Mad, Bad, and Sad: A History of Women and the Mind Doctors

by Lisa Appignanesi

  Only ten years older than his patient, Jung had allowed an eroticized transference to get the upper hand in his relations with Sabina and had engaged in a full-scale affair, one which combined intellectual and spiritual affinities with sex. On 20 June 1908, he writes to her to say, ‘You have vigorously taken my unconscious into your hands with your saucy letters.’ The letters move from being addressed to ‘My dear Miss’ to ‘My dear friend’ to ‘My dear’. He is happy at last to have hopes of loving a person who isn’t smothered in the ‘banality of habit’. He feels ‘calmer and freer’ after their meetings.

  That sex followed on from therapy was perhaps not altogether surprising in the heady atmosphere at the Burghölzli in those years. This is evident not only from Sabina’s highly charged and subtle diary, but from Jung’s adventurously ‘wild analysis’ of the rampant ‘polygamist’ Otto Gross and his own descriptions of how women understand Freud best of all. An erotic atmosphere pervaded the hospital wards as a whole: ‘It is amusing to see how the female outpatients go about diagnosing each other’s erotic complexes although they have no insight into their own.’ With uneducated patients the chief obstacle seems to be the atrociously crude transference.

  Spielrein’s affair with Jung climbed to dangerous peaks of intellectual romanticism. Half in love with each other’s symbolic ethnicities, the ‘other’ they represented in myth and imagination, both prone to a heightened spiritualizing of experience, Jung and Spielrein, German and Jew, fantasized the birth of their own Wagnerian Siegfried, the hero of the new age–the symbol of a redemptive coming together of male heroism and feminine instinct, of destruction and creation. Each played out incestuous fantasies of the other in dreams and interpretation. Hope, doom, secrecy, a sexual charge doubled because of the intimacy forged in the doctor–patient dyad–all these are beautifully and intelligently evoked in the pages of Sabina’s diary, where she emerges as a more generous spirit than the Jung she idealizes, who is naturally enough worried about his rich wife and his respectable career. But from that Spielrein–Jung coupling come the ideas which shape both their later work.

  Both Freud and Jung later acknowledged, though never fully enough, their debt to Sabina. Freud seems uncomfortable with her formulations in the same way he would be with Lou Andreas-Salomé’s. High-sounding, philosophical and soulful, rooted in German philosophy and poetry, they always seem to sound meaningful but evanesce into vagueness. Freud seems at once to want to recognize the value of such grand pronouncements as the ‘opposing forces of creation and destruction in the sex instinct’ and to worry about the use of substantives which lack the grounded detail he tried to give even his pleasure principle and its opposing death instinct. Far closer to Sabina Spielrein is Jung’s own work. The precognition she had lived during their affair, so close to his own experiences, made him reconsider the nature of the unconscious. Both thought in terms of polarized mythical and mystical forces. Jung’s later work journeyed into the meanings of symbols and their transformative potential. In contrast to Freud, he hypothesized a collective, rather than individual, unconscious–a realm of shared archetypes and cultural narratives necessary to the journey towards an integrated self.

  Jung’s first communication to Freud was not the letter he had initially thought would go as a referral with Sabina. Instead, in April 1906, a year after that had been penned, he sent Freud his Diagnostic Association Studies, which of course included the association tests he had performed on Sabina. That summer, Freud wrote his study Gradiva, where the ‘cure through love’ was named. The cure, here, was enacted by a woman, and it is perhaps not coincidental that Sabina, the patient cured in the hothouse of association that was the Burghölzli, went on to become one of the first women analysts.

