Hidden Minds (12 page)

By the time Breuer and Freud came to write
Studies on Hysteria
the unconscious had become an essential concept in their theoretical framework.
Studies on Hysteria
contains an important chapter titled ‘Unconscious ideas and ideas inadmissible to consciousness – splitting of the mind’. However, it was written entirely by Breuer, suggesting that, of the two authors, Breuer was considered the greater authority on the unconscious. Indeed, Freud’s very first reference to the unconscious is rather inconsequential. It appears buried in a footnote attached to one of the case studies, that of Frau Emmy von N, a name rarely given much significance in the annals of psychiatry.

Studies on Hysteria
merits more than a superficial reading. It tries to keep a secret – and fails. It tries to fudge an uncomfortable truth, but in doing so attracts further attention to a glaring inconsistency.

In his account of the case of Anna O, Breuer admits to ‘having suppressed a large number of quite interesting details’. This statement appears to be a casual remark and Breuer immediately goes on to imply that some ruthless editing was necessary in order to contain an already much extended case study. His admission that some interesting details were omitted, however, follows a curiously ambiguous passage in which Breuer summarises the very final stages of Pappenheim’s treatment.

What does this mean? On the one hand, Pappenheim’s treatment was successful and she was free of disturbances. But on the other hand, she was still mentally unbalanced.

The fact of the matter was that Breuer never really finished treating Pappenheim. In the summer of 1882 Breuer referred her on to a colleague, Dr Robert Binswanger, who cared for her at a Swiss sanatorium. The talking cure was abruptly terminated, and although Pappenheim’s health had improved, she was still complaining of several symptoms; for example, odd absences of awareness, language problems, and psychogenic pain. Breuer had simply glossed over the ending of what in every other respect was a meticulously written case study.

Why? What went wrong?

Breuer and Pappenheim had developed a very close relationship. For over a year Breuer had been visiting her. He had sat by her side, evening after evening, listening to her poetic flights of imagination. She must have seemed like a nineteenth-century Scheherazade – captivating Breuer with her sad, whimsical stories. She fascinated him. Moreover, Breuer came to respect and admire her. When he described her he wrote of a woman who was imaginative, gifted, intelligent, ‘sharp’, and kind. He genuinely liked her.

In such circumstances Breuer was understandably shaken when, close to completing therapy, he discovered her one evening in a confused state, writhing around and clutching her stomach. When he asked her what was wrong she told him she was pregnant with his child.

This wasn’t what he wanted to hear. Breuer was a respectable middle-aged doctor. He had spent a lot of time alone with a woman half his age, and this sort of allegation was most unwelcome. And, of course, there was also the matter of Frau Breuer to consider. What would she have to say?

Even though Pappenheim’s symptoms were just about under control, Breuer decided he couldn’t carry on. It was all too risky. He packed Pappenheim off to Switzerland and tried to forget about the whole affair. That is, until a stifling evening in 1883 when he decided to disclose the whole story to his young colleague, Sigmund Freud.

Clearly, Breuer was still embarrassed by Pappenheim’s phantom pregnancy when he wrote up the case of Anna O some twelve years after her ‘treatment’, hence his guilty admission of having suppressed certain details. However, some commentators – fancifully, perhaps – have suggested that even though his narrative was guarded, Breuer was unable to conceal his sexual desire for Pappenheim, By choosing the name Anna Û to disguise Pappenheim’s real identity he gave himself away. Feminist writers have pointed out that the circle, or letter ‘0’, is an ancient symbol representing the female genitalia.

If Breuer had completed Pappenheim’s treatment in 1882 and then published her case study, he would have preceded Janet by several years. Although Breuer underscored some differences between his own and Janet’s understanding of hysteria, such differences are relatively minor compared with their commonalties. Both men agreed that the symptoms of hysteria were caused by unconscious traumatic memories, and that the recovery of these memories was important if treatment were to be successful. The two men also share the dubious distinction of having been largely forgotten because of Freud’s celebrity.

Breuer was a real pioneer. He was one of the first recognisably modern practitioners (as opposed to the early hypnotists) to devise a psychological treatment based on the recovery of unconscious memories. He also wrote the first extended essay on the unconscious in the psychoanalytic canon. Yet, after the publication of
Studies on Hysteria,
he played no significant role in the development of what became psychoanalysis and did nothing more to further contemporary understanding of the unconscious. He simply let Freud carry on without him.

The reason for Breuer’s retreat from the avant-garde of nineteenth-century psychology was remarkably straightforward. It was sex – or at least his junior partner’s growing obsession with it.

Freud became increasingly convinced that sexual feelings were very significant in the development of mental illness. Thus, he was gradually edging towards a sexual theory of hysteria. This was by no means an original idea. Freud was familiar with the work of another Viennese physician called Moritz Benedickt, who from 1864 had been suggesting that hysteria might be caused by a closely kept sexual secret, and that the symptoms of hysteria would disappear if such a secret were revealed. Therefore, by the time Freud was advocating his own sexual theory of hysteria this kind of thinking had already achieved some currency among broad-minded Viennese doctors. Unfortunately, Breuer wasn’t one of them. Very swiftly an irreconcilable rift opened between the two erstwhile collaborators.

In the end, the case of Anna O probably divided Freud and Breuer more than it ever brought them together. Whereas Freud was extremely interested in the erotic implications of the case, Breuer found them awkward and embarrassing. It seems likely that whenever Freud insisted on the importance of sexual impulses in the development of hysteria, Breuer was rudely reminded of an intelligent and attractive young woman, clutching her abdomen, claiming to be in labour with his child.

