Max Eitingon, 1909: Anna got into a state of faintness, anemia and disgust at eating, and this became so bad that in her great pain she wanted to distance herself from the care of the sick person. So she fled, and at the same time due to her condition became bedridden herself. Thus she also got into bed, although into another one, and the above symptom complex looks not only similar to the expression of a pregnancy fantasy.214
Eitingon, after criticising Breuer’s blindness to the transference of which he was the object, wondered in fine about the true reasons for Anna O.’s healing, concluding that the cathartic method used by the Forelians was unsophisticated and outdated (this, of course, was the point of his whole talk).
Eitingon: For a long time the cathartic method . . . despite the fact that it still has proponents, can no longer be seen as a rational psychotherapeutic method.215
It is unclear to what extent Eitingon was simply echoing conversations he had had with Freud, or if he was proposing an original interpretation of his own. Whatever the case, it is clear enough that this rereading of Breuer’s case history was essentially intended retroactively to make it fall in line with the subsequent developments of psychoanalytic theory. The fantastic tale of Anna O.’s hysterical childbirth lent colour to this theoretical interpretation. Even Kurt Eissler, at the end of a life dedicated to defending Freud’s probity and moral rectitude against his detractors, was forced to recognise this fact, speaking in this regard of a ‘hardly believable derailment’ by his hero.216
Kurt Eissler: Freud’s version is false throughout, as is reliably documented . . . Freud was a fairly reliable reporter of events, sometimes amazingly accurate . . . But here is an incident in which he became the victim of an extensive paramnesia . . . Freud’s documented ambivalence to Breuer, the extreme improbability of the actions he attributed to Breuer, and the several fatal contradictions of his own account by documentary evidence leave no doubt that Freud was a victim of his own personal imagery in his letter to Zweig. Breuer’s alleged remark, whatever it may have been, must have been submitted in Freud’s unconscious to elaboration until the reconstruction suddenly appeared, decades later, with its convincing impression of reality . . . [Freud] must have expected that his correction of Zweig’s portrait of Breuer would find its way into print. Why this urge to denigrate Breuer after so many decades? It was not only an act of ingratitude but also an act of indiscretion. He divulged intimate matters which, so he claimed, he had obtained at a time of Breuer’s trusting friendship. Freud acted here in a way that is in contrast to his usual fidelity of character: he was ungrateful, indiscreet, and slanderous.217
Eissler, of course, tries to psychologise the whole affair, viewing it as the symptom of Freud’s unconscious ambivalence towards his old friend – which once again gives psychoanalysis the last word. However, the episode cannot be reduced to the ‘personal’, for it clearly had a strategic role. The rewriting of Anna O.’s history, as well as the origins of psychoanalysis, came at exactly the right time to settle a scientific controversy and to get rid of a bothersome fact, which carried with it the risk of ‘falsifying’ Freudian theory and giving ammunition to its adversaries. Asexualised, Anna O. refuted Freudian psychoanalysis. On the other hand, rolling about on the ground, holding her lower abdomen, she refuted Forelian psychanalysis and made Breuer look like a fool. Freud’s narrative victory over Breuer was total, as the conflict of interpretations that divided them no longer even appeared as such. Readers were presented with a historical event that put an end to the discussion – a matter of fact that no one could henceforth draw into question.
But it was an interprefaction. For those upon whom it is foisted, an interprefaction (without uptake) is at best a forgery, at worst a calumny. In 1953, Ernest Jones brought out the first volume of his biography of Freud, in which he revealed the true identity of Anna O. and, for the first time, enlightened the public at large on the history of her ‘hysterical childbirth (pseudocyesis), the logical termination of a phantom pregnancy’.218 Jones claimed to have received this account directly from Freud; but in a note, he added that his source, insofar as the biography of Bertha Pappenheim was concerned, had been one of her cousins, Mrs Ena Lewisohn. On 20 June 1954, Aufbau, the newspaper of German-speaking immigrants in New York City, printed a letter from Paul Homburger, the executor of Bertha Pappenheim’s will.
Paul Homburger: I am one of the rare members of Bertha Pappenheim’s close family circle who is still living and I have the duty as her executor to speak in the name of the family and to establish that the family is not capable of an inexcusable lack of piety to authorise the lifting of a medical secret which Bertha had guarded during her life. But much worse than the revelation of her name as such is the fact that Dr. Jones on p. 225 adds on his own account a completely superficial and misleading version of Bertha’s life after the conclusion of Dr. Breuer’s treatment. Instead of informing us how Bertha was finally cured and how, completely mentally reestablished, she led a new life of active social work, he gives the impression that she was never cured and that her social activity and even her piety were another phase of the development of her illness . . . Anyone who has known Bertha Pappenheim during the decades which followed will regard this attempt at interpretation on the part of a man who never knew her personally as defamation.219
It may be objected that what is at issue here is nothing other than ‘human, all too human’ failings of Freud, which were hardly particular to him. However, our aim here is not to stand in judgement concerning Freud’s conduct, nor to evaluate it morally. Rather it is to show the significant strategic functions of Freud’s interprefactions in establishing how psychoanalysis became, for so many, a reality.
