by Frank Tallis
At the age of sixteen, Cassandra had developed an eating disorder. This went into remission after a year; however, from that time onwards, she had experienced intermittent episodes of mild depression. She was now in her twenties and I was seeing her for a short course of structured psychotherapy. Every fortnight, I reviewed her mood and thought diaries, checked her activity schedules and set new goals. Cassandra liked working in this systematic (if somewhat inflexible) fashion. She had received exploratory, non-directive counselling when she was at school and had found the approach woolly and unhelpful.
It was a hot summer’s day and I had opened the window. A breeze provided welcome relief from the stifling heat but the traffic was extremely noisy. Frustrated drivers—unable to make progress—were revving engines and sounding their horns.
‘I’ve had something on my mind for a while,’ Cassandra said, momentarily distracted by the billowing net curtain. ‘I haven’t written about it in my diaries.’ I had been studying a sheet of paper on which she had kept a record of her thoughts and feelings. I looked up and she continued. ‘I didn’t think it was appropriate—or relevant, even. But it’s becoming an issue. I need to talk about it.’ She raised one leg and hugged her knee. ‘I’ve been seeing someone. It’s been a while—a couple of months now, at least.’
‘Where did you meet?’
‘In a park… I was jogging and I’d stopped, just to catch my breath, and there was this guy—sitting under a tree—strumming a guitar. He said hello and we got chatting. He was from Australia and he’d travelled quite a lot: South America, China, Bhutan. I’ve been meaning to go travelling. It’s something I’ve wanted to do for ages but I never seem to have enough money.’ A car horn, sustained for several seconds, was joined by two more. ‘He was interesting,’ Cassandra persevered, ‘and a lot of fun. He started singing songs—his own material—and he was really good.’ She was oddly insistent about this point. ‘I mean really good. He used to gig in Sydney.’ She swallowed and added: ‘His name’s Dan.’
After Dan’s impromptu concert they had gone for a coffee. Dan invited Cassandra back to his flat and later the same day they had made love.
‘He’s really easy to be with. I haven’t met anyone like him for ages—not since university. We stay up late, talking about music, philosophy, art.’ She made her voice comically ponderous. ‘The meaning of life… it gets really intense sometimes, but I think that’s a good thing. He’s reminded me of how much I used to enjoy that kind of conversation. My friends just aren’t interested any more. All they want to talk about is shopping and money and careers.’ She released her knee and sat normally. ‘He introduced me to one of his friends—Emily—who was nice. She’s from Australia too. Anyway, he was saying how sad it is that we all end up living dull, conventional lives—how we get brainwashed—and how we’d all be a lot happier if we were more open to experience, willing to experiment with different ways of living. And then he asked me how I felt about…’ She stretched the hem of her T-shirt. ‘Well… having a threesome with Emily. And I thought—yeah—why not? I mean, he was right. We do just shut ourselves off from new experiences; we are all brainwashed. So… he spoke to Emily and set it up. Emily came round. Dan rolled some joints—I didn’t smoke any—weed messes with my head too much—and the three of us went to bed. It happened again last week.’ Cassandra tapped her finger tips together. ‘I’m not stupid. I knew what was likely to happen. But Emily—she comes on too strong—and on both occasions, Dan just backed off and watched. And—the thing is—I’m not really bisexual. I go along with it, but it’s not really me.’
‘Have you told him that?’
‘Yes. And he said fine—that’s okay. But I know that he wants us to carry on.’
‘Perhaps you should talk to Emily.’
Cassandra didn’t acknowledge my suggestion; her attitude became introspective. When she spoke, it felt like she was finishing a syllogism that had been worked through in silence. ‘I really like him.’ Her voice betrayed her: a lurch of emotion—capsized, floundering, drowning.
‘Are you worried that he’ll see you differently now?’ I asked. ‘That he’ll lose interest—and the relationship will end?’
Her assent was as subtle as a vibration. The tension went out of her body and she allowed herself to fall back into the chair. Her arms were hanging by her sides, palms facing outwards. There was something almost post-coital about her abandon. She looked at me down the length of her nose with provocative hauteur: ‘I love the way he does it, the way he moves. He never rushes.’ Her eyes closed and opened. ‘He never rushes.’ The repetition was devotional—like an incantation. The car horns reproduced a brassy, discordant syncopation. ‘I don’t want it to end. Not now. Not yet.’
