Freud - Complete Works (19 page)

Studies On Hysteria

89

   The examples which follow throw
light on the behaviour of her memory in somnambulism. In
conversation one day she expressed her delight at the beauty of a
plant in a pot which decorated the entrance hall of the
nursing-home. ‘But what is its name, doctor? Do you know? I
used to know its German and its Latin names, but I’ve
forgotten them both.’ She had a wide knowledge of plants,
while I was obliged on this occasion to admit my lack of botanical
education. A few minutes later I asked her under hypnosis if she
now knew the name of the plant in the hall. Without any hesitation
she replied; ‘The German name is
"
Türkenlilie
" [Turk’s-cap lily]; I
really
have
forgotten the Latin one.’ Another time,
when she was feeling in good health, she told me of a visit she had
paid to the Roman Catacombs, but could not recall two technical
terms; nor could I help her with them. Immediately afterwards I
asked her under hypnosis which words she had in mind. But she did
not know them in hypnosis either. So I said to her:
‘Don’t bother about them any more now, but when you are
in the garden to-morrow between five and six in the afternoon -
nearer six than five - they will suddenly occur to you.’ Next
evening, while we were talking about something which had no
connection with catacombs, she suddenly burst out:
‘"Crypt", doctor, and
"Columbarium".’ ‘Ah! those are the words you
couldn’t think of yesterday. When did they occur to
you?’ ‘In the garden this afternoon just before I went
up to my room.’ I saw that she wanted to let me know in this
way that she had followed out my instructions as to time exactly,
as she was in the habit of leaving the garden at about six
o’clock.

   Thus we see that even in
somnambulism she did not have access to the whole extent of her
knowledge. Even in that state there was an actual and a potential
consciousness. It used often to happen that when I asked her during
her somnambulism, where this or that phenomenon was derived from,
she would wrinkle her forehead, and after a pause would answer in a
deprecatory tone: ‘I don’t know.’ On such
occasions I had made it my practice to say: ‘Think a moment;
it will come to mind directly’; and after a short reflection
she would be able to give me the desired information. But it
sometimes happened that nothing came to her mind and that I was
obliged to leave her with the task of remembering it by the next
day; and this never failed to occur.

   In her ordinary life Frau von N.
scrupulously avoided any untruthfulness, nor did she ever lie to me
under hypnosis. Occasionally, however, she would give me incomplete
answers and keep back part of her story until I insisted a second
time on her completing it. It was usually - as in the instance
quoted on
p. 73
- the
distaste inspired by the topic which closed her mouth in
somnambulism no less than in ordinary life. Nevertheless, in spite
of these restrictive traits, the impression made by her mental
behaviour during somnambulism was, on the whole, one of an
uninhibited unfolding of her mental powers and of a full command
over her store of memories.

Studies On Hysteria

90

   Though it cannot be denied that in
a state of somnambulism she was highly suggestible, she was far
from exhibiting a pathological absence of resistance. It can be
asserted on the whole that I did not make more impression on her in
that state than I might have expected to do if I were making an
investigation of this kind into the psychical mechanisms of someone
in full possession of his faculties who put complete confidence in
what I said. The only difference was that Frau von N. was unable,
in what passed as her normal state, to meet me with any such
favourable mental attitude. If, as with her animal phobia, I failed
to give her convincing reasons, or did not go into the psychical
history of the origin of a symptom but tried to operate by the
agency of authoritative suggestion, I invariably observed a
strained and dissatisfied expression on her face; and when, at the
end of the hypnosis, I asked her whether she would still be afraid
of the animal, she would answer: ‘No - since you
insist.’ A promise like this, based only on her obedience to
me, never met with any success, any more than did the many general
injunctions which I laid upon her, instead of which I might just as
well have repeated the single suggestion that she should get
well.

