Freud - Complete Works (7 page)

   The regular order of things was:
the somnolent state in the afternoon, followed after sunset by the
deep hypnosis for which she invented the technical name of
‘clouds’.² If during this she was able to narrate
the hallucinations she had had in the course of the day, she would
wake up clear in mind, calm and cheerful. She would sit down to
work and write or draw far into the night quite rationally. At
about four she would go to bed. Next day the whole series of events
would be repeated. It was a truly remarkable contrast: in the
day-time the irresponsible patient pursued by hallucinations, and
at night the girl with her mind completely clear.

  
¹
[In English in the original.]

  
²
[In English in the original.]

Studies On Hysteria

28

   In spite of her euphoria at
night, her psychical condition deteriorated steadily. Strong
suicidal impulses appeared which made it seem inadvisable for her
to continue living on the third floor. Against her will, therefore,
she was transferred to a country house in the neighbourhood of
Vienna (on June 7, 1881). I had never threatened her with this
removal from her home, which she regarded with horror, but she
herself had, without saying so, expected and dreaded it. This event
made it clear once more how much the affect of anxiety dominated
her psychical disorder. Just as after her father’s death a
calmer condition had set in, so now, when what she feared had
actually taken place, she once more became calmer. Nevertheless,
the move was immediately followed by three days and nights
completely without sleep or nourishment, by numerous attempts at
suicide (though, so long as she was in a garden, these were not
dangerous), by smashing windows and so on, and by hallucinations
unaccompanied by
absences
which she was able to distinguish
easily from her other hallucinations. After this she grew quieter,
let the nurse feed her and even took chloral at night.

   Before continuing my account of
the case, I must go back once more and describe one of its
peculiarities which I have hitherto mentioned only in passing. I
have already said that throughout the illness up to this point the
patient fell into a somnolent state every afternoon and that after
sunset this period passed into a deeper sleep -
‘clouds’. (It seems plausible to attribute this regular
sequence of events merely to her experience while she was nursing
her father, which she had had to do for several months. During the
nights she had watched by the patient’s bedside or had been
awake anxiously listening till the morning; in the afternoons she
had lain down for a short rest, as is the usual habit of nurses.
This pattern of waking at night and sleeping in the afternoons
seems to have been carried over into her own illness and to have
persisted long after the sleep had been replaced by a hypnotic
state.) After the deep sleep had lasted about an hour she grew
restless, tossed to and fro and kept repeating ‘tormenting,
tormenting’, with her eyes shut all the time. It was also
noticed how, during her
absences
in day-time she was
obviously creating some situation or episode to which she gave a
clue with a few muttered words. It happened then - to begin with
accidentally but later intentionally - that someone near her
repeated one of these phrases of hers while she was complaining
about the ‘tormenting’. She at once joined in and began
to paint some situation or tell some story, hesitatingly at first
and in her paraphasic jargon; but the longer she went on the more
fluent she became, till at last she was speaking quite correct
German. (This applies to the early period before she began talking
English only.) The stories were always sad and some of them very
charming, in the style of Hans Andersen’s
Picture-book
without Pictures
, and, indeed, they were probably constructed
on that model. As a rule their starting-point or central situation
was of a girl anxiously sitting by a sick-bed. But she also built
up her stories on quite other topics. - A few moments after she had
finished her narrative she would wake up, obviously calmed down,
or, as she called it, ‘
gehäglich
’.¹
During the night she would again become restless, and in the
morning, after a couple of hours’ sleep, she was visibly
involved in some other set of ideas. - If for any reason she was
unable to tell me the story during her evening hypnosis she failed
to calm down afterwards, and on the following day she had to tell
me
two
stories in order for this to happen.

  
¹
[She used this made-up word instead of the
regular German ‘
behaglich
’, meaning
‘comfortable’.]

