Sigmund Freud* (5 page)

During her treatment with Breuer, it was Anna who noticed that she seemed to get the most relief when she talked about distressing experiences and upsetting fantasies that plagued her. Her symptoms seemed somehow connected to her fantasies. They discovered that if she was able to trace a fantasy (one, for example, involved a fear of snakes) to the original incident that triggered it, then the accompanying symptom would disappear. The process was painstaking, but to Breuer’s surprise, it seemed to work.

Anna O. took to calling the method “chimney sweeping,” and also came up with the name that is still used, “the talking cure.” For Breuer—who got more personally involved with his patients than Freud did—the work was too emotionally draining, and he eventually decided to stop treating hysterics.

But Freud, hearing all about the talking cure secondhand, was thrilled. The case of Anna O. was a crucial factor in Freud’s developing theories of mental illness. It was now that he decided that “hysterics suffer mainly from reminiscences.” From unpleasant memories, not lesions in the brain or some other physical problem. The painful memories, hidden or repressed, turned into distressing physical symptoms. But the damage from this buildup of energy could be repaired through talk. Talking seemed to relieve the pressure of pent-up emotions that were at the root of the hysterical behavior. Once painful memories could be recalled and understood, the symptoms would disappear or diminish.

Bertha Pappenheim (the real name of the woman known as Anna O.) was not as completely cured as Breuer claimed. She worsened for a time and had to be hospitalized several times. But eventually she recovered, going on to lead a full life as a social worker; an author of short stories, plays, and books on social issues; and a prominent activist for women’s rights. She died in 1936, and in 1954 West Germany issued a postage stamp in her honor.

As Anna O., she is famous for being the first person to undergo psychoanalysis.

This became Freud’s new term for the talking cure. Pierre Janet, a doctor doing work similar to Freud’s in France, was calling his therapy “psychological analysis.” Freud shortened it to “psychoanalysis” to mean his own technique for treating mental illness. His faith in hypnosis had ebbed. He found many patients simply “unhypnotizable.” From now on he would use the cathartic method without hypnosis—just listening and questioning.

One of his own patients, “Emmy von N.,” was responsible for adding a new dimension to his technique. Since her husband’s death, Emmy had experienced tics, stuttering, and hallucinations of rats and snakes. In one of the sessions during her fifteen weeks of treatment, Emmy (real name: Baroness Fanny Moser) made a request. Would Dr. Freud kindly stop interrupting her and just let her talk? Without his questions and comments, she could jump from one thought to another. In this way, she might make connections and better understand the source of her ailments.

This incident prompted Freud to allow patients to freely associate: By expressing any random, seemingly unassociated thoughts that came to mind, the patient could uncover hidden experience. In some ways, free association resembled the automatic writing promoted by Ludwig Börne, the writer Freud had admired in childhood.

Once patients began freely associating, one thought triggered another. The rules of logic no longer applied. Freud encouraged all they said, convinced it would ultimately make sense. Free association appeared to work, although he didn’t understand why. Not yet. Each night he feverishly wrote up his observations. Case studies, he was calling them, as though they were police files—and he was the detective, discovering clues.

Freud started to visualize the mind as being like an iceberg. Most of it was underwater. The part beneath the surface he came to call the unconscious. Freud never claimed to have invented or discovered the unconscious. He always acknowledged the many poets and philosophers before him. He was following a long tradition in literature, from Aristotle and Shakespeare to more recent writers like Samuel Coleridge and William Blake. A few early psychologists—William Wundt in Germany, William James in the United States—had also hypothesized its existence.

But Freud was the first to try to develop a systematic way—a scientific way—to study unconscious mental activity. He poured hours into his case studies—Emmy von N., Lucy R. (a governess haunted by the smell of burned pudding), Katharina (an eighteen-year-old terrified of suffocating), Elisabeth von R. (barely able to walk after her father and sister died). What did these people have in common? What was the pattern? They’d all suffered traumatic experiences—sudden deaths of loved ones, physical or emotional abuse. And they’d all reacted by developing troubling physical symptoms.

According to Freud’s understanding, some feelings are simply too painful for people to bear. So they banish the feelings from their conscious mind. The memories remain but are repressed—they go “underwater”—hidden away in the unconscious mind. The painful memories show up as physical symptoms of illness—seizures, paralysis, muteness, and all the other signs of hysteria.

Most scientists of the day believed that when we acquired knowledge and experience, we exercised rational control over them. The brain worked in an orderly, step-by-step fashion. But here was Freud, suggesting that such claims were delusions, that we’re not even entirely aware of our own thoughts, and that we often act from wayward unconscious motives.

This was a revolutionary idea, one that turned traditional thinking on its head. Now he was anxious to get his theory out there before anyone else did and received credit. Publishing ideas, sharing discoveries, is an important part of the scientific process. Plus getting himself into print would make his reputation, make him famous. With Breuer, Freud co-authored a book—
Studies in Hysteria
—and published it in 1895. While Breuer wrote about Anna O., Freud presented the other case studies he’d been writing up.

