Freud - Complete Works (240 page)

Fragment Of An Analysis Of A Case Of Hysteria

1360

   The family circle of the
eighteen-year-old girl who is the subject of this paper included,
besides herself, her two parents and a brother who was one and a
half years her senior. Her father was the dominating figure in this
circle, owing to his intelligence and his character as much as to
the circumstances of his life. It was those circumstances which
provided the framework for the history of the patient’s
childhood and illness. At the time at which I began the
girl’s treatment her father was in his late forties, a man of
rather unusual activity and talents, a large manufacturer in very
comfortable circumstances. His daughter was most tenderly attached
to him, and for that reason her critical powers, which developed
early, took all the more offence at many of his actions and
peculiarities.

   Her affection for him was still
further increased by the many severe illnesses which he had been
through since her sixth year. At that time he had fallen ill with
tuberculosis and the family had consequently moved to a small town
in a good climate situated in one of our southern provinces. There
his lung trouble rapidly improved; but, on account of the
precautions which were still considered necessary, both parents and
children continued for the next ten years or so to reside chiefly
in this spot, which I shall call B--. When her father’s
health was good, he used at times to be away, on visits to his
factories. During the hottest part of the summer the family used to
move to a health resort in the hills.

   When the girl was about ten years
old, her father had to go through a course of treatment in a
darkened room on account of a detached retina. As a result of this
misfortune his vision was permanently impaired. His gravest illness
occurred some two years later. It took the form of a confusional
attack, followed by symptoms of paralysis and slight mental
disturbances. A friend of his (who plays a part in the story with
which we shall be concerned later on) persuaded him, while his
condition had scarcely improved, to travel to Vienna with his
physician and come to me for advice. I hesitated for some time as
to whether I ought not to regard the case as one of tabo-paralysis,
but I finally decided upon a diagnosis of a diffuse vascular
affection; and since the patient admitted having had a specific
infection before his marriage, I prescribed an energetic course of
anti-luetic treatment, as a result of which all the remaining
disturbances passed off. It is no doubt owing to this fortunate
intervention of mine that four years later he brought his daughter,
who had meanwhile grown unmistakably neurotic, and introduced her
to me, and that after another two years he handed her over to me
for psychotherapeutic treatment.

   I had in the meantime also made
the acquaintance in Vienna of a sister of his, who was a little
older than himself. She gave clear evidence of a severe form of
psychoneurosis without any characteristically hysterical symptoms.
After a life which had been weighed down by an unhappy marriage,
she died of a marasmus which made rapid advances and the symptoms
of which were, as a matter of fact, never fully cleared up. An
elder brother of the girl’s father, whom I once happened to
meet, was a hypochondriacal bachelor.

Fragment Of An Analysis Of A Case Of Hysteria

1361

   The sympathies of the girl
herself, who, as I have said, became my patient at the age of
eighteen, had always been with the father’s side of the
family, and ever since she had fallen ill she had taken as her
model the aunt who has just been mentioned. There could be no
doubt, too, that it was from her father’s family that she had
derived not only her natural gifts and her intellectual precocity
but also the predisposition to her illness. I never made her
mother’s acquaintance. From the accounts given me by the girl
and her father I was led to imagine her as an uncultivated woman
and above all as a foolish one, who had concentrated all her
interests upon domestic affairs, especially since her
husband’s illness and the estrangement to which it led. She
presented the picture, in fact, of what might be called the
‘housewife’s psychosis’. She had no understanding
of her children’s more active interests, and was occupied all
day long in cleaning the house with its furniture and utensils and
in keeping them clean - to such an extent as to make it almost
impossible to use or enjoy them. This condition, traces of which
are to be found often enough in normal housewives, inevitably
reminds one of forms of obsessional washing and other kinds of
obsessional cleanliness. But such women (and this applied to the
patient’s mother) are entirely without insight into their
illness, so that one essential characteristic of an
‘obsessional neurosis’ is lacking. The relations
between the girl and her mother had been unfriendly for years. The
daughter looked down on her mother and used to criticize her
mercilessly, and she had withdrawn completely from her
influence.¹

  
¹
I do not, it is true, adopt the position
that heredity is the only aetiological factor in hysteria. But, on
the other hand - and I say this with particular reference to some
of my earlier publications, e.g. ‘Heredity and the Aetiology
of the Neuroses’ (1896
n
), in which I combated that
view - I do not wish to give an impression of underestimating the
importance of heredity in the aetiology of hysteria or of asserting
that it can be dispensed with. In the case of the present patient
the information I have given about her father and his brother and
sister indicates a sufficiently heavy taint; and, indeed, if the
view is taken that pathological conditions such as her
mother’s must also imply a hereditary predisposition, the
patient’s heredity may be regarded as a convergent one. To my
mind, however, there is another factor which is of more
significance in the girl’s hereditary or, properly speaking,
constitutional predisposition. I have mentioned that her father had
contracted syphilis before his marriage. Now a
strikingly
high
percentage of the patients whom I have treated
psycho-analytically come of fathers who have suffered from tabes or
general paralysis. In consequence of the novelty of my therapeutic
method, I see only the
severest
cases, which have already
been under treatment for years without any success. In accordance
with the Erb-Fournier theory, tabes or general paralysis in the
male parent may be regarded as evidence of an earlier luetic
infection; and indeed I was able to obtain direct confirmation of
such an infection in a number of cases. In the most recent
discussion on the offspring of syphilitic parents (Thirteenth
International Medical Congress, held in Paris, August 2nd to 9th,
1900: papers by Finger, Tarnowsky, Jullien, etc.), I find no
mention of the conclusion to which I have been driven by my
experience as a neuro-pathologist - namely, that syphilis in the
male parent is a very relevant factor in the aetiology of the
neuropathic constitution of children.

