Freud - Complete Works (681 page)

   No doubt not the whole of what
Charcot taught us at that time holds good to-day: some of it has
become doubtful, some has definitely failed to withstand the test
of time. But enough is left over that has found a permanent place
in the storehouse of science. Before leaving Paris I discussed with
the great man a plan for a comparative study of hysterical and
organic paralyses. I wished to establish the thesis that in
hysteria paralyses and anaesthesias of the various parts of the
body are demarcated according to the popular idea of their limits
and not according to anatomical facts. He agreed with this view,
but it was easy to see that in reality he took no special interest
in penetrating more deeply into the psychology of the neuroses.
When all is said and done, it was from pathological anatomy that
his work had started.

An Autobiographical Study

4192

   Before I returned to Vienna I
stopped for a few weeks in Berlin, in order to gain a little
knowledge of the general disorders of childhood. Kassowitz, who was
at the head of a public institute in Vienna for the treatment of
children’s diseases, had promised to put me in charge of a
department for the nervous diseases of children. In Berlin I was
given assistance and a friendly reception by Baginsky. In the
course of the next few years I published, from the Kassowitz
Institute, several monographs of considerable size on unilateral
and bilateral cerebral palsies in children. And for that reason, at
a later date (in 1897), Nothnagel made me responsible for dealing
with the same subject in his great
Handbuch der allgemeinen und
speziellen Therapie
.

   In the autumn of 1886 I settled
down in Vienna as a physician, and married the girl who had been
waiting for me in a distant city for more than four years. I may
here go back a little and explain how it was the fault of my
fiancée
that I was not already famous at that
youthful age. A side interest, though it was a deep one, had led me
in 1884 to obtain from Merck some of what was then the little-known
alkaloid cocaine and to study its physiological action. While I was
in the middle of this work, an opportunity arose for making a
journey to visit my
fiancée
, from whom I had been
parted for two years. I hastily wound up my investigation of
cocaine and contented myself in my monograph on the subject with
prophesying that further uses for it would soon be found. I
suggested, however, to my friend Königstein, the
ophthalmologist, that he should investigate the question of how far
the anaesthetizing properties of cocaine were applicable in
diseases of the eye. When I returned from my holiday I found that
not he, but another of my friends, Carl Koller (now in New York),
whom I had also spoken to about cocaine, had made the decisive
experiments upon animals’ eyes and had demonstrated them at
the Ophthalmological Congress at Heidelberg. Koller is therefore
rightly regarded as the discoverer of local anaesthesia by cocaine,
which has become so important in minor surgery; but I bore my
fiancée
no grudge for the interruption.

An Autobiographical Study

4193

   I will now return to the year
1886, the time of my settling down in Vienna as a specialist in
nervous diseases. The duty devolved upon me of giving a report
before the ‘Gesellschaft der Aerzte’ upon what I had
seen and learnt with Charcot. But I met with a bad reception.
Persons of authority, such as the chairman (Bamberger, the
physician), declared that what I said was incredible. Meynert
challenged me to find some cases in Vienna similar to those which I
had described and to present them before the Society. I tried to do
so; but the senior physicians in whose departments I found any such
cases refused to allow me to observe them or to work at them. One
of them, an old surgeon, actually broke out with the exclamation:
‘But, my dear sir, how can you talk such nonsense?
Hysteron
(
sic
) means the uterus. So how can a man be
hysterical?’ I objected in vain that what I wanted was not to
have my diagnosis approved, but to have the case put at my
disposal. At length, outside the hospital, I came upon a case of
classical hysterical hemi-anaesthesia in a man, and demonstrated it
before the ‘Gesellschaft der Aerzte’. This time I was
applauded, but no further interest was taken in me. The impression
that the high authorities had rejected my innovations remained
unshaken; and, with my hysteria in men and my production of
hysterical paralyses by suggestion, I found myself forced into the
Opposition. As I was soon afterwards excluded from the laboratory
of cerebral anatomy and for terms on end had nowhere to deliver my
lectures, I withdrew from academic life and ceased to attend the
learned societies. It is a whole generation since I have visited
the ‘Gesellschaft der Aerzte’.

