Freud - Complete Works (243 page)

Fragment Of An Analysis Of A Case Of Hysteria

1373

   When a patient brings forward a
sound and incontestable train of argument during psycho-analytic
treatment, the physician is liable to feel a moment’s
embarrassment, and the patient may take advantage of it by asking:
‘This is all perfectly correct and true, isn’t it? What
do you want to change in now that I’ve told it you?’
But it soon becomes evident that the patient is using thoughts of
this kind, which the analysis cannot attack, for the purpose of
cloaking others which are anxious to escape from criticism and from
consciousness. A string of reproaches against other people leads
one to suspect the existence of a string of self-reproaches with
the same content. All that need be done is to turn back each
particular reproach on to the speaker himself. There is something
undeniably automatic about this method of defending oneself against
a self-reproach by making the same reproach against some one else.
A model of it is to be found in the
tu quoque
arguments of
children; if one of them is accused of being a liar, he will reply
without an instant’s hesitation: ‘You’re
another.’ A grown-up person who wanted to throw back abuse
would look for some really exposed spot in his antagonist and would
not necessarily lay the chief stress upon the same content being
repeated. In paranoia the projection of a reproach on to another
person without any alteration in its content and therefore without
any consideration for reality becomes manifest as the process of
forming delusions.

Fragment Of An Analysis Of A Case Of Hysteria

1374

   Dora’s reproaches against
her father had a ‘lining’ or ‘backing’ of
self-reproaches of this kind with a corresponding content in every
case, as I shall show in detail. She was right in thinking that her
father did not wish to look too closely into Herr K.’s
behaviour to his daughter, for fear of being disturbed in his own
love-affair with Frau K. But Dora herself had done precisely the
same thing. She had made herself an accomplice in the affair, and
had dismissed from her mind every sign which tended to show its
true character. It was not until after her adventure by the lake
that her eyes were opened and that she began to apply such a severe
standard to her father. During all the previous years she had given
every possible assistance to her father’s relations with Frau
K. She would never go to see her if she thought her father was
there; but, knowing that in that case the children would have been
sent out, she would turn her steps in a direction where she would
be sure to meet them, and would go for a walk with them. There had
been some one in the house who had been anxious at an early stage
to open her eyes to the nature of her father’s relations with
Frau K., and to induce her to take sides against her. This was her
last governess, an unmarried woman, no longer young, who was
well-read and of advanced views.¹ The teacher and her pupil
were for a while upon excellent terms, until suddenly Dora became
hostile to her and insisted on her dismissal. So long as the
governess had any influence she used it for stirring up feeling
against Frau K. She explained to Dora’s mother that it was
incompatible with her dignity to tolerate such an intimacy between
her husband and another woman; and she drew Dora’s attention
to all the obvious features of their relations. But her efforts
were in vain. Dora remained devoted to Frau K. and would hear of
nothing that might make her think ill of her relations with her
father. On the other hand she very easily fathomed the motives by
which her governess was actuated. She might be blind in one
direction, but she was sharp-sighted enough in the other. She saw
that the governess was in love with her father. When he was there,
she seemed to be quite another person: at such times she could be
amusing and obliging. While the family were living in the
manufacturing town and Frau K. was not on the horizon, her
hostility was directed against Dora’s mother, who was then
her more immediate rival. Up to this point Dora bore her no
ill-will. She did not become angry until she observed that she
herself was a subject of complete indifference to the governess,
whose pretended affection for her was really meant for her father.
While her father was away from the manufacturing town the governess
had no time to spare for her, would not go for walks with her, and
took no interest in her studies. No sooner had her father returned
from B-- than she was once more ready with every sort of service
and assistance. Thereupon Dora dropped her.

  
¹
This governess used to read every sort of
book on sexual life and similar subjects, and talked to the girl
about them, at the same time asking her quite frankly not to
mention their conversations to her parents, as one could never tell
what line they might take about them. For some time I looked upon
this woman as the source of all Dora’s secret knowledge, and
perhaps I was not entirely wrong in this.