Sylvie was in her early thirties and had been troubled for several years by a pervasive sense of dissatisfaction. She didn’t know what she wanted from life any more. She felt directionless, unmotivated. Her discontent was slowly fermenting into depression. ‘I feel trapped,’ she said, making a cage with her fingers and inviting me to imagine an imprisoned bird inside. ‘I don’t know how this happened. I wasn’t like this when I was younger.’ Sylvie often made unfavourable comparisons of this kind, contrasting present and past selves. ‘I was so much more alive then.’
When she was eighteen, Sylvie had worked as an au pair for a wealthy couple called Peter and Amy. The couple had two small children. A condition of employment was travel to Greece, where the family owned a villa on one of the islands. They spent every summer there and Sylvie was delighted to go with them.
‘It was fabulous. I loved it. Every day, Peter would take me out in the yacht. He’d moor in some cove and we’d jump off the side and swim. We were spending quite a lot of time together—alone—and… I suppose he seduced me. I didn’t put up much resistance. Actually, I really fancied him. It became a regular fixture and I began to feel quite guilty. I didn’t like deceiving Amy. She’d always been good to me. We got on well together. I told Peter that I was unhappy with the situation and he said that I shouldn’t worry—that Amy wouldn’t mind. They had an understanding. A few days later, Amy took me aside and said she knew what was going on and—as far as she was concerned—it wasn’t a problem. I guess it felt a bit weird having that conversation, but—to tell the truth—everything felt weird. I’d left my normal life behind and it felt like I was living in a dream.’
The blazing sun, the scintillating blue of the Aegean Sea, the sky a psychedelic shade of purple: the yacht at anchor, the burning sand, a young woman—her nudity translated into a kind of abstract brilliance—and an older man.
‘Peter started coming to my room. He’d knock on the door and I’d let him in. He never stayed until morning. He always went back to Amy. This carried on for a week or so. Then, one night, Amy joined us. They never asked me how I felt about this—there was no discussion. And they’d obviously planned it. Peter wasn’t at all surprised when she appeared. I should have felt manipulated—exploited. But I didn’t. It was great—really great. And I felt so alive.’ She stroked her collar bone and smiled, coyly. ‘There was so much… contact.’ She crossed her legs—allowed the heel of her shoe to detach itself from her foot—and waited for my reaction.
Freud advised psychotherapists to model themselves on surgeons, to lay aside any feelings that might disrupt concentration or hinder technique. But that’s easier said than done. Listening to Cassandra and Sylvie, I can’t say I was unaffected by their confessions. Their narratives suggested pictures that formed in my mind. I wasn’t emotionally inert.
Eric Berne—the psychiatrist who developed transactional analysis—identified a number of ‘games people play’ in social situations. These games—or entrenched patterns of behaviour—can appear innocent but often serve an ulterior motive. In ‘The Stocking Game’, a woman raises her leg in the presence of others and remarks: ‘Oh my, I have a run in my stocking.’ This manoeuvre is calculated primarily to attract attention and cause sexual excitement. Berne’s
writing—in this context at least—feels a little regressive, a reversion to a time when men were uneasy and mistrustful of female sexuality. However, human beings—both women and men—frequently employ such tactics (either consciously or unconsciously) to enhance self-esteem, exercise power or control others.
A female colleague told me about a patient of hers, an athletic, muscular man who had entered therapy because he no longer found his wife attractive. He frequently made references to the size of his penis. In order to demonstrate that his boast was not an idle one, he started attending sessions wearing clingy sportswear. His favoured position was low in the chair with his legs spread wide apart.
The standard cartoon image of psychoanalysis, which shows the analysist, sitting out of view, listening intently to a patient lying on a couch, owes its existence to various late-nineteenth-century permutations of the stocking game. Freud tried placing his chair in various positions before finally deciding that the safest place to sit was next to the head of the couch. Some of his female patients were behaving provocatively and he wanted to keep well out of harm’s way. His friend and mentor—Josef Breuer—had once underestimated the power and significance of patient sexuality and had consequently paid a high personal price. Freud didn’t want to make the same mistake.