Fragment Of An Analysis Of A Case Of Hysteria

1362

   During the girl’s earlier
years, her only brother (her elder by a year and a half) had been
the model which her ambitions had striven to follow. But in the
last few years the relations between the brother and sister had
grown more distant. The young man used to try so far as he could to
keep out of the family disputes; but when he was obliged to take
sides he would support his mother. So that the usual sexual
attraction had drawn together the father and daughter on the one
side and the mother and son on the other.

   The patient, to whom I shall in
future give the name of ‘Dora’, had even at the age of
eight begun to develop neurotic symptoms. She became subject at
that time to chronic dyspnoea with occasional accesses in which the
symptom was very much aggravated. The first onset occurred after a
short expedition in the mountains and was accordingly put down to
over-exertion. In the course of six months, during which she was
made to rest and was carefully looked after, this condition
gradually passed off. The family doctor seems to have had not a
moment’s hesitation in diagnosing the disorder as purely
nervous and in excluding any organic cause for the dyspnoea; but he
evidently considered this diagnosis compatible with the aetiology
of over-exertion.¹

   The little girl went through the
usual infectious diseases of childhood without suffering any
lasting damage. As she herself told me - and her words were
intended to convey a deeper meaning - her brother was as a rule the
first to start the illness and used to have it very slightly, and
she would then follow suit with a severe form of it. When she was
about twelve she began to suffer from unilateral headaches in the
nature of a migraine, and from attacks of nervous coughing. At
first these two symptoms always appeared together, but they became
separated later on and ran different courses. The migraine grew
rarer, and by the time she was sixteen she had quite got over it.
But attacks of
tussis nervosa
, which had no doubt been
started by a common catarrh, continued to occur over the whole
period. When, at the age of eighteen, she came to me for treatment,
she was again coughing in a characteristic manner. The number of
these attacks could not be determined; but they lasted from three
to five weeks, and on one occasion for several months. The most
troublesome symptom during the first half of an attack of this
kind, at all events in the last few years, used to be a complete
loss of voice. The diagnosis that this was once more a nervous
complaint had been established long since; but the various methods
of treatment which are usual, including hydrotherapy and the local
application of electricity, had produced no result. It was in such
circumstances as these that the child had developed into a mature
young woman of very independent judgement, who had grown accustomed
to laugh at the efforts of doctors, and in the end to renounce
their help entirely. Moreover, she had always been against calling
in medical advice, though she had no personal objection to her
family doctor. Every proposal to consult a new physician aroused
her resistance, and it was only her father’s authority which
induced her to come to me at all.

   I first saw her when she was
sixteen, in the early summer. She was suffering from a cough and
from hoarseness, and even at that time I proposed giving her
psychological treatment. My proposal was not adopted, since the
attack in question, like the others, passed off spontaneously,
though it had lasted unusually long. During the next winter she
came and stayed in Vienna with her uncle and his daughters after
the death of the aunt of whom she had been so fond. There she fell
ill of a feverish disorder which was diagnosed at the time as
appendicitis.² In the following autumn, since her
father’s health seemed to justify the step, the family left
the health-resort of B--- for good and all. They first moved to the
town where her father’s factory was situated, and then,
scarcely a year later, settled permanently in Vienna.

  
¹
The probable precipitating cause of this
first illness will be discussed later on.

  
²
On this point see the analysis of the
second dream.

Fragment Of An Analysis Of A Case Of Hysteria

1363

   Dora was by that time in the
first bloom of youth - a girl of intelligent and engaging looks.
But she was a source of heavy trials for her parents. Low spirits
and an alteration in her character had now become the main features
of her illness. She was clearly satisfied neither with herself nor
with her family; her attitude towards her father was unfriendly,
and she was on very bad terms with her mother, who was bent upon
drawing her into taking a share in the work of the house. She tried
to avoid social intercourse, and employed herself - so far as she
was allowed to by the fatigue and lack of concentration of which
she complained - with attending lectures for women and with
carrying on more or less serious studies. One day her parents were
thrown into a state of great alarm by finding on the girl’s
writing-desk, or inside it, a letter in which she took leave of
them because, as she said, she could no longer endure her
life.¹ Her father, indeed, being a man of some perspicacity,
guessed that the girl had no serious suicidal intentions. But he
was none the less very much shaken; and when one day, after a
slight passage of words between him and his daughter, she had a
first attack of loss of consciousness² - an event which was
subsequently covered by an amnesia - it was determined, in spite of
her reluctance, that she should come to me for treatment.

  
¹
As I have already explained, the treatment
of the case, and consequently my insight into the complex of events
composing it, remained fragmentary. There are therefore many
questions to which I have no solution to offer, or in which I can
only rely upon hints and conjectures. This affair of the letter
came up in the course of one of our sessions, and the girl showed
signs of astonishment. ‘How on earth’, he asked,
‘did they find the letter? It was shut up in my desk.’
But since she knew that her parents had read this draft of a
farewell letter, I conclude that she had herself arranged for it to
fall into their hands.

  
²
The attack was, I believe, accompanied by
convulsions and delirious states. But since this event was not
reached by the analysis either, I have no trustworthy recollections
on the subject to fall back upon.