Studies On Hysteria

29

   The essential features of this
phenomenon - the mounting up and intensification of her
absences
into her auto-hypnosis in the evening, the effect
of the products of her imagination as psychical stimuli and the
easing and removal of her state of stimulation when she gave
utterance to them in her hypnosis - remained constant throughout
the whole eighteen months during which she was under
observation.

   The stories naturally became
still more tragic after her father’s death. It was not,
however, until the deterioration of her mental condition, which
followed when her state of somnambulism was forcibly broken into in
the way already described, that her evening narratives ceased to
have the character of more or less freely-created poetical
compositions and changed into a string of frightful and terrifying
hallucinations. (It was already possible to arrive at these from
the patient’s behaviour during the day.) I have already
described how completely her mind was relieved when, shaking with
fear and horror, she had reproduced these frightful images and
given verbal utterance to them.

   While she was in the country,
when I was unable to pay her daily visits, the situation developed
as follows. I used to visit her in the evening, when I knew I
should find her in her hypnosis, and I then relieved her of the
whole stock of imaginative products which she had accumulated since
my last visit. It was essential that this should be effected
completely if good results were to follow. When this was done she
became perfectly calm, and next day she would be agreeable, easy to
manage, industrious and even cheerful; but on the second day she
would be increasingly moody, contrary and unpleasant, and this
would become still more marked on the third day. When she was like
this it was not always easy to get her to talk, even in her
hypnosis. She aptly described this procedure, speaking seriously,
as a ‘talking cure’¹, while she referred to it
jokingly as ‘chimney-sweeping’.¹ She knew that
after she had given utterance to her hallucinations she would lose
all her obstinacy and what she described as her
‘energy’; and when, after some comparatively long
interval, she was in a bad temper, she would refuse to talk, and I
was obliged to overcome her unwillingness by urging and pleading
and using devices such as repeating a formula with which she was in
the habit of introducing her stories. But she would never begin to
talk until she had satisfied herself of my identity by carefully
feeling my hands. On those nights on which she had not been calmed
by verbal utterance it was necessary to fall back upon chloral. I
had tried it on a few earlier occasions, but I was obliged to give
her 5 grammes, and sleep was preceded by a state of intoxication
which lasted for some hours. When I was present this state was
euphoric, but in my absence it was highly disagreeable and
characterized by anxiety as well as excitement. (It may be remarked
incidentally that this severe state of intoxication made no
difference to her contractures.) I had been able to avoid the use
of narcotics, since the verbal utterance of her hallucinations
calmed her even though it might not induce sleep; but when she was
in the country the nights on which she had not obtained hypnotic
relief were so unbearable that in spite of everything it was
necessary to have recourse to chloral. But it became possible
gradually to reduce the dose.

  
¹
[In English in the original.]

Studies On Hysteria

30

   The persisting somnambulism did
not return. But on the other hand the alternation between two
states of consciousness persisted. She used to hallucinate in the
middle of a conversation, run off, start climbing up a tree, etc.
If one caught hold of her, she would very quickly take up her
interrupted sentence without knowing anything about what had
happened in the interval. All these hallucinations, however, came
up and were reported on in her hypnosis.

   Her condition improved on the
whole. She took nourishment without difficulty and allowed the
nurse to feed her; except that she asked for bread but rejected it
the moment it touched her lips. The paralytic contracture of the
leg diminished greatly. There was also an improvement in her power
of judgement and she became much attached to my friend Dr. B., the
physician who visited her. She derived much benefit from a
Newfoundland dog which was given to her and of which she was
passionately fond. On one occasion, though, her pet made an attack
on a cat, and it was splendid to see the way in which the frail
girl seized a whip in her left hand and beat off the huge beast
with it to rescue his victim. Later, she looked after some poor,
sick people, and this helped her greatly.

