Hysteria's Notorious History

David Sedgwick reviews Approaching Hysteria: Disease and Its Interpretations and Remembering Anna O.: A Century of Mystification

Hysteria's Notorious History

Mark Micale. Approaching Hysteria: Disease and Its Interpretations. Princeton, Princeton University Press, 1995.
Mikkel Borch-Jacobsen. Remembering Anna O.: A Century of Mystification. New York and London, Routledge, 1996.

Reviewed by David Sedgwick.

Published in the San Francisco Jung Institute Library Journal 16, no. 3 (1997): 39-46. 

An intriguing painting hangs over the couch in Sigmund Freud's London office: it is a portrait of hysteria. It shows a bare-shouldered woman, in a trance or otherwise overcome, fainting into the strong left arm of a physician during a medical demonstration. Rows of interested doctors look on.

As Mark Micale's new book, Approaching Hysteria, informs us, this etching is Brouillet's Une lecon clinique a la Saltpetriere, the swooning patient is Blanche Wittman ("Queen of the Hysterics"), the man catching her is Joseph Babinski, and the seated physician orchestrating the whole demonstration is the famous J.-M. Charcot, "father of neurology" and, briefly, Sigmund Freud's teacher.

This image of hysteria looms over Freud's couch. Along with Bedlam and, indeed, the analytic couch itself, this Grand Rounds-type scene is one of the best- known psychiatric images in the world. But, as Robert Lowell might say, the traditional image of hysteria "sticks like a fishbone" in the throat of psychoanalysis. All that critics find disturbing about psychoanalysis is embodied in the etching: latent sexism, aspirations towards a clinical-medical objectivity, power differentials, erotic undertones, the potential for empathic failure, the patriarchal aspects, and just the dusty archaic quality of it all--it's so "old."

Hysteria, in fact, no longer exists (not as a clinical entity anyway). The diagnosis and patients seen in fin-de-siecle Europe are long gone. All of hysteria's symptoms have been modified and farmed out into other psychiatric classifications (somatoform and dissociative disorders primarily, but also Axis II personality disorders which describe its more dramatic characterological features).

What's worse for classical psychoanalysis, not only is hysteria dead but, according to Mikkel Borch-Jacobsen's Remembering Anna O., Anna O., the "first patient of psychoanalysis," never had it in the first place. She faked it, and her case and the whole "origin-myth" of psychoanalysis are therefore a fraud.

A heavy charge, and, if true, quite a predicament for Freud and his followers. Never mind that Anna O. was never Freud's patient (she was Josef Breuer's). And never mind that this etching is in Freud's London office, where the exiled and dying Freud spent only the final year or so of his life: Micale's encyclopedic study tells us that the picture was centrally located in Freud's Vienna consulting room as well (Micale, p. 144). Hysteria and the case of Anna O. are right there at Freud's beginning and end.

Because hysteria no longer exists and because it has an ancient and colorful history, it has already been subject to discussion for some time now. Micale's Approaching Hysteria reviews both early explorations and what he terms "the new hysteria studies"--an explosion of recent studies with historical rather than clinical focus. Psychoanalysis, which coincides with so much of hysteria's notorious history and which to some people seems to be in its own death throes, has also become an archaeological dig. Borch-Jacobsen's Remembering Anna O. is an example of "the new Freud Studies"--scholarly academic explorations which for the most part come to bury psychoanalysis rather than praise it.

Micale's Approaching Hysteria, however, covers not just psychoanalytic hysteria, so to speak, but medical, cultural, literary, religious, and even political perspectives on the disease. His wide-ranging survey is essentially a literature review and, as such, it is impressive. Micale seems to synopsize all the studies of hysteria that have been made; his book is basically a review of prior reviews. Sometimes it is even a review of a review of a review, as, for example, when he studies King's exploration of Veith's exploration of Hippocratic texts apparently mistranslated by Littre (p. 43). Other times--this brings us back to the new Freud scholarship--Micale reviews a text that sounds like academia run amok:

McGrath establishes that Freud's basic explanatory strategy in creating a new theory of the neuroses involved the use of architectural metaphors, especially metaphors drawn from Catholic medieval architecture. (p. 59)

Medieval Architecture? Freud? Catholic? Could be, but one begins to think about an S.J. Perelman or Woody Allen treatment here ("Everything you always wanted to know about hysteria but...").

