Freud (first row, left corner) and the Vienna First Public Institute for Sick Children staff, c. 1893. (photo credit 9.2)
Freud’s demeanor oscillated up and down, depending on the day and his social encounters. Lonely and alienated from many of his medical colleagues, he began to take out his frustrations on his wife in a most upsetting and irritable manner. In face-to-face conversations and in the occasional sheepish letter, a guilty Sigmund apologized to Martha for being “violent and passionate, with all sorts of devils…[that] rumble about me inside or else are released against you, you dear one.” Sigmund’s professional insecurity and his long but not always productive work hours, combined with the psychic costs of cocaine abuse, encouraged a melancholic state of mind. He frequently described his mood during these years as “dead tired” and complained to friends that he felt as if he were being devoured by a cancer.
Sigmund also appears to have engaged in reckless behavior, sexual indiscretion, and a deceptively double life during these years. Long debated by Freudians is the question of whether he had a clandestine physical relationship with his sister-in-law Minna Bernays. At almost the same moment he was courting and falling in love with Martha, in April 1882, he was smitten with her younger, bright, and sarcastic sister. For many years, Sigmund wrote Minna warm, loving letters, and they appear to have enjoyed a rich and deep platonic relationship; indeed, Sigmund freely discussed his intellectual life with Minna on a level he never did with Martha. In 1896, a year after Sigmund and Martha elected to become sexually abstinent after the birth of their sixth child, Minna came to live with them in Vienna and stayed for the next forty-two years.
Freud, age twenty-nine, and Martha Bernays, age twenty-four, at Wandsbeck, near Hamburg, in 1885, during their protracted, four-year engagement. Freud wrote her on January 6, 1886, “Such perseverance as we have shown should melt a heart of stone, and you will see that when we marry the whole family will wish us luck.” (photo credit 9.3)
Minna Bernays, Freud’s sister-in-law, at about the age of twenty-five, c. 1890. (photo credit 9.4)
According to Carl Jung, who visited the Freud family in early March 1907, Minna asked to speak with him. “She was very much bothered by her relationship with Freud and felt guilty about it,” Jung recalled decades later, in 1969. “From her I learned that Freud was in love with her and that their relationship was indeed very intimate.” During their 1909 trip to Clark University in Worchester, Massachusetts, Freud told Jung of “some dreams that bothered him very much. The dreams were about the triangle—Freud, his wife, and wife’s younger sister.” When Jung pressed him for some more personal details, Freud—who was unaware of the conversation Jung had had earlier with Minna—abruptly stopped. “He looked at me with bitterness and said, ‘I could tell you more but I cannot risk my authority!’ ” Many historians initially dismissed this account because of the subsequent ugly turn of Jung and Freud’s relationship.
In 2006, however, a German sociologist uncovered a leatherbound register from the Schweizerhaus, an inn in Maloja, Switzerland. It documents Minna and Sigmund’s two-week stay there in mid- to late August 1898. With the practiced duplicity of an accomplished substance abuser, Sigmund registered for room 11 in his spiky handwriting: “Dr. Sigm Freud u frau.” Although Freud kept this affair of the heart, like his cocaine abuse, a guarded secret, the newly discovered hotel register has convinced many doubters that there was, in fact, a physical relationship. No matter what transpired during those summer nights in that double room in the Swiss Alps, or elsewhere, it would have invited certain scandal if discovered at the time.
INTELLECTUALLY, FREUD REMAINED EXCITED by what he learned from Jean-Martin Charcot, even if the master was not nearly as revered in Vienna as in Paris. Sigmund was particularly captivated by the Frenchman’s observation that “anatomy has finished its work and the theory of organic disease might be called complete; now the time of the neuroses had come.” None of the listings in the long catalog of psychological quirks met this requirement better than hysteria, an entity that baffled mental health experts and laypersons alike.
