Freud - Complete Works (13 page)

  
May 13
. - Once again she
had slept badly, owing to gastric pains. She had not eaten any
supper. She also complained of pains in her right arm. But she was
in a good mood; she was cheerful, and, since yesterday, has treated
me with special distinction. She asked me my opinion about all
sorts of things that seemed to her important, and became quite
unreasonably agitated, for instance, when I had to look for the
towels needed in massage, and so on. Her clacking and facial
tic
were frequent.

  
Hypnosis
. - Yesterday
evening it had suddenly occurred to her why the small animals she
saw grew so enormous. It happened to her for the first time at D--
during a theatrical performance in which a huge lizard appeared on
the stage. This memory had tormented her a great deal yesterday as
well.¹

  
¹
The visual memory of the big lizard had no
doubt only attained its great importance owing to its coinciding in
time with a powerful affect which she must have experienced during
the theatrical performance. In treating the present patient, as I
have already confessed, I was often content to receive the most
superficial explanations. In this instance, too, I failed to make
any further investigation. - We shall be reminded, moreover, of
hysterical macropsia. Frau Emmy was extremely short-sighted and
astigmatic, and her hallucinations may often have been provoked by
the indistinctness of her visual perceptions.

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62

   The reason for the re-appearance
of the clacking was that yesterday she had abdominal pains and had
tried not to show it by groaning. She knew nothing of the true
precipitating cause of the clacking (see
above
). She remembered, too, that I had
instructed her to discover the origin of her gastric pains. She did
not know it, however, and asked me to help her. I asked whether,
perhaps, on some occasion after a great excitement, she had forced
herself to eat. She confirmed this. After her husband’s death
she had for a long time lost her appetite completely and had only
eaten from a sense of duty; and her gastric pains had in fact begun
at that time. I then removed her gastric pains by stroking her a
few times across the epigastrium. She then began of her own accord
to talk about the things that had most affected her. ‘I have
told you,’ she said, ‘that I was not fond of the child.
But I ought to add that one could not have guessed it from my
behaviour. I did everything that was necessary. Even now I reproach
myself for being fonder of the elder one.’

  
May 14
. - She was well and
cheerful and had slept till 7.30 this morning. She only complained
of slight pains in the radial region of her hand and in her head
and face. What she tells me before the hypnosis becomes more and
more significant. To-day she had scarcely anything dreadful to
produce. She complained of pains and loss of sensation in her right
leg. She told me that she had had an attack of abdominal
inflammation in 1871; when she had hardly recovered from this, she
had nursed her sick brother, and it was then that the pains first
came on. They had even led to a temporary paralysis of her right
leg.

Studies On Hysteria

63

   During the hypnosis I asked her
whether it would now be possible for her to take part in social
life or whether she was still too much afraid. She said it was
still disagreeable to have anyone standing behind her or just
beside her. In this connection she told me of some more occasions
on which she had been disagreeably surprised by someone suddenly
appearing. Once, for instance, when she had been going for a walk
with her daughters on the island of Rügen, two
suspicious-looking individuals had come out from some bushes and
insulted them. In Abbazia, while she was out for a walk one
evening, a beggar had suddenly emerged from behind a rock and had
knelt down in front of her. It seems that he was a harmless
lunatic. Lastly, she told me of how her isolated country house had
been broken into at night, which had very much alarmed her. It is
easy to see, however, that the essential origin of this fear of
people was the persecution to which she had been subjected after
her husband’s death.¹

  
Evening
. - Though she
appeared to be in high spirits, she greeted me with the
exclamation: ‘I’m frightened to death; oh, I can hardly
tell you, I hate myself!’ I learned at last that she had had
a visit from Dr. Breuer and that on his appearance she had given a
start of alarm. As he noticed it, she had assured him that it was
‘only this once’. She felt so very sorry on my account
that she should have had to betray this relic of her former
nervousness. I have more than once had occasion to notice during
these last few days how hard she is on herself, how liable she is
to blame herself severely for the least signs of neglect if the
towels for the massage are not in their usual place or if the
newspaper for me to read when she is asleep is not instantly ready
to hand. After the removal of the first and most superficial layer
of tormenting recollections, her morally oversensitive personality,
with its tendency to self-depreciation, has come into view. Both in
her waking state and under hypnosis, I duly told her (what amounted
to the old legal tag ‘
de minimis non curat lex
’)
that there is a whole multitude of indifferent, small things lying
between what is good and what is evil - things about which no one
need reproach himself. She did not take in my lesson, I fancy, any
more than would an ascetic mediaeval monk, who sees the finger of
God or a temptation of the Devil in every trivial event of his life
and who is incapable of picturing the world even for a brief moment
or in its smallest corner as being without reference to
himself.

   In her hypnosis she brought up
some further horrifying images (in Abbazia, for instance, she saw
bloody heads on every wave of the sea). I made her repeat the
lessons I had given her while she was awake.

  
¹
At the time I wrote this I was inclined to
look for a
psychical
origin for all symptoms in cases of
hysteria. I should now explain this sexually abstinent
woman’s tendency to anxiety as being due to
neurosis
(i.e. anxiety neurosis).

