Freud - Complete Works (239 page)

   In face of the incompleteness of
my analytic results, I had no choice but to follow the example of
those discoverers whose good fortune it is to bring to the light of
day after their long burial the priceless though mutilated relics
of antiquity. I have restored what is missing, taking the best
models known to me from other analyses; but, like a conscientious
archaeologist, have not omitted to mention in each case where the
authentic parts end and my constructions begin.

   There is another kind of
incompleteness which I myself have intentionally introduced. I have
as a rule not reproduced the process of interpretation to which the
patient’s associations and communications had to be
subjected, but only the results of that process. Apart from the
dreams, therefore, the technique of the analytic work has been
revealed in only a very few places. My object in this case history
was to demonstrate the intimate structure of a neurotic disorder
and the determination of its symptoms; and it would have led to
nothing but hopeless confusion if I had tried to complete the other
task at the same time. Before the technical rules, most of which
have been arrived at empirically, could be properly laid down, it
would be necessary to collect material from the histories of a
large number of treatments. Nevertheless, the degree of shortening
produced by the omission of the technique is not to be exaggerated
in this particular case. Precisely that portion of the technical
work which is the most difficult never came into question with the
patient; for the factor of ‘transference’, which is
considered at the end of the case history, did not come up for
discussion during the short treatment.

Fragment Of An Analysis Of A Case Of Hysteria

1356

   For a third kind of
incompleteness in this report neither the patient nor the author is
responsible. It is, on the contrary, obvious that a single case
history, even if it were complete and open to no doubt, cannot
provide an answer to
all
the questions arising out of the
problem of hysteria. It cannot give an insight into all the types
of this disorder, into all the forms of internal structure of the
neurosis, into all the possible kinds of relation between the
mental and the somatic which are to be found in hysteria. It is not
fair to expect from a single case more than it can offer. And any
one who has hitherto been unwilling to believe that a psychosexual
aetiology holds good generally and without exception for hysteria
is scarcely likely to be convinced of the fact by taking stock of a
single case history. He would do better to suspend his judgement
until his own work has earned him the right to a
conviction.¹

   ¹
[
Footnote added
1923:] The treatment
described in this paper was broken off on December 31st, 1899.
[1900] My account of it was written during the two weeks
immediately following, but was not published until 1905. It is not
to be expected that after more than twenty years of uninterrupted
work I should see nothing to alter in my view of such a case and in
my presentment of it; but it would obviously be absurd to bring the
case history ‘up to date’ by means of emendations and
additions. In all essentials, therefore, I have left it as it was,
and in the text I have merely corrected a few oversights and
inaccuracies to which my excellent English translators, Mr. and
Mrs. James Strachey, have directed my attention. Such critical
remarks as I have thought it permissible to add I have incorporated
in these additional notes: so that the reader will be justified in
assuming that I still hold to the opinions expressed in the text
unless he finds them contradicted in the footnotes. The problem of
medical discretion which I have discussed in this preface does not
touch the remaining case histories contained in this volume; for
three of them were published with the express assent of the
patients (or rather, as regards little Hans, with that of his
father), while in the fourth case (that of Schreber) the subject of
the analysis was not actually a person but a book produced by him.
In Dora’s case the secret was kept until this year. I had
long been out of touch with her, but a short while ago I heard that
she had recently fallen ill again from other causes, and had
confided to her physician that she had been analysed by me when she
was a girl. This disclosure made it easy for my well-informed
colleague to recognize her as the Dora of 1899. No fair judge of
analytic therapy will make it a reproach that the three
months’ treatment she received at that time effected no more
than the relief of her current conflict and was unable to give her
protection against subsequent illnesses.

Fragment Of An Analysis Of A Case Of Hysteria

1357

I

THE
CLINICAL PICTURE

   In my
Interpretation of
Dreams
, published in 1900, I showed that dreams in general can
be interpreted, and that after the work of interpretation has been
completed they can be replaced by perfectly correctly constructed
thoughts which can be assigned a recognizable position in the chain
of mental events. I wish to give an example in the following pages
of the only practical application of which the art of interpreting
dreams seems to admit. I have already mentioned in my book¹
how it was that I came upon the problem of dreams. The problem
crossed my path as I was endeavouring to cure psychoneuroses by
means of a particular psychotherapeutic method. For, among their
other mental experiences, my patients told me their dreams, and
these dreams seemed to call for insertion in the long thread of
connections which spun itself out between a symptom of the disease
and a pathogenic idea. At that time I learnt how to translate the
language of dreams into the forms of expression of our own
thought-language, which can be understood without further help. And
I may add that this knowledge is essential for the psycho-analyst;
for the dream is one of the roads along which consciousness can be
reached by the psychical material which, on account of the
opposition aroused by its content, his been cut off from
consciousness and repressed, and has thus become pathogenic. The
dream, in short, is one of the
détours by which
repression can be evaded
; it is one of the principal means
employed by what is known as the indirect method of representation
in the mind. The following fragment from the history of the
treatment of a hysterical girl is intended to show the way in which
the interpretation of dreams plays a part in the work of analysis.
It will at the same time give me a first opportunity of publishing
at sufficient length to prevent further misunderstanding some of my
views upon the psychical processes of hysteria and upon its organic
determinants. I need no longer apologize on the score of length,
since it is now agreed that the exacting demands which hysteria
makes upon physician and investigator can be met only by the most
sympathetic spirit of inquiry and not by an attitude of superiority
and contempt. For,

                                               
Nicht kunst und Wissenschaft allein,

                                               
Geduld will bei dem Werke sein!
²

  
¹
The Interpretation of Dreams
,
Chapter II.