Psychoanalysis begins, not with Freud, but with Breuer. This is a contentious statement, because firstly, Breuer never really practised as a fully fledged psychoanalyst, and secondly, many psychiatrists and neurologists were conducting similar therapeutic experiments before Breuer; however, Breuer’s treatment of the young woman known as ‘Anna O.’ influenced Freud’s thinking profoundly and the case-study documenting her treatment, which Breuer wrote up many years later, set a stylistic precedent.
Breuer was a successful general practitioner and medical researcher. It was while he was working in the laboratory of the famous physiologist Ernst Brücke that he first became acquainted with Freud (his junior by fourteen years). On 18 November 1882 Breuer told Freud about his treatment of Bertha Pappenheim (a friend of Freud’s fiancée and destined to be immortalised as Anna O.). Over a period of approximately eighteen months, Bertha had displayed a quite sensational range of hysterical symptoms and behaviours. These included headaches, loss of hearing, coughing, squinting, impaired vision, paralysis, cramps, cleaning rituals, tubercular emaciation (anorexia), hydrophobia, stiff joints, muteness, mood swings, agitation, violence, confusion, stupor, speaking only in a foreign language and attempted suicide. Sometimes she would slip backwards in time, avoiding or bumping into furniture that had been moved. And she would lapse into dream-like states and experience terrifying hallucinations. No physical cause for any of these symptoms was discovered.
Every evening, Bertha entered a trance-like state and muttered incomprehensibly. Breuer discovered that if he said certain phrases—repetitions of things she had said earlier in the day, or words charged with special meaning—her language became increasingly coherent until it became clear she was telling a story. The stories she recited reminded Breuer of those written by Hans Christian Andersen. When Bertha finished her stories she became calm, cheerful and lucid. She described this procedure as the ‘talking cure’—a term we now use to describe all forms of psychotherapy. The benefit, however, was short-lived, and her condition deteriorated over a period of several days, until she was once again hallucinating and muttering in a trance.
Breuer’s great therapeutic breakthrough involved hypnosis and the retrieval of memories. He was able to establish that each of her symptoms was related to a forgotten traumatic event that had occurred while she had been nursing her dying father. Her blurred vision and squinting, for example, were attributable to memories of crying. Sometimes, Bertha would actually re-enact her traumatic experiences—releasing her emotions by means of a cathartic theatrical performance.
Several years after Breuer had told Freud about Bertha, Freud was in a position to conduct his own therapeutic experiments. In due course, the two men collaborated on a major work titled Studies on Hysteria, which was published in 1895. The most important case in the book is that of Anna O.: the name given to Bertha to conceal her true identity. Feminist writers have made much of this moniker. It has been suggested that the palindromic ‘Anna’ represents the divided female psyche and that the O represents the madness of Ophelia or the ancient symbol for the female genitalia. The truth is probably less exciting: A and O are Bertha Pappenheim’s initials (B and P) moved back a space in the alphabet. But there is more to decode than Pappenheim’s clinical alias. Close to the end of the case study, Breuer makes an oblique admission: almost in passing, he says that he has ‘suppressed a large number of quite interesting details’.
What details?
Bertha was twenty-one years old, pretty, petite—only 4 foot 11 inches tall—and endowed with the striking combination of dark hair and blue eyes. She was also extremely intelligent. She spoke five languages, painted pictures, wrote well, played the piano and had a passion for Shakespeare. For Breuer, going back home to Frau Breuer must have become increasingly dull, particularly after listening to Bertha’s stories and enjoying her histrionics. Even though he lived only a short distance from the Pappenheim residence, he made a conspicuously large number of house calls. He saw Bertha every day for eighteen months and, needless to say, they became very close. For long periods, they would speak to each other in English—excluding others. She insisted that she be allowed to touch him—which he permitted. And when Bertha’s father died, it was Breuer who soothed her agitation and put her quietly to bed.
