Freud - Complete Works (29 page)

Studies On Hysteria

141

   It had inevitably become clear to
me long since what all this was about; but the patient, deep in her
bitter-sweet memories, seemed not to notice the end to which she
was steering, and continued to reproduce her recollections. She
went on to her visit to Gastein, the anxiety with which she looked
forward to every letter, finally the bad news about her sister, the
long wait till the evening, which was the first moment at which
they could get away from Gastein, then the journey, passed in
tormenting uncertainty, and the sleepless night - all of these
accompanied by a violent increase in her pains. I asked her whether
during the journey she had thought of the grievous possibility
which was afterwards realized. She answered that she had carefully
avoided the thought, but she believed that her mother had from the
beginning expected the worst. - Her memories now went on to their
arrival in Vienna, the impression made on them by the relatives who
met them, the short journey from Vienna to the summer resort in its
neighbourhood where her sister lived, their reaching there in the
evening, the hurried walk through the garden to the door of the
small garden house, the silence within and the oppressive darkness;
how her brother-in-law was not there to receive them, and how they
stood before the bed and looked at her sister as she lay there
dead. At that moment of dreadful certainty that her beloved sister
was dead without bidding them farewell and without her having eased
her last days with her care - at that very moment another thought
had shot through Elisabeth’s mind, and now forced itself
irresistibly upon her once more, like a flash of lightning in the
dark: ‘Now he is free again and I can be his wife.’

Studies On Hysteria

142

   Everything was now clear. The
analyst’s labours were richly rewarded. The concepts of the
‘fending off’ of an incompatible idea, of the genesis
of hysterical symptoms through the conversion of psychical
excitations into something physical and the formation of a separate
psychical group through the act of will which led to the
fending-off - all these things were, in that moment, brought before
my eyes in concrete form. Thus and in no other way had things come
about in the present case. This girl felt towards her
brother-in-law a tenderness whose acceptance into consciousness was
resisted by her whole moral being. She succeeded in sparing herself
the painful conviction that she loved her sister’s husband,
by inducing physical pains in herself instead; and it was in the
moments when this conviction sought to force itself upon her (on
her walk with him, during her morning reverie, in the bath, by her
sister’s bedside) that her pains had come on, thanks to
successful conversion. At the time when I started her treatment the
group of ideas relating to her love had already been separated from
her knowledge. Otherwise she would never, I think, have agreed to
embarking on the treatment. The resistance with which she had
repeatedly met the reproduction of scenes which operated
traumatically corresponded in fact to the energy with which the
incompatible idea had been forced out of her associations.

   The period that followed,
however, was a hard one for the physician. The recovery of this
repressed idea had a shattering effect on the poor girl. She cried
aloud when I put the situation drily before her with the words:
‘So for a long time you had been in love with your
brother-in-law.’  She complained at this moment of the
most frightful pains, and made one last desperate effort to reject
the explanation: it was not true, I had talked her into it, it
could
not be true, she was incapable of such wickedness, she
could never forgive herself for it. It was easy to prove to her
that what she herself had told me admitted of no other
interpretation. But it was a long time before my two pieces of
consolation - that we are not responsible for our feelings, and
that her behaviour, the fact that she had fallen ill in these
circumstances, was sufficient evidence of her moral character - it
was a long time before these consolations of mine made any
impression on her.