3 Case histories
Freud to Fliess on the ‘Dora’ case, 25 January 1901: ‘It is the subtlest thing I have written so far.’
Freud (1985), 433
Freud’s account [of the Rat Man case] remains exemplary as an exposition of a classic obsessional neurosis. It brilliantly serves to buttress Freud’s theories, notably those postulating the childhood roots of neurosis, the inner logic of the most flamboyant and most inexplicable symptoms, and the powerful, often hidden, pressures of ambivalent feelings.
Peter Gay (1988), 267
The case history known as that of the ‘Wolfman’ is assuredly the best [of Freud’s case histories]. Freud was then at the very height of his powers.
Jones (1955), 274
The legend of Anna O.’s hysterical childbirth is a typical example of the psychoanalytic rewriting of history. Here, as elsewhere, Freud applied to the history of psychoanalysis (and later to history itself, if we consider Totem and Taboo, Moses and Monotheism and Woodrow Wilson) the same method of interpretation that he used in the privacy of his office to ‘reconstruct’ his patients’ forgotten and repressed memories. From this point of view, there is little difference between the ‘case’ of Anna O. and the Breuer ‘case’, the Schreber ‘case’, the Fliess ‘case’, the ‘case’ of the Wolf Man and the ‘cases’ of Jung, Rank or Ferenczi. Everyone – colleague or patient, sane or raving mad, dead or alive – was subjected to the same deciphering from the same hermeneutics of unconscious desire. In this sense, we can well say that Freud’s ‘case histories’ (Krankengeschichten) are no less mythical than the fabulous ‘history of the psychoanalytic movement’ narrated in his autobiographical writings or the history of humanity described in his phylogenetic and anthropological fictions. No matter where we look, we find the same rewriting of history, the same narrativising of arbitrary interpretations, the same transformation of hypotheses into facts.
One may object that there is, nevertheless, a difference between Freud’s polemical fictions and his case histories, a difference that we emphasised several times in the previous chapter: the vicious analyses of opponents, which completely disregard the protests of those concerned, are merely interprefactions; while the case histories and clinical observations record the results of an analytic deciphering to which the
patients have, if not actively participated in, at least given their consent. As today’s psychoanalysts freely admit, in the end what matters in analysis is not so much the ‘historical truth’ of the construction proposed by the analyst, but its ‘narrative truth’;1 that is, the fact that patients make use of it to rewrite their histories in a way that ‘makes sense’ for them. In other words, it matters little that this construction is a fiction; it only matters that the patients accept and understand this fiction as their history and their truth.
Jacques Lacan: Let’s be categorical: in psychoanalytic anamnesis, what is at stake is not reality, but truth, because the effect of full speech is to reorder past contingences by conferring on them the sense of necessities to come.2
Lacan: History is not the past . . . the fact that the subject relives, comes to remember, in the intuitive sense of the word, the formative events of his existence, is not in itself so very important. What matters is what he reconstructs of it . . . What is essential is reconstruction, the term he [Freud] employs right up until the end . . . I would say – when all is said and done, it is less a matter of remembering than of rewriting history.3
Jürgen Habermas: [The analyst] makes interpretive suggestions for a story that the patient cannot tell. Yet they can be verified in fact only if the patient adopts them and tells his own story with their aid.4
Roy Schafer: The analyst establishes new, though often contested or resisted, questions that amount to regulated narrative possibilities. The end product of this interweaving of texts is a radically new, jointly authored work or way of working.5
We could say a lot about these reformulated versions (‘structuralist’, ‘hermeneutical’, ‘narrativist’) of psychoanalysis – and especially about the fact that they continue to present themselves as being psychoanalysis, even as they seem to disregard Freud’s pretensions of revealing the objective truth of the psyche. If the final criterion for the fiction proposed by the therapist is that the patient accept (veri-fy) it, why insist on perpetrating Freudian fictions in accordance with psychoanalytic theory as opposed to any others? Why the inevitable interpretation of the patient’s biography in terms of desire, repression, resistance or transference – and not, let’s say, in terms of class struggle, astrological constellations, the evil eye, diet or psychopharmacology? And in what way is the psychoanalytic account superior to others, especially if its truth value comes not from what it recounts, but only from its assimilation by the one to whom it is recounted?
Schafer: People going through psychoanalysis – analysands – tell the analyst about themselves and others in the past and present. In making interpretations, the analyst retells these stories . . . This retelling is done along psychoanalytic lines.6
The truth is that, despite appeals for collaboration with the patients (designated as ‘analysands’, to better emphasise their active participation), psychoanalytic theory always provides the framework for the stories to be recounted on the couch, and later in the case history. There is nothing inherently wrong with this (after all, the therapist has to start from somewhere), but we at least need to recognise that little has fundamentally changed since Freud’s more authoritarian and ‘suggestive’ psychoanalysis, in which the patient was indoctrinated.