  In that electric early part of their correspondence, where letters and ideas fly between Jung and Freud as if each has at last found a worthy interlocutor, Freud writes sometimes twice a day to the younger man; his hope–not all that distant in some sense from Sabina’s–is of an extension of his all too Jewish science into the wider German world. On 6 December 1906, Freud writes–as if he might already in advance have sensed that Jung is in some erotic trouble–before the latter has recounted a dream where fears about his marriage are there for everyone except himself to see (29 December 1906). Jung defends himself from any Freudian imputation that there might be a sexual lack. Freud proceeds to give him a lesson in analysis, which rings uncannily, though in the kindest of terms, as if he somehow knows or empathetically imagines what Jung has been up to:

  You are probably aware that our cures are brought about through the fixation of the libido prevailing in the unconscious (transference), and that this transference is most readily obtained in hysteria. Transference provides the impulse necessary for understanding and translating the language of the ucs. [unconscious]; where it is lacking, the patient does not make the effort or does not listen when we submit our translation to him. Essentially, one might say, the cure is effected by love. And actually transference provides the most cogent, indeed, the only unassailable proof that neuroses are determined by the individual’s love life.

  Jung’s rejection of Freud’s interpretation, his unwillingness wholly to accept this succinct account of how transference works in psychoanalysis–its very existence generated by the patient’s sexual difficulties–may have something to do with the whole Sabina muddle as much as with any growing intellectual unwillingness to accept Freud’s sexual aetiology, already under attack elsewhere.

  Nonetheless, Jung’s stress that his patient base is usually so very different from Freud’s, together with Bleuler’s emphasis on the lack of affect in schizophrenia, may point to a wider problem in this understanding of transference as sexually charged, particularly with patients in whom the very nature of affect, its impossibility, is what has gone awry. It may be that transference with schizophrenic or ‘psychotic’ patients is precisely what can’t exist. So while he was defending himself from acknowledging what was happening with Sabina, a matter perhaps not altogether unconnected with his later overt rejection of the whole sexual base of the Freudian project, Jung was also pointing to a real area of professional concern and theoretical difference. As ever, theoretical differences doubled up with personal ones: Jung, who found gratitude difficult and returned few favours unpunished, broke with a Freud who too often wanted more loyalty than was either possible or reasonable from his growing psychoanalytic progeny.

  Sabina Spielrein finally made her way to Freud–as herself, and not cloaked as case material–when her affair with Jung as well as their working relationship had broken down. An anonymous tell-tale letter had reached her mother–probably through Emma Jung, who might have sensed that her duplicitous husband had reached the end of his tether. In any case, with a new baby in tow, this time the much desired and symbolically feared male, Emma was seriously overstretched. Mrs Spielrein confronted her daughter, who wrote to Freud in great distress in June 1909 and asked for a ‘brief audience’.

  On the very day he received the letter, Freud wrote to Jung to inquire who this woman was. His tone is light, a note between professionals: is she ‘a chatterbox, or a paranoiac?’ Jung telegrammed, allowing Freud to write to Sabina to ask what she wanted of him more precisely: he cannot have her travel all the way to Vienna without knowing whether the journey will be expedient or not. Meanwhile, an explanatory and rather deceitful letter of 4 June 1909 arrives from Jung on Freud’s desk. Jung explains that Freud already knows about Sabina as his ‘test case, for which reason I remembered her with special gratitude and affection. Since I knew from experience that she would immediately relapse if I withdrew my support, I prolonged the relationship over the years and in the end found myself morally obliged, as it were, to devote a large measure of friendship to her, until I saw that an unintended wheel had started turning, whereupon I finally broke with her.’

  All of which might just about be taken as a gentlemanly masquerade. But Jung goes on to add that all the while Sabina was ‘
systematically planning my seduction…and is now seeking revenge’. He accuses her of spreading rumours that he will soon get a divorce and marry her; and collides all this insidiously with the business of that arch seducer Otto Gross whose presence has legitimated amorous imaginings in everyone.

  In his reply Freud pacifies, man to man, and explains again how treacherous the analytic business can be, particularly to one as young as Jung, when confronted with women who want to charm. He advises that Jung use the experience to thicken his skin so that he can dominate the ‘“countertransference”–which is after all a permanent problem for us’. The cure through love, Freud is saying, is not an actual love affair.