Such criticism of the book may be a bit unfair, as scholars can pursue what they wish and Micale is not responsible for their studies per se. However, the comprehensiveness of Micale's own scholarship and detective work is both the book's success and, at least for the average reader, a potential hazard. Reading Approaching Hysteria can be an upstream paddle for any but diehard "historical specialists" (which would not be a problem except that Micale specifically states that he is trying to broaden his horizons). This snare is unavoidable, though: his study cannot be reader-friendly yet at the same time "survey as encyclopedically as possible" (p. 285) hysteria's multitudinous, often obscure interpretations throughout the two thousand years of its history. The two goals are mutually exclusive. For all that, Micale's is a excellent and well-written reference book--where else can one find, for example, the name, artist, and interesting history of the painting above Freud's couch? Approaching Hysteria is surely the definitive meta-analysis of historical studies of hysteria.

The book's thoroughness serves us well in terms of hysteria and psychoanalysis. Micale not only provides basic background on the case of Anna O. (Bertha Pappenheim), who invented "the talking cure" under the care of Breuer (not Freud), but also reviews the wide range of scholarship and controversy surrounding this case. The main controversy, aside from the interesting though "unresolvable" (as Micale rightly points out, p. 62) debate over Anna O.'s diagnosis, is that Anna O. was by no means "cured" by the talking cure. Like "Dora," another of Freud's famous "hysterics," Anna O. did not improve with treatment (unlike Dora, Pappenheim apparently was able to move on to a fulfilling life anyway).

Borch-Jacobsen's small volume, Remembering Anna O., picks up here, recounting in detail Anna O.'s extensive, post-Breuer treatment. One month after the "cure" in 1882, Anna O. was hospitalized in the Bellevue Sanitarium at Kreuzlingen (a Swiss hospital with a later Jungian connection) for treatment of hysteria and addiction to morphine. She was hospitalized elsewhere at least three more times during the next four years (Borch-Jacobsen, p. 24). This is not quite the return to "complete health" which Breuer claimed for her when he noted: "After this [his cathartic treatment] she left Vienna and travelled for awhile; but it was a considerable time before she regained her mental balance completely" (Breuer and Freud, Studies on Hysteria. 1893-95. In Vol. 2 of The Complete Psychological Works of Sigmund Freud. Standard Edition. London, Hogarth Press, 1955, pp. 40-41.) Breuer's understatement seems disingenuous at best. According to Borch-Jacobsen, Anna O. never spoke of psychoanalysis again and went on to become a "pioneer of social work and feminism in Germany." But her "unexpected recovery...owed nothing whatsoever to the `talking cure.'" (Borch-Jacobsen, p. 24-25)

Breuer and Freud appear to have declared victory with Anna O., and the historians have smoked them out. The above evidence suggests that they both had to know the real story when they wrote Studies in Hysteria, thirteen years after Breuer's treatment of Anna O. terminated. The problem the new Freud historians find here is less with the treatment failure per se--hers was a difficult case--than with the apparent lack of integrity in its presentation. Borch-Jacobson maintains that Freud "press[ed] Breuer to publish Bertha's case history" and made "false claims" about its efficacy in order to bolster his own techniques and to beat French physician-hypnotists "to market" (pp. 26-7). Freud confirms in The History of the Psychoanalytic Movement that he "induced" Breuer to publish the case, though Freud's self-described motives were not so mercenary as Borch-Jacobsen asserts. (Freud, The History of the Psychoanalytic Movement, 1914. Reprint, New York, Collier, 1963, p. 43)

All this smells fishy enough, but rereading the original Studies in Hysteria, even without this aftermath of hyping a dubious breakthrough, reveals something suspect about the termination of the case. First, Anna O. unilaterally sets her own termination date, 7 June 1882--exactly one year to the day after Breuer originally hospitalized her (in a decompensated state of anorexia and transient psychosis following the death of her father). This date-setting is too pat, too arbitrary, too frivolous (too hysterical?) and, obviously, too soon (as evidenced by her re- hospitalization in a month). Moreover, on the very last day of treatment, Anna O. manages to produce and abreact the key hallucination--a black snake coming to bite her father as she sat paralyzed at his bedside--"which constituted the root of her whole illness" (Breuer, p. 40).