Breuer’s treatment of Bertha was officially concluded in June 1882. What happened immediately after is believed by many to be one of the ‘quite interesting details’ that Breuer chose to suppress. The reliability of documentary sources has been repeatedly challenged by historians of psychotherapy; however, these sources include Freud’s recollections (as recorded by his biographer Ernest Jones) and Freud’s personal correspondence. Breuer—we are told—was called back to the Pappenheim residence where he found Bertha going through the melodramatic agonies of a hysterical childbirth. In a letter written by Freud to the author Stefan Zweig, Freud says that Bertha cried out: ‘Now Dr B’s child is coming.’ This was too much for Breuer, the respectable, trusted, general practitioner with a reputation to consider. He hypnotised Bertha, calmed her down and fled, according to Jones, ‘in a cold sweat’. He then took his wife to Venice for a second honeymoon; she had become jealous of Bertha and needed attention. Bertha continued to have problems and Breuer referred her to a colleague. He hoped that his ‘patient, who has always meant a great deal to me, will soon be safely in your care’.
Freud was convinced that sexual feelings played a critical role in the development of hysterical symptoms. Breuer, given what had happened, wasn’t overly keen to pursue this line of inquiry. Freud became frustrated with Breuer, their friendship suffered and their collaboration came to an end. Many years later, Freud characterised Breuer’s abandonment of Bertha Pappenheim as a form of scientific cowardice: he had retreated when he should have been pushing forward. As Freud slowly assembled the theoretical edifice that was to become psychoanalysis, he gave great significance to the sexual feelings a patient might feel for a therapist. He believed that such feelings should be discussed and interpreted because they were, in fact, displacements from childhood and formerly associated with the opposite-sex parent. Freud called the phenomenon ‘transference’ and came to regard it as an essential part of the therapeutic process. The reverse can also happen. When a therapist experiences sexual feelings for a patient it is termed ‘counter-transference’. This is a problematic development and has no therapeutic value.
The notion of transference has broadened since Freud’s time. All feelings (rage, anger, suspicion) displaced from any prior relationship can be usefully discussed in therapy. Analysing transference effects is a way of bringing historical problems into the present—the here-and-now—so that they can be dealt with more easily.
Breuer returned from his second honeymoon and resolved never to become so deeply involved with a patient again. He was a modest, unambitious man and, unlike Freud, was not overly concerned with posterity, which is perhaps why he allowed his young protégé to develop his ideas. Breuer’s generous patronage set Freud on course for greatness.
Bertha continued to suffer from hysterical symptoms, but her subsequent achievements suggest that ultimately her health was restored. She published a book of children’s stories, wrote a play and became a social worker, a reformer and what we would now probably describe as a ‘feminist activist’. She translated Mary Wollstonecraft’s Vindication of the Rights of Woman and was a founder member of the German League of Jewish Women. She travelled to Russia, Poland and Romania in order to rescue children whose parents had been murdered in anti-Semitic pogroms.
In late-nineteenth-century Vienna, very little was expected of a 21-year-old woman from a middle-class Jewish family: sewing, stringing pearls, embroidery and some small musical accomplishments. Usually, this unstimulating existence continued until an arranged marriage obliged her to keep her husband’s house in order. For a person of Bertha’s intelligence, life must have been excruciatingly dull and—looking ahead—there would have been little prospect of change.
In the 1920s, the surrealists Louis Aragon and André Breton made an observation concerning hysteria that demonstrates a superior degree of understanding than any of their medical contemporaries. They suggested that hysteria was not an illness, but an act of rebellion and a means of self-expression. Perhaps—in spite of having so many symptoms—Bertha was never really ill, not in the accepted medical sense. Perhaps she was just bored, angry and very sexually frustrated.
The man she had fallen in love with was irreplaceable. She would never be as intimate with anyone again. She had allowed him to peel away layer after layer of her being—memories, dreams, fantasies—until her very essence was exposed. She had been naked, in front of Breuer, like no other woman had ever been naked before. She had let him ‘know’ her. Unsurprisingly, she never married. What kind of pale imitation of intimacy could she expect from a conventional bourgeois marriage?