An Autobiographical Study

4194

   Anyone who wants to make a living
from the treatment of nervous patients must clearly be able to do
something to help them. My therapeutic arsenal contained only two
weapons, electrotherapy and hypnotism, for prescribing a visit to a
hydropathic establishment after a single consultation was an
inadequate source of income. My knowledge of electrotherapy was
derived from W. Erb’s text-book, which provided detailed
instructions for the treatment of all the symptoms of nervous
diseases. Unluckily I was soon driven to see that following these
instructions was of no help whatever and that what I had taken for
an epitome of exact observations was merely the construction of
phantasy. The realization that the work of the greatest name in
German neuropathology had no more relation to reality than some
‘Egyptian’ dream-book, such as is sold in cheap
book-shops, was painful, but it helped to rid me of another shred
of the innocent faith in authority from which I was not yet free.
So I put my electrical apparatus aside, even before Moebius had
saved the situation by explaining that the successes of electric
treatment in nervous disorders (in so far as there were any) were
the effect of suggestion on the part of the physician.

   With hypnotism the case was
better. While I was still a student I had attended a public
exhibition given by Hansen the ‘magnetist’, and had
noticed that one of the subjects experimented upon had become
deathly pale at the onset of cataleptic rigidity and had remained
so as long as that condition lasted. This firmly convinced me of
the genuineness of the phenomena of hypnosis. Scientific support
was soon afterwards given to this view by Heidenhain; but that did
not restrain the professors of psychiatry from declaring for a long
time to come that hypnotism was not only fraudulent but dangerous
and from regarding hypnotists with contempt. In Paris I had seen
hypnotism used freely as a method for producing symptoms in
patients and then removing them again. And now the news reached us
that a school had arisen at Nancy which made an extensive and
remarkably successful use of suggestion, with or without hypnosis,
for therapeutic purposes. It thus came about, as a matter of
course, that in the first years of my activity as a physician my
principal instrument of work, apart from haphazard and unsystematic
psychotherapeutic methods, was hypnotic suggestion.

An Autobiographical Study

4195

   This implied, of course, that I
abandoned the treatment of organic nervous diseases; but that was
of little importance. For on the one hand the prospects in the
treatment of such disorders were in any case never promising,
while, on the other hand, in the private practice of a physician
working in a large town, the quantity of such patients was nothing
compared to the crowds of neurotics, whose number seemed further
multiplied by the way in which they hurried, with their troubles
unsolved, from one physician to another. And, apart from this,
there was something positively seductive in working with hypnotism.
For the first time there was a sense of having overcome one’s
helplessness; and it was highly flattering to enjoy the reputation
of being a miracle-worker. It was not until later that I was to
discover the drawbacks of the procedure. At the moment there were
only two points to complain of: first, that I could not succeed in
hypnotizing every patient, and secondly, that I was unable to put
individual patients into as deep a state of hypnosis as I should
have wished. With the idea of perfecting my hypnotic technique, I
made a journey to Nancy in the summer of 1889 and spent several
weeks there. I witnessed the moving spectacle of old
Liébeault working among the poor women and children of the
labouring classes. I was a spectator of Bernheim’s
astonishing experiments upon his hospital patients, and I received
the profoundest impression of the possibility that there could be
powerful mental processes which nevertheless remained hidden from
the consciousness of men. Thinking it would be instructive, I had
persuaded one of my patients to follow me to Nancy. This patient
was a very highly gifted hysteric, a woman of good birth, who had
been handed over to me because no one knew what to do with her. By
hypnotic influence I had made it possible for her to lead a
tolerable existence and I was always able to take her out of the
misery of her condition. But she always relapsed again after a
short time, and in my ignorance I attributed this to the fact that
her hypnosis had never reached the stage of somnambulism with
amnesia. Bernheim now attempted several times to bring this about,
but he too failed. He frankly admitted to me that his great
therapeutic successes by means of suggestion were only achieved in
his hospital practice and not with his private patients. I had many
stimulating conversations with him, and undertook to translate into
German his two works upon suggestion and its therapeutic
effects.