   But this same person who clung so
obstinately to her symptoms in the face of suggestion and would
only abandon them in response to psychical analysis or personal
conviction, was on the other hand as amenable as the best medium to
be found in any hospital, so far as irrelevant suggestions were
concerned - so far as it was a question of matters not connected
with her illness. I have given instances of her post-hypnotic
obedience in the course of the case history. There does not seem to
me to be anything contradictory in this behaviour. Here, too, the
stronger idea was bound to assert itself. If we go into the
mechanism of ‘
idées fixes
’, we find that
they are based upon and supported by so many experiences operating
with such intensity that we cannot be surprised to find that these
ideas are able to put up a successful resistance against the
opposing idea brought forward by suggestion, which is clothed with
only limited powers. It would have to be a truly pathological brain
from which it was possible to blow away by mere suggestion such
well founded products of intense psychical events.¹

  
¹
I have been deeply impressed in another of
my patients by this interesting contrast during somnambulism
between a most far-reaching obedience in everything unconnected
with the symptoms and the obstinacy with which those symptoms
persist because they are deeply rooted and inaccessible to
analysis. A lively and gifted girl, who had suffered for eighteen
months from severe disturbances of her power of walking, was under
my treatment for more than five months without my being able to
help her. She was analgesic and had painful areas in both legs and
a rapid tremor in her hands. She walked bent forward, dragging her
legs and with short steps; she staggered as though she was a
cerebellar case and, indeed, often fell down. Her temperament was
strikingly cheerful. One of the leading authorities in Vienna at
the time was misled by this syndrome into diagnosing her case as
one of multiple sclerosis. Another specialist recognized her as a
hysteric - a diagnosis which was supported by the complicated
picture presented by the disease in its beginnings (pains,
fainting-fits, amaurosis) - and handed her on to me for treatment.
I tried to improve her gait by suggestion, manipulation of her legs
under hypnosis, etc., but I had no success in spite of her being an
excellent subject for somnambulism. One day, after she once more
came tottering into the room, one arm supported on her
father’s, the other on an umbrella whose tip was already much
worn down, I lost patience and shouted at her in her hypnosis:
‘This has gone on too long. To-morrow morning that umbrella
of yours will break in your hands and you’ll have to walk
without it, and from that time on you will never need an umbrella
again.’ I cannot imagine how I came to be so foolish as to
give a suggestion to an umbrella. Afterwards I felt ashamed of
myself, and did not suspect that my clever patient would save my
reputation in the eyes of her father, who was a physician and was
present during her hypnoses. Next day her father said to me:
‘What do you think she did yesterday? We were walking along
the Ringstrasse when she suddenly got into the highest spirits. She
began singing - in the very middle of the street - "Ein freies
Leben führen wir" [‘We live a free life’] and
beat time on the pavement with her umbrella and broke it.’ Of
course she herself had no notion that she had wittily transformed a
nonsensical suggestion into a brilliantly successful one. Since her
condition was not improved by assurances, commands and treatment
under hypnosis, I turned to psychical analysis and requested her to
tell me what emotion had preceded the onset of her illness. She
answered (under hypnosis but without any signs of feeling) that a
short time previously a young relative of hers had died to whom she
had for many years considered herself engaged. This piece of
information, however, produced no alteration whatever in her
condition. Accordingly, during her next hypnosis, I told her I was
quite convinced that her cousin’s death had had nothing at
all to do with her state, but that something else had happened
which she had not mentioned. At this she gave way to the extent of
letting fall a single significant phrase; but she had hardly said a
word before she stopped, and her old father, who was sitting behind
her, began to sob bitterly. Naturally I pressed my investigation no
further; but I never saw the patient again.

Studies On Hysteria

91

   It was while I was studying Frau
von N.’s abulias that I began for the first time to have
grave doubts about the validity of Bernheim’s assertion,
‘
tout est dans la suggestion
’ [‘suggestion
is everything’] and about his clever friend Delboeuf’s
inference: '
Comme quoi il n’y a pas
d’hypnotisme
’ [‘That being so, there is no
such thing as hypnotism’]. And to this day I cannot
understand how it can be supposed that by merely holding up a
finger and saying once ‘go to sleep’ I had created in
the patient the peculiar psychical state in which her memory had
access to all her psychical experiences. I may have
called
up
the state by my suggestion but I did not
create
it,
since its features - which are, incidentally, found universally -
came as such a surprise to me.