Breuer had lifted the lid on the unconscious and forbidden fruit had tumbled out. But while Breuer was struggling to shut it all up again, Freud was already trying to step inside.

In 1897 Freud decided to see a psychoanalyst; however, given that he was the only one practising in Vienna at the time, he was more or less forced to consult himself. In a bizarre manoeuvre that still seems somewhat surreal, he put himself on the couch and attempted to storm his own unconscious.

This bold gesture is often portrayed by psychoanalytic hagiographers as an epic journey. Freud, like a Homeric hero, sets out on a perilous voyage of discovery. And when he returns, he does so as a changed man – altered by his experiences and in possession of arcane knowledge.

Of course, Freud was not the first to emulate the mythic heroes of Greece and Rome by descending into the underworld of his own unconscious. As we have already discovered, writers such as Coleridge and De Quincey had undertaken similar voyages, returning to document their visions and strange encounters in works of poetry and prose. Coleridge and De Quincey had experienced the unconscious directly in their dreams, which were made more colourful (and nightmarish) through the action of opium on the brain. The relationship between dreams and the unconscious did not escape Freud (who also shared with Coleridge and De Quincey a weakness for drugs in the form of a cocaine addiction). Freud recognised that by examining the contents of his own dreams he too might learn more about the workings of the unconscious mind. After analysing his dreams (and those of his patients), he was able to write a book that has since become a cultural landmark,
The Interpretation of Dreams.
Later, reflecting on his achievement, he wrote:

The Interpretation of Dreams
was published in 1899, but dated 1900. Only 600 copies were printed and it took some eight years to sell them all. Since then it has been a permanent presence in book shops all over the world and continues to sell in respectable numbers. The success of
The interpretation of Dreams
can be ascribed to both its literary and scientific appeal. Indeed, some have argued that it represents an entirely new form of writing – a complex amalgam of scientific history, clinical case study, philosophical investigation, and candid autobiography. Although Freud continued to write about psychoanalysis for the rest of his life, he always insisted that
The Interpretation of Dreams
contained his most important work. In it, Freud established the unconscious as a central concept in his theoretical framework, explained the mechanisms that shape dreams, and justified his break with Breuer by ‘proving’ that repressed sexual urges (including those dating back to childhood) were causally related to the symptoms of mental illness.

The most striking feature of
The Interpretation of Dreams,
however, is the great significance that Freud gives to unconscious processes, not merely in relation to psychopathology and dream interpretation, but in the broader context of mental life. Already Freud was suggesting that the importance of consciousness was routinely overestimated, and that the really significant features of the human mind operated below the awareness threshold.

For Freud, then, the unconscious was ‘the true psychical reality’. The great ‘unknown’. One way ot another, he spent the rest of his life either thinking or writing about it.

Freud described psychoanalysis in many ways; as a ‘medical treatment’, a specialist science, a branch of psychology, a depth-psychology, and a ‘psychology of the unconscious’ (to cite just a few examples). He wrote approximately three and a half million words on psychoanalysis and revised, modified, and developed psychoanalytic ¡deas throughout his life. Nevertheless, a number of key concepts survived these revisions, and they represent the foundations of psychoanalysis.

Freud’s understanding of the fundamental forces operating in the mind was influenced considerably by nineteenth-century science; in particular, by the branch of physics known as dynamics. Observations had shown that forces can combine or work in opposition; energy can be generated, stored, and eventually discharged. Freud believed that the human mind also contained energies, and that these behaved in much the same way For Freud, the most important energy in the mind (and body) was sexual. He called this
libido.
According to Freud, the build-up of sexual energy in the body is associated with the intrusion of sexual thoughts and images in awareness. The ensuing state of tension is ordinarily reduced by sex itself.

According to Freud, mental life takes place on three different levels. He described them as
conscious, preconscious,
and
unconscious.
The standard method of explaining their relationship is the searchlight analogy. If the beam of a searchlight represents awareness, then objects illuminated by that beam reflect the contents of the conscious mind. Some objects will be just outside the beam but within its range. Those can be termed preconscious; however, some objects are simply too far away to be illuminated, and these correspond with the contents of the unconscious.

Much later, Freud also divided the mind into three ‘agencies’. The
id, ego,
and
superego.
They are not simply different parts of the mind, but powers -each with a specific function.

The id operates unconsciously, and its principal function is to bias mental life in such a way as to engineer the discharge of libido. The ego has conscious, preconscious, and unconscious regions, and it has a largely managerial function – initiating and monitoring thoughts and movements. The superego too has conscious, preconscious, and unconscious regions, but its function is to act as moral judge. In everyday language, the id can be thought of as the source of passion, the ego can be thought of as ‘the self, and the superego as corresponding with the idea of conscience.

When babies are born, their behaviour is entirely dictated by the id. Life is nothing but striving to satisfy basic needs and drives that are shaped, at least initially, by unconscious processes. Among these drives is a primitive form of the sexual instinct, motivating the baby to seek the ‘sensual’ (or at least physical) pleasure of maternal contact. With experience, a section of the id separates, and becomes organised around an identity – the ego. Later in infancy, the absorbed values and attitudes of family and society achieve a degree of independence, and the superego is formed; however, it should not be forgotten that parts of both the ego and the superego remain unconscious. Although the human mind develops self-awareness, no division of the mind is completely transparent. Thus, in Freud’s scheme, the unconscious is relevant to every level and division of the mind.