Fragment Of An Analysis Of A Case Of Hysteria

1375

   The poor woman had thrown a most
unwelcome light on a part of Dora’s own behaviour. What the
governess had from time to time been to Dora, Dora had been to Herr
K.’s children. She had been a mother to them, she had taught
them, she had gone for walks with them, she had offered them a
complete substitute for the slight interest which their own mother
showed in them. Herr K. and his wife had often talked of getting a
divorce; but it never took place, because Herr K., who was an
affectionate father, would not give up either of the two children.
A common interest in the children had from the first been a bond
between Herr K. and Dora. Her preoccupation with his children was
evidently a cloak for something else that Dora was anxious to hide
from herself and from other people.

   The same inference was to be
drawn both from her behaviour towards the children, regarded in the
light of the governess’s behaviour towards herself, and from
her silent acquiescence in her father’s relations with Frau
K. - namely, that she had all these years been in love with Herr K.
When I informed her of this conclusion she did not assent to it. It
is true that she at once told me that other people besides (one of
her cousins, for instance - a girl who had stopped with them for
some time at B--) had said to her: ‘Why you’re simply
wild about that man!’ But she herself could not be got to
recollect any feelings of the kind. Later on, when the quantity of
material that had come up had made it difficult for her to persist
in her denial, she admitted that she might have been in love with
Herr K. at B--' but declared that since the scene by the lake
it had all been over.¹ In any case it was quite certain that
the reproaches which she made against her father of having been
deaf to the most imperative calls of duty and of having seen things
in the light which was most convenient from the point of view of
his own passions - these reproaches recoiled on her own
head.²

  
¹
Compare the second dream.

  
²
The question then arises: If Dora loved
Herr K., what was the reason for her refusing him in the scene by
the lake? Or at any rate, why did her refusal take such a brutal
form, as though she were embittered against him? And how could a
girl who was in love feel insulted by a proposal which was made in
a manner neither tactless nor offensive?.

Fragment Of An Analysis Of A Case Of Hysteria

1376

   Her other reproach against her
father was that his ill-health was only a pretext and that he
exploited it for his own purposes. This reproach, too, concealed a
whole section of her own secret history. One day she complained of
a professedly new symptom, which consisted of piercing gastric
pains. ‘Whom are you copying now?’ I asked her, and
found I had hit the mark. The day before she had visited her
cousins, the daughters of the aunt who had died. The younger one
had become engaged, and this had given occasion to the elder one
for falling ill with gastric pains, and she was to be sent off to
Semmering. Dora thought it was all just envy on the part of the
elder sister; she always got ill when she wanted something, and
what she wanted now was to be away from home so as not to have to
look on at her sister’s happiness.¹ But Dora’s own
gastric pains proclaimed the fact that she identified herself with
her cousin, who, according to her, was a malingerer. Her grounds
for this identification were either that she too envied the luckier
girl her love, or that she saw her own story reflected in that of
the elder sister, who had recently had a love-affair which had
ended unhappily.² But she had also learned from observing Frau
K. what useful things illnesses could become. Herr K. spent part of
the year in travelling. Whenever he came back, he used to find his
wife in bad health, although, as Dora knew, she had been quite well
only the day before. Dora realized that the presence of the husband
had the effect of making his wife ill, and that she was glad to be
ill so as to be able to escape the conjugal duties which she so
much detested. At this point in the discussion Dora suddenly
brought in an allusion to her own alternations between poor and bad
health during the first years of her girlhood at B--; and I was
thus driven to suspect that her states of health were to be
regarded as depending upon something else, in the same way as Frau
K.’s. (It is a rule of psycho-analytic technique that an
internal connection which is still undisclosed will announce its
presence by means of a contiguity - a temporal proximity of
associations; just as in writing, if ‘a’ and
‘b’ are put side by side, it means that the syllable
‘ab’ is to be formed out of them.) Dora had had a very
large number of attacks of coughing accompanied by loss of voice.
Could it be that the presence or absence of the man she loved had
had an influence upon the appearance and disappearance of the
symptoms of her illness? If this were so, it must be possible to
discover some coincidence or other which would betray the fact. I
asked her what the average length of these attacks had been.
‘From three to six weeks, perhaps.’ How long had Herr
K.’s absences lasted? ‘Three to six weeks, too’,
she was obliged to admit. Her illness was therefore a demonstration
of her love for K., just as his wife’s was a demonstration of
her
dislike
. It was only necessary to suppose that her
behaviour had been the opposite of Frau K.’s and that she had
been ill when he was absent and well when he had come back. And
this really seemed to have been so, at least during the first
period of the attacks. Later on it no doubt became necessary to
obscure the coincidence between her attacks of illness and the
absence of the man she secretly loved, lest its regularity should
betray her secret. The length of the attacks would then remain as a
trace of their original significance.