  His next letter to Jung–who he has just learned has, like him, been invited to America–is to underline the point once more and advise that he must learn to handle such ‘laboratory explosions’. Meanwhile, having found out independently from Sabina that she wants to talk to him about Jung, he uses diplomacy, and suggests to her that perhaps it is time to shed feelings that come out of the therapeutic situation: ‘I would urge you to ask yourself whether the feelings that have outlived this close relationship are not best suppressed and eradicated, from your own psyche, I mean, and without external intervention and the involvement of third persons.’

  Sabina’s strength is visible in that what she took from Freud’s advice was the sense that he loved Jung and was thus well placed to understand what they had been through. She wrote out their affair. That act itself helped her to regain some composure, and she was able to face Jung after a lecture and say she wanted peace. Eventually they found it: recently released documents reveal that after a cooling-off period they resumed an epistolary friendship, occasionally met at congresses and sent each other work. Sabina, now the peacemaker, even tried to bring some understanding between Freud and Jung. By 1913 they had thoroughly fallen out, ostensibly over the sexual question. Meanwhile, Sabina had completed her medical degree, had married and had a child, and trained as an analyst to become one of the early women members of Freud’s Vienna Psychoanalytic Society–the only woman member at the time. She later acted as the formidable developmental psychologist Jean Piaget’s analyst, and became one of the leading figures in post-revolutionary Russian psychoanalysis, setting up an experimental school in Moscow with Vera Schmidt.

  Her trajectory marks out what was to become a usual enough one in the field, perhaps already traced out at the birth of the profession with Pinel, who made warders of his patients. Sabina moves from patient to practitioner, having learned the lessons of the unconscious and, in her case, the particular dangers of the eroticized transference. Jung, of course, would repeat the process with Tony Wolff, another Jewish woman, one this time who would remain his lifelong mistress and intellectual partner.

  Sabina Spielrein’s medical dissertation, ‘On the Psychological Content of a Case of Schizophrenia (Dementia Praecox)’, was begun under Bleuler while she was working as a medical assistant at the Burghölzli. Bleuler was slow in reading the draft, and Sabina in the summer of 1910 decided to show it to Jung, who had by this time resigned from the Burghölzli and set up in his newly built estate as an independent practitioner. He was also now, in part thanks to Freud, President of the International Psychoanalytical Association and editor of its Jahrbuch. Bleuler, who independently of Sabina also referred her thesis to Jung, suggested it should be published in the Jahrbuch, where it eventually appeared in 1911.

  The thesis, on which Jung congratulated her and which also marked ‘a new era’ in their relations, demonstrates the kinship in Spielrein’s and Jung’s thinking. It also shows just how adept Spielrein was–undoubtedly aided by her own recent experience and her literary bent, as well as her interest, like Jung, in mythological parallels–at chasing meanings in disconnected talk. No injunction to Freud’s ‘free association’ is necessary with her ‘schizophrenic’ patient. The woman seems to have no inner controls at all, no resistance of that kind, at least, to overcome. The sense Spielrein is able to make of her fractured discourse, the patience she, and indeed Bleuler’s entire team, brought to bear on their ‘schizophrenic’s’ disquisitions, bring to mind R.D. Laing’s later insistence that even his wildest patients were talking sense. Indeed, in Spielrein’s well educated, hostile and irritating woman whose compulsive flow of coded language circles around disease, dirt and dissolution, there is something of Laing’s Mary Barnes, who painted with her faeces.

  Spielrein’s patient is a Protestant woman married to a Catholic, who is something of a womanizer and betrays her repeatedly. Spielrein uncovers a ‘Catholicizing’ complex in her. This includes images of the birth of mankind and a host of ‘Sistine Experiments’. Underlying it is a fear of being overwhelmed by sexual ideas, a conflict between desire and resistance which brings with it hallucinated punishments. Shades, again, of Celia Brandon. ‘Poetry’–a term Sabina’s patient shares with her analyst for sexual congress overlaid with a religious patina, or what might be called a beneficent and transformative sexuality–seems to come from Auguste Forel’s book, The Sexual Question, in which the psychiatrist who had preceded Bleuler as Director of the Burghölzli reflected on abstinence.