In retrospect, this insta-cure seems pretty suspicious and certainly naive, as was Breuer's failure to challenge Anna O.'s own premature termination-setting. The buried "memory" turns out to be a buried hallucination. There is no attempt by the clinicians to understand the hallucination in terms of, for instance, Anna's anxieties about her father's condition, her helplessness, her own death wishes or aggression, or even her sexual-oedipal issues (this meaning of "snake" would be perfectly obvious to Freud only later), her own sense of personal disintegration, or some other trauma of her own. This was 1882, before anybody really knew anything about psychotherapy, before Freud was twenty-seven, and before Jung had shown that the content of psychotic symptoms could have symbolic meaning (Jung, "The Psychology of Dementia Praecox," 1907. In The Collected Works of C.G. Jung. Vol. 3, The Psychogenesis of Mental Disease, Princeton, Princeton University Press, 1960).

As the treating physician, Breuer might well have been thrilled by the clearing of his recalcitrant patient's grim symptoms--and disappointed when she relapsed later. Breuer knew he was on to something, however, and thirteen years later, in conjunction with Freud and with the latter's encouragement, he made his clinical intuition public. The interesting tale of what happened between Freud and Breuer during the thirteen-year hiatus, and the degree to which Freud influenced Breuer, is not in Borch-Jacobsen's book, but it is clear the two neurologists were in close contact. Many of Breuer's statements in Studies on Hysteria about the disease's sexual origins sound very Freudian, as James Strachey, editor of Freud's works, has pointed out (Introduction to Studies on Hysteria, 1955, p. xxvi). As was so often the case between Freud and his close associates (Fleiss, Adler, Jung, Stekel, Rank, Ferenczi), there was ultimately a falling out between the collaborators. Freud later went on to publicly express the opinion that Breuer (despite his written statements) could not negotiate the sexual transference that Anna O. directed towards him. Privately, to psychoanalytic insiders, Freud revealed additional facts about the case: that Anna O. staged an hysterical pregnancy and childbirth--their transference child--that so terrified Breuer that he fled the scene; that Breuer could not handle his countertransference; that Breuer's wife was jealous (and even suicidal) due to Breuer's involvement with his patient, and that the Breuers dashed off for a second honeymoon (resulting in the wife's pregnancy). Some of this material--the phantom childbirth, for instance--was first revealed to the public in Ernest Jones's 1953 biography of Freud.

Borch-Jacobsen challenges Freud's account of the treatment as a "spiteful piece of slander that was built up over the years," which, to Borch-Jacobsen, is not surprising because everyone knows that "the official history of psychoanalysis is a vast anthology of tall tales" (p. 34). He follows a complex paper trail of letters and diaries to indicate that Freud's "reconstruction" of what happened to Breuer and even Freud's statement that Breuer's daughter confirmed it were basically "Freud's fantasy" (p. 48). In other words, to serve his own ends, Freud faked Breuer's countertransference.

Some of this critique of Freud is quite effective, as when it is shown that the Breuers's daughter was born three months before the end of Anna O.'s treatment. Borch-Jacobsen's tone here and elsewhere is combative (and reminiscent, to my ear, of R. Noll's overwrought attack on Jung and Jungians in The Jung Cult), to the point where it almost threatens his interesting evidence and belies the book's promotional claim that "unlike other Freud-bashers...Borch-Jacobsen is cool and distanced." Some of his evidence, moreover, is not as crystal clear as the author's sometimes sarcastic tone implies: Breuer could well have had a complex countertransference towards Pappenheim and possibly an erotic one, and the jealous Mrs. Breuer might have attempted suicide in response. Borch-Jacobsen chooses to ridicule these assertions by Freud, but mockery does not answer them (and the other evidence Borch- Jacobson presents does not totally eliminate them).