   It was after I returned from a
holiday trip which lasted several weeks that I received the most
convincing evidence of the pathogenic and exciting effect brought
about by the ideational complexes which were produced during her
absences
, or
condition seconde
, and of the fact that
these complexes were disposed of by being given verbal expression
during hypnosis. During this interval no ‘talking cure’
had been carried out, for it was impossible to persuade her to
confide what she had to say to anyone but me - not even to Dr. B.
to whom she had in other respects become devoted. I found her in a
wretched moral state, inert, unamenable, ill-tempered, even
malicious. It became plain from her evening stories that her
imaginative and poetic vein was drying up. What she reported was
more and more concerned with her hallucinations and, for instance,
the things that had annoyed her during the past days. These were
clothed in imaginative shape, but were merely formulated in
stereotyped images rather than elaborated into poetic productions.
But the situation only became tolerable after I had arranged for
the patient to be brought back to Vienna for a week and evening
after evening made her tell me three to five stories. When I had
accomplished this, everything that had accumulated during the weeks
of my absence had been worked off. It was only now that the former
rhythm was re-established: on the day after her giving verbal
utterance to her phantasies she was amiable and cheerful, on the
second day she was more irritable and less agreeable and on the
third positively ‘nasty’. Her moral state was a
function of the time that had elapsed since her last utterance.
This was because every one of the spontaneous products of her
imagination and every event which had been assimilated by the
pathological part of her mind persisted as a psychical stimulus
until it had been narrated in her hypnosis, after which it
completely ceased to operate.

Studies On Hysteria

31

   When, in the autumn, the patient
returned to Vienna (though to a different house from the one in
which she had fallen ill), her condition was bearable, both
physically and mentally; for very few of her experiences - in fact
only her more striking ones - were made into psychical stimuli in a
pathological manner. I was hoping for a continuous and increasing
improvement, provided that the permanent burdening of her mind with
fresh stimuli could be prevented by her giving regular verbal
expression to them. But to begin with I was disappointed. In
December there was a marked deterioration of her psychical
condition. She once more became excited, gloomy and irritable. She
had no more ‘really good days’ even when it was
impossible to detect anything that was remaining
‘stuck’ inside her. To wards the end of December, at
Christmas time, she was particularly restless, and for a whole week
in the evenings she told me nothing new but only the imaginative
products which she had elaborated under the stress of great anxiety
and emotion during the Christmas of 1880. When the scenes had been
completed she was greatly relieved.

   A year had now passed since she
had been separated from her father and had taken to her bed, and
from this time on her condition became clearer and was systematized
in a very peculiar manner. Her alternating states of consciousness,
which were characterized by the fact that, from morning onwards,
her
absences
(that is to say, the emergence of her
condition seconde
) always became more frequent as the day
advanced and took entire possession by the evening - these
alternating states had differed from each other previously in that
one (the first) was normal and the second alienated; now, however,
they differed further in that in the first she lived, like the rest
of us, in the winter of 1881-2, whereas in the second she lived in
the winter of 1880-1, and had completely forgotten all the
subsequent events. The one thing that nevertheless seemed to remain
conscious most of the time was the fact that her father had died.
She was carried back to the previous year with such intensity that
in the new house she hallucinated her old room, so that when she
wanted to go to the door she knocked up against the stove which
stood in the same relation to the window as the door did in the old
room. The change-over from one state to another occurred
spontaneously but could also be very easily brought about by any
sense-impression which vividly recalled the previous year. One had
only to hold up an orange before her eyes (oranges were what she
had chiefly lived on during the first part of her illness) in order
to carry her over from the year 1882 to the year 1881. But this
transfer into the past did not take place in a general or
indefinite manner; she lived through the previous winter day by
day. I should only have been able to
suspect
that this was
happening, had it not been that every evening during the hypnosis
she talked through whatever it was that had excited her on the same
day in 1881, and had it not been that a private diary kept by her
mother in 1881 confirmed beyond a doubt the occurrence of the
underlying events. This re-living of the previous year continued
till the illness came to its final close in June, 1882.