The book failed to rock the world. The medical community mostly ignored it. A few critics pointed out that Freud was blind to certain details that didn’t fit in with his theories. Others questioned how his theories could be considered a new science—which is how he always proposed it. Wasn’t this a science without experiments and provable results—in other words, a contradiction in terms? And anyway, weren’t there simply too many variables in applying science to people’s complex minds?

Studies in Hysteria
sold only six hundred copies over the next thirteen years. Still, less than ten years into private practice, at age forty, Freud felt he had now earned a place alongside previous scientists who’d shattered their world. Speaking of himself in the third person, he wrote, “Copernicus had displaced humanity from the center of the world; Darwin had compelled it to recognize its kinship with the animals; Freud showed that reason is not master in its own house.” In other words, humans behave for reasons of which we’re not always aware.

This was very big indeed. A breakthrough. “I have the distinct feeling that I have touched on one of the great secrets of nature,” he declared.

CHAPTER FIVE

Nasal Passages

IT’S ODD THAT criticism of his first book from other scientists didn’t sting Freud more painfully. He was, after all, a medical doctor—he considered his theories scientific. In fact, at the same time as he was writing
Studies in Hysteria
with Breuer, he was also working on a solo effort, a grandiose tome he called “Project for a Scientific Psychology.”

By now, of course, psychology was his passion, the study of normal and abnormal behavior. Psychology was still ill-defined, drifting between study of the nervous system—physical symptoms in the body—and the study of behavior. Freud was going to straighten it all out.

“Project for a Scientific Psychology” aimed to offer a blueprint for a whole system, based on what was known about the brain, for describing behavior. The first sentence announced Freud’s intention to “furnish a psychology that shall be a natural science.” He wanted to prove that his field was another branch of science, with reliable, precise laws similar to Newton’s laws of motion and gravity. By what laws does physical energy get converted into mental energy, from one nerve to the next inside the brain?

At first he felt uniquely qualified to accomplish this Herculean task. He’d seen both sides of psychology—in a lab, studying brain cells under a microscope, and in his office, observing the effect of the brain’s mysterious workings with real-live patients. How could he describe what he had learned from his office research in terms of a network of cells and fibers? In 1891 a German anatomist, Wilhelm Waldeyer, had named the basic unit of the nervous system—the “neuron.” Freud theorized a system of three types of neurons that controlled how energy traveled through the brain.

Knowledge of the makeup of the brain was still in its infancy, with few shoulders besides Waldeyer’s to stand on. Freud quickly reached an impasse. Today we know that neurons in the human brain number 100 billion, and we’re
still
researching how they work. But in 1895, so little was known about neurons, much less how they produced mental states, that Freud had to abandon his project as impossibly ambitious. (At least for the time being; parts did reappear in later, influential works.)

He trudged on with his work treating hysterical patients. In some ways so perceptive and ahead of his time, Freud still wandered down strange paths. Just as he had once put faith in cocaine, he put his faith in a fascinating, charismatic biologist from Berlin, Wilhelm Fliess, who had some exceptionally quirky notions of illness. Fliess became Freud’s new best friend, and the relationship lasted over ten years.

As a nose and throat doctor, Fliess believed that the nose was the most important organ in the body. It was the cause of all human illness, both physical and psychological. Specific spots in the nasal passages were directly linked to organs in the body. Illness could therefore be cured by . . . nose surgery. Fliess was happy to perform such surgery, or use other techniques, like applying cocaine directly to the nasal membranes.

It sounds cracked, like a Monty Python sketch, almost as if Fliess was putting people on. Yet Freud regarded him as “the new Kepler” who would “unveil the ironclad rules of the biological mechanism to us.” Freud also just enjoyed being around his new friend, finding his praise “nectar and ambrosia.” He even let Fliess operate on his nose—twice—for distressing symptoms he was having with his heart.

Fliess believed that parts of the nose corresponded to the sexual organs—injuring the nose would affect one’s genitals or sex life. Perhaps influenced by Fliess’s emphasis on sex, Freud came to identify the root cause of all hysteria. A painful loss or frightening childhood experience? Upsetting, to be sure, but not responsible for hysteria. Oh, no. Repression of sexual urges—that was the key. Because sexuality was so difficult to discuss, patients
didn’t
talk about it, and so their repressed feelings morphed into hysterical symptoms.

Why did these two doctors see sex everywhere? One reason was Darwin’s influence. Darwin suggested that all biological drives have the same goal—the survival of the species. And the only way a species can survive is through reproduction. All other drives, like hunger, serve the primary one—the sex drive.

In the 1890s polite people never mentioned many parts of the body by name, and certainly kept every inch of themselves covered. Even Martha was once reported to refer to her husband’s work as “a form of pornography.” With Fliess, Freud could freely discuss his work. Fliess made him feel important, almost heroic.

After quitting his “Project for a Scientific Psychology,” Freud busied himself with various other books, the ones later to make him famous. As he wrote, he sent every paragraph to Fliess for comment. During this, his most creative period, Fliess was his biggest influence, his trusted mentor.

Some would say that Freud, in seeking guidance from Fliess, was making a detour from science. The nose?