Freud - Complete Works (26 page)

   The task on which I now embarked
turned out, however, to be one of the hardest that I had ever
undertaken, and the difficulty of giving a report upon it is
comparable, moreover, with the difficulties that I had then to
overcome. For a long time, too, I was unable to grasp the
connection between the events in her illness and her actual
symptom, which must nevertheless have been caused and determined by
that set of experiences.

   When one starts upon a cathartic
treatment of this kind, the first question one asks oneself is
whether the patient herself is aware of the origin and the
precipitating cause of her illness. If so, no special technique is
required to enable her to reproduce the story of her illness. The
interest shown in her by the physician, the understanding of her
which he allows her to feel and the hopes of recovery he holds out
to her - all these will decide the patient to yield up her secret.
From the beginning it seemed to me probable that Fräulein
Elisabeth was conscious of the basis of her illness, that what she
had in her consciousness was only a secret and not a foreign body.
Looking at her, one could not help thinking of the poet’s
words:

Das Mäskchen da weissagt verborgnen
Sinn.
¹

  
¹
[‘Her mask reveals a hidden
sense.’] Nevertheless, it will be seen later that I was
mistaken in this.

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   In the first instance, therefore,
I was able to do without hypnosis, with the reservation, however,
that I could make use of it later if in the course of her
confession material arose to the elucidation of which her memory
was unequal. Thus it came about that in this, the first full-length
analysis of a hysteria undertaken by me, I arrived at a procedure
which I later developed into a regular method and employed
deliberately. This procedure was one of clearing away the
pathogenic psychical material layer by layer, and we liked to
compare it with the technique of excavating a buried city. I would
begin by getting the patient to tell me what was known to her and I
would carefully note the points at which some train of thought
remained obscure or some link in the causal chain seemed to be
missing. And afterwards I would penetrate into deeper layers of her
memories at these points by carrying out an investigation under
hypnosis or by the use of some similar technique. The whole work
was, of course, based on the expectation that it would be possible
to establish a completely adequate set of determinants for the
events concerned. I shall discuss presently the methods used for
the deep investigation.

   The story which Fräulein
Elisabeth told of her illness was a wearisome one, made up of many
different painful experiences. While she told it she was not under
hypnosis; but I made her lie down and keep her eyes shut, though I
made no objection to her occasionally opening them, changing her
position, sitting up, and so on. When she was more deeply moved
than usual by a part of her story she seemed to fall into a state
more or less resembling hypnosis. She would then lie motionless and
keep her eyes tightly shut.

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   I will begin by repeating what
emerged as the most superficial layer of her memories. The youngest
of three daughters, she was tenderly attached to her parents and
spent her youth on their estate in Hungary. Her mother’s
health was frequently troubled by an affection of the eyes as well
as by nervous states. Thus it came about that she found herself
drawn into especially intimate contact with her father, a vivacious
man of the world, who used to say that this daughter of his took
the place of a son and a friend with whom he could exchange
thoughts. Although the girl’s mind found intellectual
stimulation from this relationship with her father, he did not fail
to observe that her mental constitution was on that account
departing from the ideal which people like to see realized in a
girl. He jokingly, called her ‘cheeky’ and
‘cock-sure’, and warned her against being too positive
in her judgements and against her habit of regardlessly telling
people the truth, and he often said she would find it hard to get a
husband. She was in fact greatly discontented with being a girl.
She was full of ambitious plans. She wanted to study or to have a
musical training, and she was indignant at the idea of having to
sacrifice her inclinations and her freedom of judgement by
marriage. As it was, she nourished herself on her pride in her
father and in the prestige and social position of her family, and
she jealously guarded everything that was bound up with these
advantages. The unselfishness, however, with which she put her
mother and elder sisters first, when an occasion arose, reconciled
her parents completely to the harsher side of her character.

   In view of the girls’ ages
it was decided that the family should move to the capital, where
Elisabeth was able for a short time to enjoy a fuller and gayer
life in the home circle. Then, however, the blow fell which
destroyed the happiness of the family. Her father had concealed, or
had perhaps himself overlooked, a chronic affection of the heart,
and he was brought home unconscious one day suffering from a
pulmonary oedema. He was nursed for eighteen months, and Elisabeth
saw to it that she played the leading part at his sick-bed. She
slept in his room, was ready to wake if he called her at night,
looked after him during the day and forced herself to appear
cheerful, while he reconciled himself to his hopeless state with
uncomplaining resignation. The beginning of her illness must have
been connected with this period of nursing, for she remembered that
during its last six months she had taken to her bed for a day and a
half on account of the pains we have described. She asserted,
however, that these pains quickly passed off and had not caused her
any uneasiness or attracted her attention. And in fact it was not
until two years after her father’s death that she felt ill
and became incapable of walking on account of her pains.

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   The gap that was caused in the
life of this family of four women by her father’s death,
their social isolation, the breaking-off of so many connections
that had promised to bring her interest and enjoyment, her
mother’s ill-health which was now becoming more marked - all
this cast a shadow over the patient’s state of feeling; but
at the same time it kindled a lively desire in her that her family
might soon find something to replace their lost happiness, and led
her to concentrate her whole affection and care on the mother who
was still living.