  
¹
An event of everyday occurrence between
sisters.

  
²
I shall discuss later on what further
conclusion I drew from these gastric pains.

Fragment Of An Analysis Of A Case Of Hysteria

1377

   I remembered that long before,
while I was working at Charcot’s clinic, I had seen and heard
how in cases of hysterical mutism writing operated vicariously in
the place of speech. Such patients were able to write more
fluently, quicker, and better than others did or than they
themselves had done previously. The same thing had happened with
Dora. In the first days of her attacks of aphonia ‘writing
had always come specially easy to her’. No psychological
elucidation was really required for this peculiarity, which was the
expression of a physiological substitutive function enforced by
necessity; it was noticeable, however, that such an elucidation was
easily to be found. Herr K. used to write to her at length while he
was travelling and to send her picture post-cards. It used to
happen that she alone was informed as to the date of his return,
and that his arrival took his wife by surprise. Moreover, that a
person will correspond with an absent friend whom he cannot talk to
is scarcely less obvious than that if he has lost his voice he will
try to make himself understood in writing. Dora’s aphonia,
then, allowed of the following symbolic interpretation. When the
man she loved was away she gave up speaking;  speech had lost
its value since she could not speak to
him
. On the other
hand, writing gained in importance, as being the only means of
communication with him in his absence.

Fragment Of An Analysis Of A Case Of Hysteria

1378

   Am I now going on to assert that
in every instance in which there are periodical attacks of aphonia
we are to diagnose the existence of a loved person who is at times
away from the patient?  Nothing could be further from my
intention. The determination of Dora’s symptoms is far too
specific for it to be possible to expect a frequent recurrence of
the same accidental aetiology. But, if so, what is the value of our
elucidation of the aphonia in the present case? Have we not merely
allowed ourselves to become the victims of a
jeu
d’esprit
? I think not. In this connection we must recall
the question which has so often been raised, whether the symptoms
of hysteria are of psychical or of somatic origin, or whether, if
the former is granted, they are necessarily
all
of them
psychically determined. Like so many other questions to which we
find investigators returning again and again without success, this
question is not adequately framed. The alternatives stated in it do
not cover the real essence of the matter. As far as I can see,
every hysterical symptom involves the participation of
both
sides. It cannot occur without the presence of a certain degree of
somatic compliance
offered by some normal or pathological
process in or connected with one of the bodily organs. And it
cannot occur more than once - and the capacity for repeating itself
is one of the characteristics of a hysterical symptom - unless it
has a psychical significance, a
meaning
. The hysterical
symptom does not carry this meaning with it, but the meaning is
lent to it, soldered to it, as it were; and in every instance the
meaning can be a different one, according to the nature of the
suppressed thoughts which are struggling for expression. However,
there are a number of factors at work which tend to make less
arbitrary the relations between the unconscious thoughts and the
somatic processes that are at their disposal as a means of
expression, and which tend to make those relations approximate to a
few typical forms. For therapeutic purposes the most important
determinants are those given by the fortuitous psychical material;
the clearing-up of the symptoms is achieved by looking for their
psychical significance. When everything that can be got rid of by
psycho-analysis has been cleared away, we are in a position to form
all kinds of conjectures, which probably meet the facts, as regards
the somatic basis of the symptoms - a basis which is as a rule
constitutional and organic. Thus in Dora’s case we shall not
content ourselves with a psycho-analytic interpretation of her
attacks of coughing and aphonia; but we shall also indicate the
organic factor which was the source of the ‘somatic
compliance’ that enabled her to express her love for a man
who was periodically absent. And if the connection between the
symptomatic expression and the unconscious mental content should
strike us as being in this case a clever
tour de force
, we
shall be relieved to hear that it succeeds in creating the same
impression in every other case and in every other instance.