Raymond de Saussure: Freud was not an excellent psychoanalytic technician . . . First of all, he had practised suggestion for too long not to have retained certain reflexes. When he was persuaded of a truth, he wasted little time in awakening it in his patient’s mind; he wanted to quickly convince him, and because of this, he talked too much. Secondly, one rapidly sensed the theoretical question with which he was preoccupied, because he often developed at length new points of view that he was in the process of clarifying in his own mind. It was beneficial for the mind, but not always to the treatment.7
Paul Roazen, citing Helene Deutsch: Freud may have been a holy figure to Helene, but she had her reservations about him as a therapist; he thought to teach more than to cure.8
Joan Riviere, on her analysis with Freud: He was much more interested in the work in general, than in me, as a person. He was interested in the translations [for the Collected Papers]. He was interested in the Verlag [blotted out] and he would as soon as one came in be quite prepared to show me a German letter and discuss it with me, you see, and argue, and that sort of thing. Well, from my point of view now it is completely impossible to see it as an analysis! . . . I was also frustrated and deprived because he practically devoted the whole session to business.9
Freud, analysis notes for the Rat Man, 8 October 1907: He [the patient] is sure of having never thought that he could wish the death of his father. – After hearing these words pronounced with growing vigour, I believe it necessary to provide him with a piece of the theory. The theory asserts that because all anxiety and anguish corresponds to an earlier, repressed wish, we must assume exactly the contrary. It is likewise certain that the unconscious is the contrary of the conscious. – He is extremely disturbed, extremely incredulous . . . [Four pages later:] But it is now time to abandon the theory and return to the self-observation and memories. Seventh Session [Wednesday 9 October] He takes up the same subject. He can’t believe that he has ever had this wish against his father.10
Whether the patient chooses to collaborate with the analyst or, on the contrary, resist his interpretations, the fact remains that everything originates from the theory informing these interpretations – no matter if it be the ‘ready-made’ theory inherited by Freud’s successors or else, as in the case of the founder himself, hypotheses and speculations tried out on patients. We thus have the right to wonder, as Albert Moll was already doing in 1909,11 if the case histories are actually at the core of the theory or if it isn’t rather the inverse. In the end, what do these case histories tell us? What the patient says or does? Or rather what the analyst reconstructs of what transpired, filling gaps and discontinuities with interpretive connections – that is, what the analyst interprefacts?
‘The famous padded door . . .’12
Freud, for his part, surely would have protested vigorously. According to him, case histories and clinical vignettes are limited to ‘observations’ and ‘experiments’, into which no speculation, presupposition or theoretical anticipation is allowed to enter. The Freudian legend, as we have seen, exists to bolster and give credibility to this constantly reaffirmed, positivistic thesis: the theory (the meta-psychology) comes after the observation or, at the least, it never interferes with it. The psychoanalyst observes what patients say (or don’t say) to him, how they behave in relation to him and how their symptoms evolve – all of this being done in an absolutely neutral and objective manner, without ever interfering with the clinical ‘data’.
Freud: It is not a good thing to work on a case scientifically while treatment is still proceeding – to piece together its structure, to try to foretell its further progress, and to get a picture from time to time of the current state of affairs, as scientific interest would demand. Cases which are devoted from the first to scientific purposes and are treated accordingly suffer in their outcome; while the most successful cases are those in which one proceeds, as it were, without any purpose in view, allows oneself to be taken by surprise by any new turn in them, and always meets them with an open mind, free from any presuppositions. The correct behaviour for an analyst lies in swinging over according to need from the one mental attitude to the other, in avoiding speculation or brooding over cases while they are in analysis, and in submitting the material obtained to a synthetic process of thought only after the analysis is concluded.13
It is this impartial observation, the fundamental cornerstone of psychoanalysis, that case histories are supposed to represent for those not present at the analysis, just like, say, the Royal Society’s seventeenth-century Philosophical Transactions or the modern reports we make of experiments today. These documents take the place of what happened in the analyst’s office; they report to the public the psychical ‘events’ brought to light dur
ing analysis – and the theory subsequently attempts, somehow or other, to make sense of these events. We immediately see the enormous role these case histories play in the official epistemology of Freudianism, inasmuch as they are equated with the analytical experience itself. They are, as Kurt Eissler proudly declared, ‘the pillars on which psychoanalysis as an empirical science rests’.14 To take this declaration seriously, though, is to admit that the entire metapsychological edifice rests on a handful of cases that were observed and described by Freud himself: Dora, the Rat Man, the Wolf Man, the Homosexual (we hesitate to add Little Hans to this extremely short list, because, with the exception of one session with Freud, his analysis was conducted entirely by his father).15 This is rather extraordinary,16 a fact acknowledged by Freud himself in his foreword to the Dora case.
The Freud Files Page 21