Studies On Hysteria

143

   In order to mitigate the
patient’s sufferings I had now to proceed along more than one
path. In the first place I wanted to give her an opportunity of
getting rid of the excitation that had been piling up so long, by
‘abreacting’ it. We probed into the first impressions
made on her in her relations with her brother-in-law, the beginning
of the feelings for him which she had kept unconscious. Here we
came across all the little premonitory signs and intuitions of
which a fully-grown passion can make so much in retrospect. On his
first visit to the house he had taken her for the girl he was to
marry and had greeted her before her elder but somewhat
insignificant-looking sister. One evening they were carrying on
such a lively conversation together and seemed to be getting on so
well that his fiancee had interrupted them half-seriously with the
remark: ‘The truth is, you two would have suited each other
splendidly.’ Another time, at a party where they knew nothing
of his engagement, the young man was being discussed and a lady
criticized a defect in his figure which suggested that he had had a
disease of the bones in his childhood. His fiancee herself listened
quietly, but Elisabeth flared up and defended the symmetry of her
future brother-in-law’s figure with a zeal which she herself
could not understand. As we worked through these recollections it
became clear to Elisabeth that her tender feeling for her
brother-in-law had been dormant in her for a long time, perhaps
even from the beginning of her acquaintance with him, and had lain
concealed all that time behind the mask of mere sisterly affection,
which her highly-developed family feeling could enable her to
accept as natural.

   This process of abreaction
certainly did her much good. But I was able to relieve her still
more by taking a friendly interest in her present circumstances.
With this end in view I arranged for an interview with Frau von R.
I found her an understanding and sensitive lady, though her vital
spirits had been reduced by her recent misfortunes. I learned from
her that on closer examination the charge of unfeeling blackmail
which had been brought by the elder brother-in-law against the
widower and which had been so painful to Elisabeth had had to be
withdrawn. No stain was left on the young man’s character. It
was a misunderstanding due to the different value which, as can
readily be seen, would be attached to money by a business man, to
whom money is a tool of his trade, and a civil servant. Nothing
more than this remained of the painful episode. I begged her mother
from that time forward to tell Elisabeth everything she needed to
know, and in the future to give her the opportunity for unburdening
her mind to which I should have accustomed her.

Studies On Hysteria

144

   I was also, of course, anxious to
learn what chance there was that the girl’s wish, of which
she was now conscious, would come true. Here the prospects were
less favourable. Her mother told me that she had long ago guessed
EIisabeth’s fondness for the young man, though she had not
known that the feeling had already been there during her
sister’s lifetime. No one seeing the two of them together -
though in fact this had now become a rare event - could doubt the
girl’s anxiety to please him. But, she told me, neither she
(the mother) nor the family advisers were particularly in favour of
a marriage. The young man’s health was by no means good and
had received a fresh set-back from the death of his beloved wife.
It was not at all certain, either, that his mental state was yet
sufficiently recovered for him to contract a new marriage. This was
perhaps why he was behaving with so much reserve; perhaps, too, it
was because he was uncertain of his reception and wished to avoid
comments that were likely to be made. In view of these reservations
on both sides, the solution for which Elisabeth longed was unlikely
to be achieved.

   I told the girl what I had heard
from her mother and had the satisfaction of benefiting her by
giving her the explanation of the money affair. On the other hand I
encouraged her to face with calmness the uncertainty about the
future which it was impossible to clear up. But at this point the
approach of summer made it urgent for us to bring the analysis to
an end. Her condition was once more improved and there had been no
more talk of her pains since we had been investigating their
causes. We both had a feeling that we had come to a finish, though
I told myself that the abreaction of the love she had so long kept
down had not been carried out very fully. I regarded her as cured
and pointed out to her that the solution of her difficulties would
proceed on its own account now that the path had been opened to it.
This she did not dispute. She left Vienna with her mother to meet
her eldest sister and her family and to spend the summer
together.

Studies On Hysteria

145

   I have a few words to add upon
the further course of Fräulein Elisabeth von R. 's case.
Some weeks after we had separated I received a despairing letter
from her mother. At her first attempt, she told me, to discuss her
daughter’s affairs of the heart with her, the girl had
rebelled violently and had since then suffered from severe pains
once more. She was indignant with me for having betrayed her
secret. She was entirely inaccessible, and the treatment had been a
complete failure. What was to be done now? she asked. Elisabeth
would have nothing more to do with me. I did not reply to this. It
stood to reason that Elisabeth after leaving my care would make one
more attempt to reject her mother’s intervention and once
more take refuge in isolation. But I had a kind of conviction that
everything would come right and that the trouble I had taken had
not been in vain. Two months later they were back in Vienna, and
the colleague to whom I owed the introduction of the case gave me
news that Elisabeth felt perfectly well and was behaving as though
there was nothing wrong with her, though she still suffered
occasionally from slight pains. Several times since then she has
sent me similar messages and each time promised to come and see me.
But it is a characteristic of the personal relationship which
arises in treatments of this kind that she has never done so. As my
colleague assures me, she is to be regarded as cured. Her
brother-in-law’s connection with the family has remained
unaltered.