The diagnosis of hysteria has long since been deleted from the American Psychiatric Association’s authoritative Diagnostic and Statistical Manual of Mental Disorders. Today the term is typically used in the vernacular to cast aspersions on a person’s over-the-top responses to daily vicissitudes. Yet such pith diminishes the clinical importance the word once held, especially during the nineteenth century. The term’s derivation from the Greek root for “uterus” indicates that many doctors of centuries past erroneously considered aberrant behaviors exhibited by women to have originated within their sexual organs. The removal of a uterus is still referred to as a hysterectomy. Before the advent of modern gynecology, this surgical procedure was considered a definitive means of curing a woman of her hysteria. Regardless of its exact cause, hysteria was strange, dramatic, and disturbing. As The Oxford Companion to Medicine succinctly notes, its victims suffered from intense “sensory and motor dysfunction, such as a loss of sensation over parts of the body, temporary blindness, paralysis of the limbs, loss or impairment of speech or hearing, convulsions, lack of concern over one’s body and health, and often worse.”
Although Freud had seen his share of hysterics in Vienna, his interest in them certainly intensified while he was studying with Charcot. Few prominent Viennese neurologists or internists considered the “female problem” of hysteria to be worthy of their time, let alone clinical consideration. But in Paris, Dr. Charcot initiated a revolutionary turn by proposing that hysteria affected both women and men and was caused by either a heretofore unidentified, underlying, inheritable organic lesion or a chemical imbalance that required a triggering traumatic or emotional event to come to the surface.
Every Tuesday, Professor Charcot demonstrated a long parade of hysterical women, and occasionally some men, in varying states of undress and sexually charged, semiparalyzed poses. These poor souls writhed and moaned, simultaneously titillating and revolting a crowded auditorium of curious students. The French neurologist also wrote dozens of dispatches on the subject in his famous journal, Charcot’s Archives, which was avidly followed by doctors around the world. Millions more throughout Europe and North America read about and saw carefully staged photographs of Charcot’s hysterical patients in the popular press. With all this attention, it is hardly surprising that Freud and many other physicians of his generation clamored to find and treat such intriguing patients. And lo and behold, as is seen with most newly proposed, collected, and celebrated medical diagnoses, these doctors promptly discovered their own cases. Almost overnight, hysteria became a respectable disease. Throughout Europe, wealthy, well-born, depressed, nervous wrecks of men and women, disassociated from their surroundings and contorted into strange body positions and facial expressions, crowded neurology and psychiatric clinics, begging for help.
A Clinical Lesson with Doctor Charcot at the Salpêtrière Hospital, 1887. Painting by Pierre André Brouillet. The patient being demonstrated to the audience is suffering from hysteria. Freud hung a copy of this painting in his consulting room. (photo credit 9.5)
In time Charcot grew frustrated with diagnosing hysteria, because he could not identify a precise physical abnormality underlying it. As Freud reminisced in his 1925 autobiography, “It was easy to see that in reality he took no special interest in penetrating more deeply into the psychology of the neuroses. When all is said and done, it was from pathological anatomy that his work had started.” Still, it is important to recall that one morning in late 1885 or early 1886, the Frenchman suggested to Freud that the cases of hysteria they were examining together had not a little to do with sex: “C’est toujours la chose génitale, toujours … toujours … toujours.”
IN THE INTERCONNECTED WORLD of Viennese medicine, Freud grew close to Josef Breuer, a superbly trained Jewish internist and physiologist who was fourteen years older than Freud and once treated their mutual friend Fleischl-Marxow. Sigmund admired Bre
uer for his exquisite bedside manner, his ability to ferret out the most obscure of diagnoses, and his successful private practice, which numbered many of the Vienna Medical School’s most prominent physicians as patients. Breuer saw Sigmund as a precociously bright younger brother and medical protégé. He and his wife virtually adopted Freud, frequently inviting him to their home for meals and loaning him considerable amounts of money as he struggled to make ends meet. Sometime between 1880 and 1882, Breuer began telling Freud about his hysteria patients, a practice that continued after Freud’s return to Vienna from Paris in 1886. Sigmund reciprocated by sharing with Breuer recollections of what he’d seen at the Salpêtrière.