Borch-Jacobsen's argument about bad faith in Freud extends to Breuer himself, whose original case report upon transferring the patient in 1882 does not mention such "traumatic memories" as the snake hallucination. By 1895, according to Borch- Jacobsen, there has been a reinterpretation and re-selection of aspects of the case in order to bring it in line with Freud's other case histories in Studies in Hysteria. This "self-serving revisionism," says Borch-Jacobsen, "is anything but innocent" (Borch- Jacobsen, p. 60).

Anna O. is implicated as well. With somewhat more circumstantial evidence, Borch-Jacobsen maintains that she and other hysterics had to have learned how to do "hysteria" from each other and from trendy hypnotic demonstrations allegedly sweeping the land. She was able to show Breuer what he expected to see, as together they "played the game called Hysteria." (Borch-Jacobsen, p. 84) This argument and interpretation of the data seems a bit strained. Anna O.'s motivation, suggests Borch-Jacobsen, was that she was "suffocated by the family atmosphere." (p. 83) If so, and if she was therefore only "simulating," this would seem to be a hard and, indeed, hysterical way to go about separating from her family.

Borch-Jacobsen's final implication is that not only the wily Pappenheim, the gullible Breuer, and the ambitious Freud faked it: psychoanalysis itself fakes us out. This tricksterism of the field is noted at the beginning and at the end of the book. Early on, Borch-Jacobsen decries the fate of "hundreds of American parents whose `adult children,' accusing them of incest, are hauling them into court on the strength of memories dug up during psychotherapy" (p. 10). But, for all its failings, psychoanalysis is the least inclined of all therapies to accept reports of trauma at face value, and analysts are frequently attacked for failing to go along with stories of victimization. Later, Borch-Jacobsen denies that something like a "dissociation of consciousness" could explain Anna O.'s phenomena, and he seems to attack the idea of "the unconscious" in general (p. 90). For him, the whole thing seems to be a sociological phenomenon, an ongoing "game" (p. 94) about something basically unreal: "Like so many other `neuroses',...hysteria is an illness that exists for the sake of the cure" (p. 83).

Psychoanalysis continues to take it on the chin. Even Micale, whose Approaching Hysteria is well-written but fairly dour, gets a dig in, referring on one surprising occasion to "the Freudian and Jungian jibberish [sic] of our own time." (p. 219) Why does the usually neutral Micale suddenly take this potshot? (Actually, more of this type of opinionating would have enlivened his book). And why is Borch- Jacobsen's combative fury sometimes so barely contained: "a good lawyer, in two minutes flat, would have ripped Freud's `reconstructions' to shreds" (p. 43)? Two seconds flat is probably the expression he or his translator wants, but one has to wonder what this open season on psychoanalysis and the "founding fathers" is all about.

There seems to be a move afoot just now to take Freud and the other analysts apart, to deconstruct them to shreds. Alongside the truth-seeking and fact-finding of the scholar appropriately on the trail, there is at times a tone of hatred--"Freud-bashing." One is led to question what is behind it. Has Freud let us down so terribly? Is psychoanalysis really this corrupt? Did someone have a bad experience in analysis, or in psychoanalytic training? Is this the ultimate negative transference? Do the young lions want to be king? Was Freud right about the "primal horde" killing the father and eating his body? Does the father, in all senses, have to die so we can step into our own light? Is this fin-de-millennium destruction necessary so that the next creative wave can come through? Or is it just piling on? Or is what we have here simply some good old-fashioned intellectual brawling?

Meanwhile, the image of hysteria from one hundred and twenty-five years ago hangs over Freud's couch and over psychoanalysis.

© David Sedgwick 1997

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