by Morton Hunt
Freud thus had reason for his lifelong anxiety about money. And about his place in society; although by the 1860s legal reforms in the empire had freed Jews to live outside the ghetto and to attend gymnasia and universities, they remained social outcasts and were barred from practicing most professions or holding high public office.
Freud was doubly an outsider. His father had thrown off the Orthodox faith of his forebears and become a freethinker, possibly in the futile hope of being assimilated into Gentile society, and although Freud always considered himself a Jew and consorted mainly with fellow Jews, he was, he once told a Protestant friend, “a totally Godless Jew,” belonging to no congregation and taking no part in the life of the Jewish community. It is not surprising that he would later seek from psychology answers to questions so unlike those asked by Helmholtz, Wundt, and James, the outstanding psychologists of his youth. In their separate ways they asked, “How does the mind work?” while Freud would ask, “What am I and what made me that way?” But he would do so only after many years of trying to become a scientist in the mold of Helmholtz.
At Freud’s birth, a peasant woman had prophesied to his mother that he would become a great man, and his parents often told him the story during his boyhood. Whether for that reason or others, he early became extremely ambitious and diligent in his studies and was first in his class in the gymnasium for seven years. Law and medicine were the two professions then open to Jews, and in his final year at the gymnasium, after reading an inspiring essay by Goethe on Nature, he decided to spend his life in science. In 1873 he enrolled in the medical school at the University of Vienna; there, despite his exclusion from the fellowship of his anti-Semitic classmates—or perhaps because of it—he excelled as a student.
But medicine, he discovered, had little intellectual appeal for him, and as for actual practice, he found the prospect repellent. Partway through medical training he came under the spell of Ernst Brücke, professor of physiology and a co-founder, with Emil Du Bois-Reymond, of the Berlin Physical Society, the nucleus of the mechanist-physiological school that had dominated psychology for a generation. Freud was impressed by Brücke’s presentation of physiological psychology and charmed by his warm and fatherly demeanor. Brücke, nearly forty years older than Freud—as was Freud’s own father—took a personal interest in his brilliant young student and became both scientific mentor and father-figure to him. Freud later said that Brücke “carried more weight with me than anyone else in my whole life,”7 a remarkable statement for one who spent nearly fifty years developing a subjective, introspective psychology totally unlike Brücke’s.
But Freud’s concern with introspection would come later. As a serious, hardworking medical student, he had no time for and no interest in inward-looking psychology; indeed, he was so taken by the physiological approach to psychology that he delayed the completion of his medical studies to do research in Brücke’s Physiological Institute. There, the person one always envisions as sitting unseen behind a couch listening to the ruminations of neurotic patients spent much of his six-year stay at laboratory tables, dissecting fish and crayfish, tracing their nerve pathways, and peering at nerve cells through a microscope.
Intellectually committed to physiological psychology, he hoped to become a physiologist and do pure research. But Brücke advised against this. Freud had no money—he still lived at home and was supported by his father—and at that time a career in pure science was impossible for a person without an independent income unless he could count on achieving a high academic position, which a Jew could not. Freud gave up the dream, reluctantly completed his medical studies, and received his M.D. in 1881.
He hung on briefly at the institute but the next year met and fell in love with a friend of one of his sisters, an attractive young woman named Martha Bernays, and soon proposed marriage. She was entranced by the darkly handsome young doctor and accepted the offer, though they would not be able to marry until he could support a wife and family. The most feasible way for him to do so was to enter private practice, but he needed clinical experience and training in a specialty he could tolerate. Neurology being the specialty closest to neuroscience, he left Brücke’s institute and joined the Vienna General Hospital, where he studied under Theodor Meynert, then the world’s leading brain anatomist, and over the next three years became expert at diagnosing different kinds of brain damage and disease.
(During this time, as nearly everyone knows, Freud briefly experimented with cocaine. He used it himself and touted it in medical circles as a valuable analgesic and antidepressant until, seeing its destructive effects on a friend who became addicted to it, he abandoned it. By then, however, he had made himself suspect in the Viennese medical community.)
His years of hard work at the General Hospital were lonely and dispiriting; Martha Bernays lived with her mother in Hamburg, and Freud saw his fiancée only at long intervals and then for brief periods. He wrote to her and she to him almost daily; in his chatty, loving letters, he envisioned himself as Dr. Sigmund Freud, Neurologist in Private Practice, earning a good living, happily married to his beloved Martha, and raising a family. Only rarely did he write of some inner turmoil (for instance: “I have been so caught up in myself, and then I have days on end—they invariably follow one another, it is like a recurring sickness— when my spirits decline for no apparent reason”8), but there is no hint in the letters that he would someday search his psyche in an effort to understand his distress, no premonition that deep-probing psychology would drive neurology out of his mind and life.
The Hypnotherapist
Freud’s move toward his unique career was initiated by his friendship and collaboration with Josef Breuer, a successful physician and physiologist fourteen years his senior whom he had met through Brücke. Despite the gap in age and status, Breuer and Freud became close friends, and Freud was a frequent visitor in the Breuer home. The friendship grew particularly close as Freud gained medical experience at the General Hospital and was able to discuss cases with Breuer.
