Freud - Complete Works (238 page)

  
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FRAGMENT OF AN ANALYSIS OF A CASE OF HYSTERIA

(1905 [1901])

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Intentionally left blank

1350

FRAGMENT OF AN ANALYSIS OF A CASE OF HYSTERIA

PREFATORY REMARKS

In 1895 and 1896 I put forward certain views
upon the pathogenesis of hysterical symptoms and upon the mental
processes occurring in hysteria. Since that time several years have
passed. In now proposing, therefore, to substantiate those views by
giving a detailed report of the history of a case and its
treatment, I cannot avoid making a few introductory remarks, for
the purpose partly of justifying from various standpoints the step
I am taking, and partly of diminishing the expectations to which it
will give rise.

   No doubt it was awkward that I
was obliged to publish the results of my enquiries without there
being any possibility of other workers in the field testing and
checking them, particularly as those results were of a surprising
and by no means gratifying character. But it will be scarcely less
awkward now that I am beginning to bring forward some of the
material upon which my conclusions were based and make it
accessible to the judgement of the world. I shall not escape blame
by this means. Only, whereas before I was accused of giving no
information about my patients, now I shall be accused of giving
information about my patients which ought not to be given. I can
only hope that in both cases the critics will be the same, and that
they will merely have shifted the pretext for their reproaches; if
so I can resign in advance any possibility of ever removing their
objections.

Fragment Of An Analysis Of A Case Of Hysteria

1351

   Even if I ignore the ill-will of
narrow-minded critics such as these, the presentation of my case
histories remains a problem which is hard for me to solve. The
difficulties are partly of a technical kind, but are partly due to
the nature of the circumstances themselves. If it is true that the
causes of hysterical disorders are to be found in the intimacies of
the patients’ psycho-sexual life, and that hysterical
symptoms are the expression of their most secret and repressed
wishes, then the complete elucidation of a case of hysteria is
bound to involve the revelation of those intimacies and the
betrayal of those secrets. It is certain that the patients would
never have spoken if it had occurred to them that their admissions
might possibly be put to scientific uses; and it is equally certain
that to ask them themselves for leave to publish their case would
be quite unavailing. In such circumstances persons of delicacy, as
well as those who were merely timid, would give first place to the
duty of medical discretion and would declare with regret that the
matter was one upon which they could offer science no
enlightenment. But in my opinion the physician has taken upon
himself duties not only towards the individual patient but towards
science as well; and his duties towards science mean ultimately
nothing else than his duties towards the many other patients who
are suffering or will some day suffer from the same disorder. Thus
it becomes the physician’s duty to publish what he believes
he knows of the causes and structure of hysteria, and it becomes a
disgraceful piece of cowardice on his part to neglect doing so, as
long as he can avoid causing direct personal injury to the single
patient concerned. I think I have taken every precaution to prevent
my patient from suffering any such injury. I have picked out a
person the scenes of whose life were laid not in Vienna but in a
remote provincial town, and whose personal circumstances must
therefore be practically unknown in Vienna. I have from the very
beginning kept the fact of her being under my treatment such a
careful secret that only one other physician - and one in whose
discretion I have complete confidence - can be aware that the girl
was a patient of mine. I have waited for four whole years since the
end of the treatment and have postponed publication till hearing
that a change has taken place in the patient’s life of such a
character as allows me to suppose that her own interest in the
occurrences and psychological events which are to be related here
may now have grown faint. Needless to say, I have allowed no name
to stand which could put a non-medical reader upon the scent; and
the publication of the case in a purely scientific, and technical
periodical should, further, afford a guarantee against unauthorized
readers of this sort. I naturally cannot prevent the patient
herself from being pained if her own case history should
accidentally fall into her hands. But she will learn nothing from
it that she does not already know; and she may ask herself who
besides her could discover from it that she is the subject of this
paper.

Fragment Of An Analysis Of A Case Of Hysteria

1352

   I am aware that - in this city,
at least - there are many physicians who (revolting though it may
seem) choose to read a case history of this kind not as a
contribution to the psychopathology of the neuroses, but as a
roman à clef
designed for their private delectation.
I can assure readers of this species that every case history which
I may have occasion to publish in the future will be secured
against their perspicacity by similar guarantees of secrecy, even
though this resolution is bound to put quite extraordinary
restrictions upon my choice of material.

   Now in this case history - the
only one which I have hitherto succeeded in forcing through the
limitations imposed by medical discretion and unfavourable
circumstances - sexual questions will be discussed with all
possible frankness, the organs and functions of sexual life will be
called by their proper names, and the pure-minded reader can
convince himself from my description that I have not hesitated to
converse upon such subjects in such language even with a young
woman. Am I then, to defend myself upon this score as well? I will
simply claim for myself the rights of the gynaecologist - or
rather, much more modest ones - and add that it would be the mark
of a singular and perverse prurience to suppose that conversations
of this kind are a good means of exciting or of gratifying sexual
desire. For the rest, I feel inclined to express my opinion on this
subject in a few borrowed words:

   ‘It is deplorable to have
to make room for protestations and declarations of this sort in a
scientific work; but let no one reproach me on this account but
rather accuse the spirit of the age, owing to which we have reached
a state of things in which no serious book can any longer be sure
of survival.’ (Schmidt, 1902, Preface.)