   In the spring of 1894 I heard
that she was going to a private ball for which I was able to get an
invitation, and I did not allow the opportunity to escape me of
seeing my former patient whirl past in a lively dance. Since then,
by her own inclination, she has married someone unknown to me.

Studies On Hysteria

146

DISCUSSION

   I have not always been a
psychotherapist. Like other neuropathologists, I was trained to
employ local diagnoses and electro-prognosis, and it still strikes
me myself as strange that the case histories I write should read
like short stories and that, as one might say, they lack the
serious stamp of science. I must console myself with the reflection
that the nature of the subject is evidently responsible for this,
rather than any preference of my own. The fact is that local
diagnosis and electrical reactions lead nowhere in the study of
hysteria, whereas a detailed description of mental processes such
as we are accustomed to find in the works of imaginative writers
enables me, with the use of a few psychological formulas, to obtain
at least some kind of insight into the course of that affection.
Case histories of this kind are intended to be judged like
psychiatric ones; they have, however, one advantage over the
latter, namely an intimate connection between the story of the
patient’s sufferings and the symptoms of his illness - a
connection for which we still search in vain in the biographies of
other psychoses.

   In reporting the case of
Fräulein Elisabeth von R. I have endeavoured to weave the
explanations which I have been able to give of the case into my
description of the course of her recovery. It may perhaps be worth
while to bring together the important points once more. I have
described the patient’s character, the features which one
meets with so frequently in hysterical people and which there is no
excuse for regarding as a consequence of degeneracy: her
giftedness, her ambition, her moral sensibility, her excessive
demand for love which, to begin with, found satisfaction in her
family, and the independence of her nature which went beyond the
feminine ideal and found expression in a considerable amount of
obstinacy, pugnacity and reserve. No appreciable hereditary taint,
so my colleague told me, could be traced on either side of her
family. It is true that her mother suffered for many years from a
neurotic depression which had not been investigated; but her
mother’s brothers and sisters and her father and his family
could be regarded as well-balanced people free from nervous
trouble. No severe case of neuro-psychosis had occurred among her
close relatives.

   Such was the patient’s
nature, which was now assailed by painful emotions, beginning with
the lowering effect of nursing her beloved father through a long
illness.

Studies On Hysteria

147

   There are good reasons for the
fact that sick-nursing plays such a significant part in the
prehistory of cases of hysteria. A number of the factors at work in
this are obvious: the disturbance of one’s physical health
arising from interrupted sleep, the neglect of one’s own
person, the effect of constant worry on one’s vegetative
functions. But, in my view, the most important determinant is to be
looked for elsewhere. Anyone whose mind is taken up by the hundred
and one tasks of sick-nursing which follow one another in endless
succession over a period of weeks and months will, on the one hand,
adopt a habit of suppressing every sign of his own emotion, and on
the other, will soon divert his attention away from his own
impressions, since he has neither time nor strength to do justice
to them. Thus he will accumulate a mass of impressions which are
capable of affect, which are hardly sufficiently perceived and
which, in any case, have not been weakened by abreaction. He is
creating material for a ‘retention hysteria’. If the
sick person recovers, all these impressions, of course, lose their
significance. But if he dies, and the period of mourning sets in,
during which the only things that seem to have value are those that
relate to the person who has died, these impressions that have not
yet been dealt with come into the picture as well; and after a
short interval of exhaustion the hysteria, whose seeds were sown
during the time of nursing, breaks out.