   When the year of mourning had
passed, her elder sister married a gifted and energetic man. He
occupied a responsible position and his intellectual powers seemed
to promise him a great future. But to his closer acquaintances he
exhibited a morbid sensitiveness and an egoistic insistence on his
fads; and he was the first in the family circle to venture to show
lack of consideration for the old lady. This was more than
Elisabeth could bear. She felt called upon to take up the fight
against her brother-in-law whenever he gave her occasion, while the
other women did not take his temperamental outbursts to heart. It
was a painful disappointment to her that the rebuilding of their
former family happiness should be thus interrupted; and she could
not forgive her married sister for the feminine pliancy with which
she persistently avoided taking sides. Elisabeth retained a number
of scenes in her memory in this connection, involving complaints,
in part not expressed in words, against her first brother-in-law.
But her chief reproach against him remained the fact that, for the
sake of a prospective promotion, he moved with his small family to
a remote town in Austria and thus helped to increase her
mother’s isolation. On this occasion Elisabeth felt acutely
her helplessness, her inability to afford her mother a substitute
for the happiness she had lost and the impossibility of carrying
out the intention she had formed at her father’s death.

   The marriage of her second sister
seemed to promise a brighter future for the family, for the second
brother-in-law, though less outstanding intellectually, was a man
after the heart of these cultivated women, brought up as they had
been in a school of consideration for others. His behaviour
reconciled Elisabeth to the institution of marriage and to the
thought of the sacrifices it involved. Moreover the second young
couple remained in her mother’s neighbourhood, and their
child became Elisabeth’s favourite. Unfortunately another
event cast a shadow over the year in which this child was born. The
treatment of her mother’s eye-trouble necessitated her being
kept in a dark room for several weeks, during which Elisabeth was
with her. An operation was then pronounced unavoidable. The
agitation at this prospect coincided with the preparations for her
first brother-in-law’s move. At last her mother came through
the operation, which was performed by a master hand. The three
families were united at a summer holiday resort, and it was hoped
that Elisabeth, who had been exhausted by the anxieties of the last
few months, would make a complete recovery during what was the
first period of freedom from sorrows and fears that the family had
enjoyed since her father’s death.

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   It was precisely during this
holiday, however, that Elisabeth’s pains and locomotor
weakness started. She had been to some extent aware of the pains
for a short while, but they came on violently for the first time
after she had had a warm bath in the bath establishment of the
little watering-place. A few days earlier she had been for a long
walk - in fact a regular tramp lasting half a day - and this they
connected with the appearance of the pains, so that it was easy to
take the view that Elisabeth had first been ‘overtired’
and had then ‘caught a cold’.

   From this time on Elisabeth was
the invalid of the family. She was advised by her doctor to devote
the rest of the same summer to a course of hydropathic treatment at
Gastein, and she went there with her mother. But a fresh anxiety
now arose. Her second sister had become pregnant again and reports
of her condition were most unfavourable, so that Elisabeth could
hardly make up her mind to travel to Gastein. She and her mother
had been there for barely a fortnight when they were called back by
the news that her sister, who had now taken to her bed, was in a
very bad state.

   There followed an agonizing
journey, during which Elisabeth was tormented not only by her pains
but by dreadful expectations; on their arrival at the station there
were signs that led them to fear the worst; and when they entered
the sick-room there came the certainty that they had come too late
to take their leave of a living person.

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   Elisabeth suffered not only from
the loss of this sister, whom she had dearly loved, but almost as
much from the thoughts provoked by her death and the changes which
it brought along with it. Her sister had succumbed to an affection
of the heart which had been aggravated by her pregnancy. The idea
now presented itself that heart disease was inherited from the
father’s side of the family. It was then recalled that the
dead sister had suffered during her early girlhood from chorea
accompanied by a mild cardiac disorder. They blamed themselves and
the doctors for having permitted the marriage, and it was
impossible to spare the unhappy widower the reproach of having
endangered his wife’s health by bringing on two pregnancies
in immediate succession. From that time onwards Elisabeth’s
thoughts were occupied without interruption with the gloomy
reflection that when, for once in a way, the rare conditions for a
happy marriage had been fulfilled, this happiness should have come
to such an end. Furthermore, she saw the collapse once more of all
she had desired for her mother. Her widowed brother-in-law was
inconsolable and withdrew from his wife’s family. It appeared
that his own family, which had been estranged from him during his
short, happy marriage, thought this was a favourable moment for
drawing him back into their own circle. There was no way of
preserving the unity that had existed formerly. It was not
practicable for him to live with her mother in view of
Elisabeth’s unmarried state. Since, also, he refused to allow
the two women to have the custody of the child, which was the dead
woman’s only legacy, he gave them occasion for the first time
to accuse him of hard-heartedness. Lastly - and this was not the
least distressing fact - a rumour reached Elisabeth that a dispute
had arisen between her two brothers-in-law. She could only guess at
its cause; it seemed, however, that the widower had put forward
financial demands which the other declared were unjustifiable and
which, indeed, in view of the mother’s present sorrow, he was
able to characterize as blackmail of the worst description.

   Here, then, was the unhappy story
of this proud girl with her longing for love. Unreconciled to her
fate, embittered by the failure of all her little schemes for
re-establishing the family’s former glories, with those she
loved dead or gone away or estranged, unready to take refuge in the
love of some unknown man - she had lived for eighteen months in
almost complete seclusion, with nothing to occupy her but the care
of her mother and her own pains.

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   If we put greater misfortunes on
one side and enter into a girl’s feelings, we cannot refrain
from deep human sympathy with Fräulein Elisabeth. But what
shall we say of the purely medical interest of this tale of
suffering, of its relations to her painful locomotor weakness, and
of the chances of an explanation and cure afforded by our knowledge
of these psychical traumas?