In November 1882, Breuer told Freud about one of his patients, a young woman suffering from hysteria whom he had treated for a year and a half. Known to history by the case-study pseudonym Anna O., she was Bertha Pappenheim, a pampered, overprotected daughter of wealthy Jewish parents and a friend of Martha Bernays’s. Freud was fascinated by the case, got Breuer to go over it with him in great detail, and a dozen years later co-authored with Breuer a report that is often called the first case of psychoanalysis, although in actuality it was only the seed from which psychoanalysis sprouted and grew.9
Bertha Pappenheim, an attractive, intellectual woman of twenty-one, was deeply attached to her father and had nursed him during his illness until she became bedridden with severe hysterical symptoms, including loss of appetite, muscular weakness, paralysis of the right arm, and a severe nervous cough. Her father died two months later, and she then became much worse. She suffered from hallucinations of black snakes and skeletons, speech difficulties (at times she was unable to speak in her native German, though she could speak in English, French, or Italian), the inability to drink even when painfully thirsty, and periods of “absence” or somnolent confusion that she called “time missing.”
Breuer told Freud that he had visited her regularly but could not help her until he accidentally stumbled on a curious method of doing so. During her “absences,” she would mutter words that arose from a train of thought, and Breuer found that by lightly hypnotizing her, he could get her to use these words as a starting point to reproduce for him the images and fantasies in her mind—after which, strangely, she would be free of mental confusion for a number of hours. The next day she might relapse into another absence, but Breuer could again dispel it by another light hypnosis. She called it “the talking cure” or sometimes “chimney sweeping.”
Breuer also told Freud that the talking cure could do much more than temporarily relieve her mental confusion; if he could get her to remember under hypnosis when, and in what c
onnection, a particular symptom first appeared, the symptom would disappear. In one session, for instance, she traced her inability to drink water back to a time when she saw a little dog drink from a water glass and was disgusted by the sight; when she came out of the trance she was able to drink and the symptom never returned. Similarly, the talking cure rid her of the paralysis in her right arm after she recalled that one time, while tending her father, that arm was draped over the back of the chair and became numb, at which point she had had a dream of a black snake approaching and of being unable to use her arm to fend it off.
By this method Breuer tackled her symptoms one by one and brought them all under control. But one evening, he told Freud, he found her confused again and writhing with abdominal cramps. He asked her what was the matter. “Now comes Dr. B.’s child,” she said.10 He realized with alarm that she was undergoing a hysterical pregnancy stemming from fantasies about him. He abruptly referred her to a colleague, went on vacation with his wife, and treated Bertha Pappenheim no more.
She had not, in fact, been cured by the catharsis of the talking cure but only temporarily relieved of her symptoms. It remained for Freud to discover years later that such patients needed to do more than remember the events that triggered each symptom; they had to search for their hidden meanings. In most cases, he would find, these were sexual, as in the episode of “Dr. B.’s child.” But Breuer was uncomfortable with the topic of sexuality, and though at the moment of the hysterical pregnancy he had “had the key in his hand” (as Freud later wrote to a friend), “he dropped it… [and] in conventional horror took to flight.”11
(Bertha Pappenheim spent some time in a sanatorium, where she eventually recovered. She went on to have a successful career, first as housemother in an orphanage, then as head of an institution for unwed mothers and young prostitutes, and the leader of a long-term campaign to protect “endangered girls.” She never married and had no recorded love life; the sexual problems underlying her hysteria were not cured but sublimated—a process Freud would later elucidate—in good works for fallen women.12)
In 1886, four years after Breuer told him about that case, Freud, then thirty-one, opened an office (and later that year married Martha) and began private practice as a specialist in neurological and brain disorders, which he treated with such physical therapies as were then available. But few patients arrived, and he was glad to get Breuer’s referrals of patients suffering from hysteria. Freud had recently taken special training in that subject; he had gone to Paris for several months on a small grant from Brücke’s Neurological Institute to study under Jean Martin Charcot, the noted neuropathologist and director of the Salpêtrière hospital. Charcot was, among other things, the discoverer of the phenomenon of hysteria. He was also a skilled hypnotist, but he hypnotized hysterics only to get them to display the symptoms of hysteria to his students. He believed that hysteria, though it may have been triggered by some traumatic event, such as a railroad accident, resulted from a hereditarily weak neurological system, and he considered the disease progressive and irreversible.
Impressed by Charcot’s views, Freud at first treated his own hysterical patients as if the neurosis were indeed a neurological disorder. For the most part he used “electrotherapy,” a method in vogue at the time; he applied electrodes to the affected part of the body and delivered a mild electric current that produced a tingling or muscular twitch. He had some initial success with the method, but his familiarity with hypnosis led him to suspect that the benefits were due less to the electric current than to suggestion—his assurance to the patient that the treatment would dispel the symptom.