  
²
[ Not Art and Science serve,
alone;

       
Patience must in the work be shown.]

Fragment Of An Analysis Of A Case Of Hysteria

1358

   If I were to begin by giving a
full and consistent case history, it would place the reader in a
very different situation from that of the medical observer. The
reports of the patient’s relatives - in the present case I
was given one by the eighteen-year-old girl’s father -
usually afford a very indistinct picture of the course of the
illness. I begin the treatment, indeed, by asking the patient to
give me the whole story of his life and illness, but even so the
information I receive is never enough to let me see my way about
the case. This first account may be compared to an unnavigable
river whose stream is at one moment choked by masses of rock and at
another divided and lost among shallows and sandbanks. I cannot
help wondering how it is that the authorities can produce such
smooth and precise histories in cases of hysteria. As a matter of
fact the patients are incapable of giving such reports about
themselves. They can, indeed, give the physician plenty of coherent
information about this or that period of their lives; but it is
sure to be followed by another period as to which their
communications run dry, leaving gaps unfilled, and riddles
unanswered; and then again will come yet another period which will
remain totally obscure and unilluminated by even a single piece of
serviceable information. The connections - even the ostensible ones
- are for the most part incoherent, and the sequence of different
events is uncertain. Even during the course of their story patients
will repeatedly correct a particular or a date, and then perhaps,
after wavering for some time, return to their first version. The
patients’ inability to give an ordered history of their life
in so far as it coincides with the history of their illness is not
merely characteristic of the neurosis.¹ It also possesses
great theoretical significance. For this inability has the
following grounds. In the first place, patients consciously and
intentionally keep back part of what they ought to tell - things
that are perfectly we known to them - because they have not got
over their feelings of timidity and shame (or discretion, where
what they say concerns other people); this is the share taken by
conscious
disingenuousness. In the second place, part of the
anamnestic knowledge, which the patients have at their disposal at
other times, disappears while they are actually telling their
story, but without their making any deliberate reservations: the
share taken by
unconscious
disingenuousness. In the third
place, there are invariably true amnesias - gaps in the memory into
which not only old recollections but even quite recent ones have
fallen - and paramnesias, formed secondarily so as to fill in those
gaps.² When the events themselves have been kept in mind, the
purpose underlying the amnesias can be fulfilled just as surely by
destroying a connection, and a connection is most surely broken by
altering the chronological order of events. The latter always
proves to be the most vulnerable element in the store of memory and
the one which is most easily subject to repression. Again we meet
with many recollections that are in what might be described as the
first stage of repression, and these we find surrounded with
doubts. At a later period the doubts would be replaced by a loss or
a falsification of memory.³

  
¹
Another physician once sent his sister to
me for psychotherapeutic treatment, telling me that she had for
years been treated without success for hysteria (pains and
defective gait). The short account which he gave me seemed quite
consistent with the diagnosis. In my first hour with the patient I
got her to tell me her history herself. When the story came out
perfectly clearly and connectedly in spite of the remarkable events
it dealt with, I told myself that the case could not be one of
hysteria, and immediately instituted a careful physical
examination. This led to the diagnosis of a not very advanced state
of tabes, which was later treated with Hg injections (Ol. cinereum)
by Professor Lang with markedly beneficial results.

  
²
Amnesias and paramnesias stand in a
complementary relation to each other. When there are large gaps in
the memory there will be few mistakes in it. And conversely,
paramnesias can at a first glance completely conceal the presence
of amnesias.

  
³
If a patient exhibits doubts in the course
of his narrative, an empirical rule teaches us to disregard such
expressions of his judgement entirely. If the narrative wavers
between two versions, we should incline to regard the first one as
correct and the second as a product of repression.

Fragment Of An Analysis Of A Case Of Hysteria

1359

   That this state of affairs should
exist in regard to the memories relating to the history of the
illness is
a necessary correlate of the symptoms and one which
is theoretically requisite
. In the further course of the
treatment the patient supplies the facts which, though he had known
them all along, had been kept back by him or had not occurred to
his mind. The paramnesias prove untenable, and the gaps in his
memory are filled in. It is only towards the end of the treatment
that we have before us all intelligible, consistent, and unbroken
case history. Whereas the practical aim of the treatment is to
remove all possible symptoms and to replace them by conscious
thoughts, we may regard it as a second and theoretical aim to
repair all the damages to the patient’s memory. These two
aims are coincident. When one is reached, so is the other; and the
same path leads to them both.

   It follows from the nature of the
facts which form the material of psycho-analysis that we are
obliged to pay as much attention in our case histories to the
purely human and social circumstances of our patients as to the
somatic data and the symptoms of the disorder. Above all, our
interest will be directed towards their family circumstances - and
not only, as will be seen later, for the purpose of enquiring into
their heredity.