenty-four hours
later, docile and submissive. When I asked her what she thought
about the origin of her gastric pains, she answered, for she was
incapable of prevarication: ‘I think they come from my
anxiety, but only because you say so.’ I then put her under
hypnosis and asked her once again: 'Why can’t you eat
more?’

   The answer came promptly and
consisted once more in her producing a series of chronologically
arranged reasons from her store of recollections: ‘I’m
thinking how, when I was a child, it often happened that out of
naughtiness I refused to eat my meat at dinner. My mother was very
severe about this and under the threat of condign punishment I was
obliged two hours later to eat the meat, which had been left
standing on the same plate. The meat was quite cold by then and the
fat was set so hard’ (she showed her disgust) ‘. . . I
can still see the fork in front of me . . . one of its prongs was a
little bent. Whenever I sit down to a meal I see the plates before
me with the cold meat and fat on them. And how, many years later, I
lived with my brother who was an officer and who had that horrible
disease. I knew it was contagious and was terribly afraid of making
a mistake and picking up his knife and fork’ (she shuddered)
‘. . . and in spite of that I ate my meals with him so that
no one should know that he was ill. And how, soon after that, I
nursed my other brother when he had consumption so badly. We sat by
the side of his bed and the spittoon always stood on the table,
open’ (she shuddered again) ‘. . . and he had a habit
of spitting across the plates into the spittoon. This always made
me feel so sick, but I couldn’t show it, for fear of hurting
his feelings. And these spittoons are still on the table whenever I
have a meal and they still make me feel sick.’ I naturally
made a thorough clearance of this whole array of agencies of
disgust and then asked why it was that she could not drink water.
When she was seventeen, she replied, the family had spent some
months in Munich and almost all of them had contracted gastric
catarrh owing to the bad drinking water. In the case of the others
the trouble was quickly relieved by medical attention, but with her
it had persisted. Nor had she been improved by the mineral water
which she was recommended. When the doctor had prescribed it she
had thought at once ‘that won’t be any use’. From
that time onwards this intolerance both of ordinary water and
mineral water had recurred on countless occasions.

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77

   The therapeutic effect of these
discoveries under hypnosis was immediate and lasting. She did not
starve herself for a week but the very next day she ate and drank
without making any difficulty. Two months later she wrote in a
letter: ‘I am eating excellently and have put on a great deal
of weight. I have already drunk forty bottles of the water. Do you
think I should go on with it?’

   I saw Frau von N. again in the
spring of the following year at her estate near D---. At this time
her elder daughter, whose name she had called out during her
‘storms in the head’, entered on a phase of abnormal
development. She exhibited unbridled ambitions which were out of
all proportion to the poverty of her gifts, and she became
disobedient and even violent towards her mother. I still enjoyed
her mother’s confidence and was sent for to give my opinion
on the girl’s condition. I formed an unfavourable impression
of the psychological change that had occurred in the girl, and in
arriving at a prognosis I had also to take into account the fact
that all her step-brothers and sisters (the children of Herr von N.
by his first marriage) had succumbed to paranoia. In her
mother’s family, too, there was no lack of a neuropathic
heredity, although none of her more immediate relatives had
developed a chronic psychosis. I communicated to Frau von N.
without any reservation the opinion for which she had asked and she
received it calmly and with understanding. She had grown stout, and
looked in flourishing health. She had felt relatively very well
during the nine months that had passed since the end of her last
treatment. She had only been disturbed by slight neck-cramps and
other minor ailments. During the several days which I spent in her
house I came for the first time to realize the whole extent of her
duties, occupations and intellectual interests. I also met the
family doctor, who had not many complaints to make about the lady;
so she had to some degree come to terms with the profession.

Studies On Hysteria

78

   She was thus in very many
respects healthier and more capable, but in spite of all my
improving suggestions there had been little change in her
fundamental character. She seemed not to have accepted the
existence of a category of ‘indifferent things’. Her
inclination to torment herself was scarcely less than it had been
at the time of her treatment. Nor had her hysterical disposition
been quiescent during this good period. She complained, for
instance, of an inability to make journeys of any length by train.
This had come on during the last few months. A necessarily hurried
attempt to relieve her of this difficulty resulted only in her
producing a number of trivial disagreeable impressions left by some
recent journeys she had made to D--- and its neighbourhood. She
seemed reluctant, however, to be communicative under hypnosis, and
even then I began to suspect that she was on the point of
withdrawing once more from my influence and that the secret purpose
of her railway inhibition was to prevent her making a fresh journey
to Vienna.

   It was during these days, too,
that she made her complaints about gaps in her memory
‘especially about the most important events’, from
which I concluded that the work I had done two years previously had
been thoroughly effective and lasting. - One day, she was walking
with me along an avenue that led from the house to an inlet in the
sea and I ventured to ask whether the path was often infested by
toads. By way of reply she threw a reproachful glance at me, though
unaccompanied by signs of horror; she amplified this a moment later
with the words ‘but the ones here are
real
’.
During the hypnosis, which I induced in order to deal with her
railway inhibition, she herself seemed dissatisfied with the
answers she gave me, and she expressed a fear that in future she
was likely to be less obedient under hypnosis than before. I
determined to convince her of the contrary. I wrote a few words on
a piece of paper, handed it to her and said: ‘At lunch to-day
you will pour me out a glass of red wine, just as you did
yesterday. As I raise the glass to my lips you will say: "Oh,
please pour me out a glass, too", and when I reach for the
bottle, you will say: "No thank you, I don’t think I
will after all". You will then put your hand in your bag, draw
out the piece of paper and find those same words written on
it.’ This was in the morning. A few hours later the little
episode took place exactly as I had pre-arranged it, and so
naturally that none of the many people present noticed anything.
When she asked me for the wine she showed visible signs of an
internal struggle - for she never drank wine - and after she had
refused the drink with obvious relief, she put her hand into her
bag and drew out the piece of paper on which appeared the last
words she had spoken. She shook her head and stared at me in
astonishment.

   After my visit in May, 1890, my
news of Frau von N. became gradually scantier. I heard indirectly
that her daughter’s deplorable condition, which caused her
every kind of distress and agitation, did eventually undermine her
health. Finally, in the summer of 1893, I had a short note from her
asking my permission for her to be hypnotized by another doctor,
since she was ill again and could not come to Vienna. At first I
did not understand why my permission was necessary, till I
remembered that in 1890 I had, at her own request, protected her
against being hypnotized by anyone else, so that there should be no
danger of her being distressed by coming under the control of a
doctor who was antipathetic to her, as had happened at -
berg
(-
tal
, -
wald
). I accordingly renounced my exclusive
prerogative in writing.