An Autobiographical Study

4196

   During the period from 1886 to
1891 I did little scientific work, and published scarcely anything.
I was occupied with establishing myself in my new profession and
with assuring my own material existence as well as that of a
rapidly increasing family. In 1891 there appeared the first of my
studies on the cerebral palsies of children, which was written in
collaboration with my friend and assistant, Dr. Oskar Rie. An
invitation which I received in the same year to contribute to an
encyclopaedia of medicine led me to investigate the theory of
aphasia. This was at the time dominated by the views of Wernicke
and Lichtheim, which laid stress exclusively upon localization. The
fruit of this enquiry was a small critical and speculative book,
Zur Auffassung der Aphasien

   But I must now show how it
happened that scientific research once more became the chief
interest of my life.

An Autobiographical Study

4197

II

   I must supplement what I have
just said by explaining that from the very first I made use of
hypnosis in
another
manner, apart from hypnotic suggestion.
I used it for questioning the patient upon the origin of his
symptom, which in his waking state he could often describe only
very imperfectly or not at all. Not only did this method seem more
effective than mere suggestive commands or prohibitions, but it
also satisfied the curiosity of the physician, who, after all, had
a right to learn something of the origin of the phenomenon which he
was striving to remove by the monotonous procedure of
suggestion.

   The manner in which I arrived at
this other procedure was as follows. While I was still working in
Brücke’s laboratory I had made the acquaintance of Dr.
Josef Breuer, who was one of the most respected family physicians
in Vienna, but who also had a scientific past, since he had
produced several works of permanent value upon the physiology of
respiration and upon the organ of equilibrium. He was a man of
striking intelligence and fourteen years older than myself. Our
relations soon became more intimate and he became my friend and
helper in my difficult circumstances. We grew accustomed to share
all our scientific interests with each other. In this relationship
the gain was naturally mine. The development of psycho-analysis
afterwards cost me his friendship. It was not easy for me to pay
such a price, but I could not escape it.

   Even before I went to Paris,
Breuer had told me about a case of hysteria which, between 1880 and
1882, he had treated in a peculiar manner which had allowed him to
penetrate deeply into the causation and significance of hysterical
symptoms. This was at a time, therefore, when Janet’s works
still belonged to the future. He repeatedly read me pieces of the
case history, and I had an impression that it accomplished more
towards an understanding of neuroses than any previous observation.
I determined to inform Charcot of these discoveries when I reached
Paris, and I actually did so. But the great man showed no interest
in my first outline of the subject, so that I never returned to it
and allowed it to pass from my mind.

An Autobiographical Study

4198

   When I was back in Vienna I
turned once more to Breuer’s observation and made him tell me
more about it. The patient had been a young girl of unusual
education and gifts, who had fallen ill while she was nursing her
father, of whom she was devotedly fond. When Breuer took over her
case it presented a variegated picture of paralyses with
contractures, inhibitions and states of mental confusion. A chance
observation showed her physician that she could be relieved of
these clouded states of consciousness if she was induced to express
in words the affective phantasy by which she was at the moment
dominated. From this discovery, Breuer arrived at a new method of
treatment. He put her into deep hypnosis and made her tell him each
time what it was that was oppressing her mind. After the attacks of
depressive confusion had been overcome in this way, he employed the
same procedure for removing her inhibitions and physical disorders.
In her waking state the girl could no more describe than other
patients how her symptoms had arisen, and she could discover no
link between them and any experiences of her life. In hypnosis she
immediately discovered the missing connection. It turned out that
all her symptoms went back to moving events which she had
experienced while nursing her father; that is to say, her symptoms
had a meaning and were residues or reminiscences of those emotional
situations. It was found in most instances that there had been some
thought or impulse which she had had to suppress while she was by
her father’s sick-bed, and that, in place of it, as a
substitute for it, the symptom had afterwards appeared. But as a
rule the symptom was not the precipitate of a single such
‘traumatic’ scene, but the result of a summation of a
number of similar situations. When the patient recalled a situation
of this kind in a hallucinatory way under hypnosis and carried
through to its conclusion, with a free expression of emotion, the
mental act which she had originally suppressed, the symptom was
abolished and did not return. By this procedure Breuer succeeded,
after long and painful efforts, in relieving his patient of all her
symptoms.