With this in mind, he began the more direct use of hypnotic suggestion, although this was disapproved of in Viennese medical circles and considered close to quackery. Freud knew that members of the “Nancy School” in France, followers of the medical hypnotist Auguste Liébeault, of whom we heard earlier, were treating hysteria by post-hypnotic suggestion. They would hypnotize their patients and tell them that the symptom would disappear when they awoke from the trance. Freud adopted the technique and was delighted by the results. In December 1887 he wrote to Wilhelm Fliess, a Berlin ear, nose, and throat specialist he had met that year and with whom he had struck up a close friendship, “During the last few weeks I have plunged into hypnotism, and have had all sorts of small but peculiar successes.”13
But all too soon he found to his sorrow that the relief was usually partial and temporary, so he took a different tack, using hypnosis as Breuer had with Bertha Pappenheim. For several years Freud hypnotized hysterics and asked them to recall and talk about the “traumatic event” that first brought about a particular symptom. He had fairly good results with some, but, disappointingly, either the improvement was temporary or the banished symptom was replaced by a different one. Moreover, the technique was inapplicable to the many patients who could not be hypnotized.
Despite these limitations, in the course of half a dozen years Breuer and he discussed a series of cases—Bertha Pappenheim and Freud’s more recent patients—and gradually worked out a theory of hysteria that, unlike Charcot’s, was wholly psychological. They concluded that “hysterics suffer from reminiscences”—memories of emotionally painful experiences—that have somehow been excluded from consciousness. As long as such memories remain forgotten, the emotion associated with them is “strangulated” or bottled up and converted into physical energy, taking the form of a physical symptom. When the memory is recovered through hypnosis, the emotion can be felt and expressed, and the symptom disappears.
This was the gist of a brief paper that Breuer and Freud published in 189314 and of a lengthy, detailed work published in 1895, Studies on Hysteria, which reported on Breuer’s one case and four of Freud’s, presented their theory of hysteria, and discussed the relief of symptoms by hypnotic catharsis—and by a better method Freud had discovered that abandoned hypnosis altogether and brought about not temporary relief but actual cure.
The Invention of Psychoanalysis
No historical or sociological account of scientific progress can adequately explain the sudden appearance of psychoanalysis and its discoveries of unconscious psychological processes. In the latter part of the nineteenth century many men reared in Vienna or other leading European cities were trained in medicine and steeped in the tradition of physiological psychology, but Freud alone went on to practice neurology, then to use hypnotherapy with hysterics, and finally to invent psychoanalysis. The evolution of his thinking was nurtured in part by the social conditions and state of scientific knowledge in his era, but in part by his genius and the personal problems that made him sensitive to similar problems in others.
Freud took his first small step toward the invention of psychoanalysis not by design but in response to a demand made by one of his patients. She was Baroness Fanny Moser, a forty-year-old widow whom he called Frau Emmy von N. in Studies on Hysteria. She sent for Freud in 1889 when she was suffering from facial tics, hallucinations of writhing snakes and dead rats, fearful dreams of vultures and fierce wild animals, frequent interruptions of her speech by a spastic clacking or popping noise that she made with her mouth, a fear of socializing, and a hatred of strangers.
Over a period of time Freud rid her of many of her symptoms by the cathartic Breuer method—she was the first patient with whom he used it—and also by the Nancy method of post-hypnotic suggestion. As he later reported in Studies:
The therapeutic success on the whole was considerable; but it was not a lasting one. The patient’s tendency to fall ill in a similar way under the impact of fresh traumas was not got rid of. Anyone who wanted to undertake the definitive cure of a case of hysteria such as this would have to enter more thoroughly into the complex of phenomena than I attempted to do.15
From Frau Emmy, however, he learned something of great importance. When he asked her to recall the traumatic episode that had initiated some symptom, she would often ramble on tediously and repetitiously without relating anything perti
nent. One day Freud asked her why she had gastric pains and what they came from:
Her answer, which she gave rather grudgingly, was that she did not know. I requested her to remember by tomorrow. She then said in a definitely grumbling tone that I was not to keep on asking her where this or that came from, but to let her tell me what she had to say.16
To his credit, Freud sensed that this was an important request and let her proceed as she wished. She began talking of her husband’s death and wandered on from there, eventually speaking of the slander circulated by his relatives and by a “shady journalist” to the effect that she had poisoned him. Although this had nothing to do with her gastric pains, it revealed to Freud why she was so isolated and unsociable, and why she hated strangers; previous urging had not elicited the significant thoughts, but allowing her to ramble freely had. He realized that, wearisome as it might be, allowing the patient to say whatever came into her mind was a more effective route to hidden memories than prodding and probing; this eventually led him to the use of the technique, critically important to both therapy and research, of “free association.”
Freud recognized, too, that the technique might spare him the attempt at hypnosis with patients who could not be hypnotized. He asked them—and, after a while, all his patients—to lie down on a couch in his office, close their eyes, concentrate on remembering, and say whatever came to mind. Often they would go blank; nothing would come to mind, or what came was irrelevant, and for good reason: Freud had already noticed that forgotten memories that were retrieved only with great difficulty were those one would prefer to forget—memories involving shame, self-reproach, “psychical pain,” or actual harm. Patients who could not remember traumatic episodes were unconsciously defending themselves from pain.