   The case history makes
sufficiently plain the way in which therapeutic work was carried
out during somnambulism. As is the usual practice in hypnotic
psychotherapy, I fought against the patient’s pathological
ideas by means of assurances and prohibitions, and by putting
forward opposing ideas of every sort. But I did not content myself
with this. I investigated the genesis of the individual symptoms so
as to be able to combat the premises on which the pathological
ideas were erected. In the course of such an analysis it habitually
happened that the patient gave verbal utterance with the most
violent agitation to matters whose accompanying affect had hitherto
only found outlet as an expression of emotion. I cannot say how
much of the therapeutic success each time was due to my suggesting
the symptom away
in statu nascendi
and how much to my
resolving the affect by abreaction, since I combined both these
therapeutic factors. Accordingly, this case cannot strictly be used
as evidence for the therapeutic efficacy of the cathartic
procedure; at the same time I must add that only those symptoms of
which I carried out a psychical analysis were really permanently
removed.

Studies On Hysteria

92

   The therapeutic success on the
whole was considerable; but it was not a lasting one. The
patient’s tendency to fall ill in a similar way under the
impact of fresh traumas was not got rid of. Anyone who wanted to
undertake the definitive cure of a case of hysteria such as this
would have to enter more thoroughly into the complex of phenomena
than I attempted to do. Frau von N. was undoubtedly a personality
with a severe neuropathic heredity. It seems likely that there can
be no hysteria apart from a disposition of this kind. But on the
other hand disposition alone does not make hysteria. There must be
reasons that bring it about, and, in my opinion, these reasons must
be appropriate: the aetiology is of a specific character. I have
already mentioned that in Frau von N. the affects of a great number
of traumatic experiences had been retained and that the lively
activity of her memory brought now one and now another of these
traumas to the surface of her mind. I shall now venture to put
forward an explanation of the reason why she retained the affects
in this way. That reason, it is true, was connected with her
hereditary disposition. For, on the one hand, her feelings were
very intense; she was of a vehement nature, capable of the
strongest passions. On the other hand, since her husband’s
death, she had lived in complete mental solitude; her persecution
by her relatives had made her suspicious of friends and she was
jealously on guard against anyone acquiring too much influence over
her actions. The circle of her duties was very wide, and she
performed the whole of the mental work which they imposed on her by
herself, without a friend or confidant, almost isolated from her
family and handicapped by her conscientiousness, her tendency to
tormenting herself and often, too, by the natural helplessness of a
woman. In short the mechanism of
the retention of large sums of
excitation
, apart from everything else, cannot be overlooked in
this case. It was based partly on the circumstances of her life and
partly on her natural disposition. Her dislike, for instance, of
saying anything about herself was so great, that, as I noticed to
my astonishment in 1891, none of the daily visitors to her house
recognized that she was ill or were aware that I was her
doctor.

Studies On Hysteria

93

   Does this exhaust the aetiology
of this case of hysteria? I do not think so. For at the time of her
two treatments I had not yet raised in my own mind the questions
which must be answered before an exhaustive explanation of such a
case is possible. I am now of the opinion that there must have been
some added factor to provoke the outbreak of illness precisely in
these last years, considering that operative aetiological
conditions had been present for many years previously. It has also
struck me that amongst all the intimate information given me by the
patient there was a complete absence of the sexual element, which
is, after all, more liable than any other to provide occasion for
traumas. It is impossible that her excitations in this field can
have left no traces whatever; what I was allowed to hear was no
doubt an
editio in usum delphini
[a bowdlerized edition] of
her life-story. The patient behaved with the greatest and to all
appearances with the most unforced sense of propriety, without a
trace of prudishness. When, however, I reflect on the reserve with
which she told me under hypnosis about her maid’s little
adventure in the hotel, I cannot help suspecting that this woman
who was so passionate and so capable of strong feelings had not won
her victory over her sexual needs without severe struggles, and
that at times her attempts at suppressing this most powerful of all
instincts had exposed her to severe mental exhaustion. She once
admitted to me that she had not married again because, in view of
her large fortune, she could not credit the disinterestedness of
her suitors and because she would have reproached herself for
damaging the prospects of her two children by a new marriage.