  Spielrein’s patient had other things in common with her young doctor. She noted about Dr. J–that is, Jung–that this attractive doctor had everyone in love with him; that he wanted to get divorced once a year. He also lay at the root of her repeated comment about being ‘flogged through Basel’–which Spielrein, in chasing associations, interpreted as her feeling humiliated by the Basel-raised Jung’s initial tests on her which she experienced as a sexual assault.

  Already looking forward to her later work on the linking of opposites–the doubling up of destruction and creation in sexuality–Spielrein noticed that her patient’s preoccupation with images of death also had a sexual base. The fragile ego of the schizophrenic, already fragmented, feared the merging that sex is as a dissolution of the self, a death-dealing activity, whatever its opposing transformative powers:

  I want to emphasize the enormous importance of ‘description by the opposite’, which was discovered by Freud, for the development of delusions. A particularly important instance of this is the description of sexual activity by death symbolism. The reason for this phenomenon is, as I see it, within the character of the sexual act itself, or to put it more clearly, in the two antagonistic components of sexuality.

  If Spielrein’s own experience informed her understanding of her patients, she was only following in Freud’s and Jung’s footsteps in this invention of the new science. The hallucinative force of her early breakdown–her schizophrenia, or hysteria–was far more akin to Jung’s experience of psychosis than to Freud’s. Her comment about what she calls the schizophrenic’s partiality for vague and abstract terms as a defence against a specificity which would put an always too porous, buffeted self on the line, marks yet another insight into the impetus behind symbol formation and the shoring-up benefits of religious thinking:

  In general, the schizophrenic likes to use vague and abstract terms and this for good reason…The less sharply circumscribed a term is, the less it means something distinct and concrete and the more it can contain. I have the impression that a symbol in general is generated through the striving of a complex for multiplication, for dissolution into the overall system of (collective) thought…By this means the complex loses its personal character for the schizophrenic.

  When Jung received a later paper of Spielrein’s, ‘On Destruction’, and his one-time patient was already in Vienna and a practising member of the psychoanalytic society there, he wrote to her in terms which could as easily apply to her thesis, which he said Freud had also commended highly:

  The paper is unusually intelligent and contains excellent ideas whose priority I am willing to recognize…Nobody should think that you have borrowed from me. There is no basis for that…Perhaps I myself borrowed from you; I have surely unintentionally swallowed a piece of your soul as well as you mine. It depends what one does w
ith it. You have made something good out of it. It pleases me that you are my representative in Vienna.

  In those heady days before the First World War, ideas flew between the various psychoanalytical and psychiatric headquarters. Conversation buzzed between analysts and patients across frontiers and in consulting room and hospital. Karl Abraham, Freud’s key follower in Berlin, had also worked with Bleuler at the Burghölzli during the Jung–Spielrein years, and he had corresponded with Freud about his observations. Combining all this input, Freud translated the findings on schizophrenia (dementia praecox) into his own language of the defences:

  Abraham has very convincingly shown that the turning away of the libido from the external world is a particularly clearly-marked feature in dementia praecox. From this feature we infer that the repression is effected by means of detachment of the libido. Here once more we may regard the phase of violent hallucinations as a struggle between repression and an attempt at recovery by bringing the libido back again on to its objects. Jung, with extraordinary analytic acumen, has perceived that the deliria and motor stereotypes occurring in this disorder are the residues of former object-cathexes, clung to with great persistence. This attempt at recovery, which observers mistake for the disease itself, does not, as in paranoia, make use of projection, but employs a hallucinatory (hysterical) mechanism. This is one of the two major respects in which dementia praecox differs from paranoia.

  Bleuler, Jung, Spielrein, the early doctors and patients at the Burghölzli, had between them invented a nascent disorder and inflected it with properties and understandings neither doctors nor perhaps patients had altogether seen before. The term ‘schizophrenia’ spread beyond the borders of Switzerland, though its use continued to be as erratic as the condition: sometimes it masked as hysteria, sometimes it fell within a more general rubric of the psychoses; at other times, it merged with the older and more genteel notion of breakdown. But in separating it out from dementia praecox, the Burghölzli, as Sabina Spielrein’s case showed, had given patients with this serious disorder the possibility of a productive life.