Josef Breuer, c. 1880s. (photo credit 9.6)
The auditorium of the Vienna Medical Society, where Sigmund gave his first formal lecture on hysteria in 1886. (photo credit 9.7)
On October 15, 1886, Sigmund delivered his first formal address to the prestigious Vienna Medical Society. He tentatively approached the ornately carved lectern overlooking a white marble, neo-Renaissance auditorium filled with physicians ensconced in narrow seats covered in red velvet. In what many members of the audience interpreted as a pedantic and not terribly data-driven lecture, Freud described a male hysteric he had observed in Charcot’s clinic. To Sigmund’s dismay, several of the distinguished physicians present, including his beloved psychiatry professor Theodor Meynert, ridiculed the presentation for its faulty scientific reasoning and Freud’s failure to locate a precise anatomical lesion explaining the patient’s symptoms. How could men become hysterical, one surgeon quarreled, without possessing a uterus? Five weeks later, on November 24, Freud boldly returned to the Vienna Medical Society to report a case of hysteria in one of his own male patients to an equally dismissive audience.
Freud was disappointed but undeterred. He argued to whoever would listen that hysteria represented the key to solving the great paradigms of the mind-body connection. “Hysterics suffer for the most part from reminiscences,” Freud would famously insist. Such individuals transformed their stressful memories and neurotic responses into physical symptoms, many of which were quite debilitating and would mysteriously wax and wane.
One of the most fascinating cases Dr. Breuer shared with Sigmund was that of a young woman named Bertha Pappenheim. She has since become world-famous as “Anna O.,” the first patient to undergo what became psychoanalysis. As Breuer told it, thanks to his verbal ministrations Bertha found a temporary reprieve from the many strange symptoms that were dominating her life: a persistent cough, a fear of drinking water, paralysis of the limbs, strange seizures, headaches, an inability to eat, visual and speaking disturbances, and episodes of mania.
Bertha Pappenheim, a.k.a. Anna O., in 1882, at the age of twenty-two. (photo credit 9.8)
Beginning in the summer of 1880, Breuer used hypnosis to explore the connection between Bertha’s physical symptoms and the emotional trauma of her beloved father’s fatal illness. He spent hours upon hours listening to Bertha in her many altered mental states as she detailed her problems and thoughts. Initially there was some respite. But by the summer of 1882 Bertha’s debilitating symptoms were so overwhelming that Breuer resorted to prescribing substantial amounts of the sedatives chloral hydrate and morphine to the point of her becoming an addict.
Eventually, Breuer had little choice but to forcibly commit Bertha to an asylum, where she was weaned off the habit-forming drugs and treated with such modalities as leeches, electrotherapy, and arsenic. The experience so emotionally exhausted Breuer that he began referring similar patients to Sigmund. Nevertheless, Breuer later left the impression in print that he had cured Bertha, despite her frequent stays at asylums long after he stopped seeing her clinically. In subsequent years, Freud and Breuer went as far as to suggest that Bertha’s hysterical symptoms resurfaced once she stopped going to daily therapy sessions. Undoubtedly, this was the first time in history that psychoanalysts complained about a patient bailing out on treatment before psychic relief had been achieved.
During the months Bertha did tell all, however, she bragged to her friends and family about her wonderful “talking cure” or “chimney sweeping,” setting in motion a profitable and ever-expanding industry of therapeutic confession. Breuer may have stumbled onto a strikingly novel treatment modality, but it was Freud (and his patients) who refined the technique now called free association. It proved to be a perfect combination; Freud’s ability to listen and interpret so beautifully meshed with his patients’ willingness to speak their minds. He hypothesized that talking at length about one’s life, memories, feelings, and virtually everything else that came up generated a catharsis, allowing dormant memories to be recalled, expressed, analyzed, and processed, all to the patient’s betterment. Regardless of what critics would say at the time or in retrospect, “the talking cure” turned out to be the great discovery he had been searching for throughout his entire career.