   I will now describe the way in
which I have overcome the
technical
difficulties of drawing
up the report of this case history. The difficulties are very
considerable when the physician has to conduct six or eight
psychotherapeutic treatments of the sort in a day, and cannot make
notes during the actual session with the patient for fear of
shaking the patient’s confidence and of disturbing his own
view of the material under observation. Indeed, I have not yet
succeeded in solving the problem of how to record for publication
the history of a treatment of long duration. As regards the present
case, two circumstances have come to my assistance. In the first
place the treatment did not last for more than three months; and in
the second place the material which elucidated the case was grouped
around two dreams (one related in the middle of the treatment and
one at the end). The wording of these dreams was recorded
immediately after the session, and they thus afforded a secure
point of attachment for the chain of interpretations and
recollections which proceeded from them. The case history itself
was only committed to writing from memory after the treatment was
at an end, but while my recollection of the case was still fresh
and was heightened by my interest in its publication. Thus the
record is not absolutely - phonographically - exact, but it can
claim to possess a high degree of trustworthiness. Nothing of any
importance has been altered in it except in some places the order
in which the explanations are given; and this has been done for the
sake of presenting the case in a more connected form.

Fragment Of An Analysis Of A Case Of Hysteria

1353

   I next proceed to mention more
particularly what is to be found in this paper and what is not to
be found in it. The title of the work was originally ‘Dreams
and Hysteria’, for it seemed to me peculiarly well-adapted
for showing how dream-interpretation is woven into the history of a
treatment and how it can become the means of filling in amnesias
and elucidating symptoms. It was not without good reasons that in
the year 1900 I gave precedence to a laborious and exhaustive study
of dreams (
The Interpretation of Dreams
) over the
publications upon the psychology of the neuroses which I had in
view. And incidentally I was able to judge from its reception with
what an inadequate degree of comprehension such efforts are met by
other specialists at the present time. In this instance there was
no validity in the objection that the material upon which had based
my assertions had been withheld and that it was therefore
impossible to become convinced of their truth by testing and
checking them. For every one can submit his own dreams to analytic
examination, and the technique of interpreting dreams may be easily
learnt from the instructions and examples which I have given. I
must once more insist, just as I did at that time, that a thorough
investigation of the problems of dreams is an indispensable
prerequisite for any comprehension of the mental processes in
hysteria and the other psychoneuroses, and that no one who wishes
to shirk that preparatory labour has the smallest prospect of
advancing even a few steps into this region of knowledge. Since,
therefore, this case history presupposes a knowledge of the
interpretation of dreams, it will seem highly unsatisfactory to any
reader to whom this presupposition does not apply. Such a reader
will find only bewilderment in these pages instead of the
enlightenment he is in search of, and he will certainly be inclined
to project the cause of his bewilderment on to the author and to
pronounce his views fantastic. But in reality this bewildering
character attaches to the phenomena of the neurosis itself; its
presence there is only concealed by the physician’s
familiarity with the facts, and it comes to light again with every
attempt a explaining them. It could only be completely banished if
we could succeed in tracing back every single element of a neurosis
to factors with which we were already familiar. But everything
tends to show that, on the contrary, we shall be driven by the
study of neuroses to assume the existence of many new thing which
will later on gradually become the subject of more certain
knowledge. What is new has always aroused bewilderment and
resistance.

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1354

   Nevertheless, it would be wrong
to suppose that dreams and their interpretation occupy such a
prominent position in all psycho-analyses as they do in this
example.

   While the case history before us
seems particularly favoured as regards the utilization of dreams,
in other respects it has turned out poorer than I could have
wished. But its shortcomings are connected with the very
circumstances which have made its publication possible. As I have
already said, I should not have known how to deal with the material
involved in the history of a treatment which had lasted, perhaps,
for a whole year. The present history, which covers only three
months could be recollected and reviewed; but its results remain
incomplete in more than one respect. The treatment was not carried
through to its appointed end, but was broken off at the
patient’s own wish when it had reached a certain point. At
that time some of the problems of the case had not even been
attacked and others had only been imperfectly elucidated; whereas,
if the work had been continued, we should no doubt have obtained
the fullest possible enlightenment upon every particular of the
case. In the following pages, therefore, I can present only a
fragment of an analysis.

Fragment Of An Analysis Of A Case Of Hysteria

1355

   Readers who are familiar with the
technique of analysis as it was expounded in the
Studies on
Hysteria
will perhaps be surprised that it should not have been
possible in three months to find a complete solution at least for
those of the symptoms which were taken in hand. This will become
intelligible when I explain that since the date of the
Studies
psycho-analytic technique has been completely
revolutionized. At that time the work of analysis started out from
the symptoms, and aimed at clearing them up one after the other.
Since then I have abandoned that technique, because I found it
totally inadequate for dealing with the finer structure of a
neurosis. I now let the patient himself choose the subject of the
day’s work, and in that way I start out from whatever surface
his unconscious happens to be presenting to his notice at the
moment. But on this plan everything that has to do with the
clearing-up of a particular symptom emerges piecemeal, woven into
various contexts, and distributed over widely separated periods of
time. In spite of this apparent disadvantage, the new technique is
far superior to the old, and indeed there can be no doubt that it
is the only possible one.