Josef and Mathilde Breuer, c. 1895. (photo credit 9.9)
Breuer and Freud went their separate ways not long after they published their book, Studies in Hysteria, in 1895. Breuer heatedly disagreed with Freud’s insistence that all neuroses were sexual in origin, the result of seduction or sexual abuse during childhood. Some have suggested that Mrs. Breuer grew weary, if not jealous, of hearing her husband confabulate about Anna O. at the dinner table night after night. Regardless of the root cause, Dr. Breuer jumped off the psychoanalytical train before it ever left the station, preferring, instead, to pursue a more orthodox medical practice. Predictably, Freud, whose need for acclaim matched his desire to advance scientific inquiry, resented Breuer’s failure to support his theories and began to denigrate Breuer’s intellectual abilities. In his later years, Freud minimized Breuer’s contributions. He told colleagues that the development of psychoanalysis may have cost him his friendship with Breuer but the discovery was so important that the price was justified.
There are many types of warriors. Most prominent are those who risk life and limb on the battlefield. But as anyone who has spent time in a laboratory or a university hospital can attest, the intellectual warfare among doctors can be just as protracted and treacherous, albeit less bloody. Freud’s “talk therapy” was, initially, as poorly regarded in staid, scientific Vienna as his ideas about hysteria. Like the reflexive jerk of a knee elicited by the doctor’s rubber hammer, the very name Freud incited a ruckus at medical meetings, in coffeehouses, and along the corridors of the Krankenhaus.
This intense disagreement over Freud’s theories arose within the context of a remarkably fertile period of medical progress and discovery. The overwhelming majority of Sigmund’s investigative colleagues demanded precise, reproducible explanations for every physiological and pathological action, a quantitative, data-driven process that still dominates medical research. Such a rigid intellectual framework, however, posed distinct challenges as he sought to expand his field in such a singularly qualitative manner that broke the bonds of nineteenth-century biology. To be sure, Freud’s ideas were presented in a clear, logical prose that made excellent use of language, metaphors, literature, art, and novel psychological models. It was, after all, his luminous texts and cogent explanations that elevated him to the pantheon of intellectual giants. But when first proposed, Sigmund’s theories were completely out of synchrony with the very physicians he most wanted to impress. As a result, his work was initially rejected by many of his peers as flighty and without scientific merit.
Like all mavericks, Sigmund paid a high social and personal cost by forging a new path, isolating himself from the academic community to which he’d once aspired. But it is critical to note that during the same period he was thinking about these concepts and coauthoring Studies in Hysteria, he was also regularly consuming cocaine. The predictable hangover and generalized grumpiness the drug engenders, once the euphoria disintegrates, could hardly have helped him when he engaged in verbally vicious debates with dismissive doctors and, at times, his closest friends. Such unproductive
exchanges frequently led colleagues to avoid and ostracize him. Nevertheless, the alluring siren of cocaine only encouraged him to ignore such warning signs and continue his toxic substance abuse.
IN HIS MASTERWORK, The Interpretation of Dreams, Freud admitted:
My emotional life has always insisted that I should have an intimate friend and a hated enemy. I have always been able to provide myself afresh with both, and it has not infrequently happened that the ideal situation of childhood has been so completely reproduced that friend and enemy have come together in a single individual—though not, of course, at once or with constant oscillations, as may have been the case in my early childhood.
As we have seen, Freud’s relationships with Nothnagel, Meynert, and Breuer all had a narrative arc of admiration and adulation followed by irritation and separation. During his long life, Sigmund repeated this pattern of intense closeness and clashes with his friends, colleagues, and acolytes but with no one more spectacularly than a general practitioner from Berlin with an intense interest in the diseases of the nose and throat named Wilhelm Fliess.
Josef Breuer introduced Freud to the twenty-nine-year-old Fliess in the fall of 1887. Fliess hailed from a Sephardic Jewish family and studied medicine at the University of Berlin under the great Helmholz and DuBois-Reymond. Like so many other ambitious doctors, Wilhelm came to Vienna, on a self-rewarded sabbatical, to increase his medical knowledge and connections. Upon meeting Breuer, Fliess inquired after a good course on neurology and was advised to attend a series of lectures Sigmund was presenting at the Krankenhaus.
An Anatomy of Addiction Page 17