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64

  
May 15
. - She had slept
till 8.30 a.m. but had become restless towards morning, and
received me with some slight signs of her
tic
, clacking and
speech-inhibition. ‘I’m frightened to death,’ she
said once more. In reply to a question she told me that the Pension
in which her children were staying was on the fourth floor of a
building and reached by a lift. She had insisted yesterday that the
children should make use of the lift for coming down as well as
going up, and was now reproaching herself about this, because the
lift was not entirely to be trusted. The owner of the Pension had
said so himself. Had I heard, she asked, the story of the Countess
Sch. who had been killed in Rome in an accident of that kind? I
happen to be acquainted with the Pension and I know that the lift
is the private property of the owner of the Pension; it does not
seem to me very likely that this man, who makes a special point of
the lift in an advertisement, would himself have warned anyone
against using it. It seemed to me that we had here one of the
paramnesias that are brought about by anxiety. I told her my view
and succeeded without any difficulty in getting her herself to
laugh at the improbability of her fears. For that very reason I
could not believe that this was the cause of her anxiety and
determined to put the question to her hypnotic consciousness.
During massage, which I resumed to-day after a few days’
interval, she told me a loosely connected string of anecdotes,
which may have been true - about a toad which was found in a
cellar, an eccentric mother who looked after her idiot child in a
strange fashion, a woman who was shut up in an asylum because she
had melancholia - and which showed the kind of recollections that
passed through her head when she was in a disquieted frame of mind.
When she had got these stories out she became very cheerful. She
described her life on her estate and her contacts with prominent
men in German Russia and North Germany; and I really found it
extremely hard to reconcile activities of this kind with the
picture of such a severely neurotic woman.

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65

   I therefore asked her in hypnosis
why she was so restless this morning. In place of her doubts about
the lift, she informed me that she had been afraid that her period
was going to start again and would again interfere with the
massage.¹

  
¹
The sequence of events had accordingly been
as follows: when she woke up in the morning she found herself in an
anxious mood, and to account for it she grasped at the first
anxious idea that came to mind. On the previous afternoon she had
had a conversation about the lift at the Pension. Over-careful of
her children as usual, she had asked their governess whether her
elder daughter, who could not walk much on account of ovarian
neuralgia on the right side and pains in the right leg, used the
lift for going down as well as up. A paramnesia then enabled her to
link the anxiety she was conscious of with the idea of the lift.
Her consciousness did not present her with the
real
cause of
her anxiety;
that
only emerged - but now it did so without
any hesitation - when I questioned her about it in hypnosis. The
process was the same as that studied by Bernheim and others after
him in persons who carry out in a post-hypnotic condition
instructions given them during hypnosis. For instance, Bernheim
(1886, 29) suggested to a patient that after he woke up he should
put both his thumbs in his mouth. He did so, and excused his action
by saying that his tongue had been giving him pain since the
previous day when he had bitten it in an epileptiform attack.
Again, in obedience to a suggestion, a girl made an attempt to
murder a law-court officer who was totally unknown to her. When she
was seized and questioned as to the motives of her act, she
invented a story of a wrong done to her which called for revenge.
There seems to be a necessity for bringing psychical phenomena of
which one becomes conscious into causal connection with other
conscious material. In cases in which the true causation evades
conscious perception one does not hesitate to attempt to make
another connection, which one believes, although it is false. It is
clear that a split in the content of consciousness must greatly
facilitate the occurrence of ‘false connections’ of
this kind.

   I
shall dwell a little on this example I have given of a false
connection, since in more than one respect it deserves to be
described as typical. It is typical, in the first place, of the
present patient’s behaviour; for in the further course of the
treatment she afforded me many opportunities of resolving such
false connections by explanations arrived at in hypnosis, and of
removing their effects. I will give a detailed account of one of
these instances, since it throws a strong light on the
psychological phenomenon in question. I had recommended Frau Emmy
to try replacing her usual luke-warm bath by a hip-bath of cool
water, which I told her would be more refreshing. She used to obey
medical instructions implicitly, but never ceased to view them with
profound mistrust. I have already said that she had hardly ever
derived any benefit from her medical treatment. My advice to her to
take cool baths was not delivered in such an authoritative manner
as to prevent her from having the courage to give open expression
to her hesitations: ‘Whenever I have taken a cool
bath,’ she said, ‘it has made me melancholy for the
rest of the day. But I will try it again, if you like; you
mustn’t think I won’t do whatever you tell me
to.’
 I pretended
to give up my proposal, but in her next hypnosis I suggested to her
that she should herself put forward the idea of cool baths - having
thought it over, she would like to try the experiment after all,
and so on. This in fact happened. Next day, she took up the idea of
having cool hip-baths; she tried to convince me with all the
arguments which I had previously used to her, and I agreed without
much enthusiasm. But on the day after she had had the hip-bath I
did in fact find her in a deep depression. ‘Why are you like
this to-day?’ I asked. ‘I knew beforehand that it would
happen,’ she answered, ‘it’s because of the cold
bath; it always happens.’ ‘It was you yourself who
asked for it,’ I said. ‘Now we know they don’t
suit you. We’ll go back to the luke-warm ones.’
Afterwards I asked her in her hypnosis, ‘Was it really the
cool bath that depressed you so much?’ ‘Oh,’ was
her answer, ‘the cool bath had nothing to do with it. But I
read in the paper this morning that a revolution had broken out in
San Domingo. Whenever there is any unrest there the whites are
always the sufferers; and I have a brother in San Domingo who has
already caused us a lot of concern, and I am worried now in case
something happens to him.’ This brought to a close the issue
between us. Next morning she took her cool hip-bath as though it
were a matter of course and continued doing so for several weeks
without ever attributing any depression to that source.

   It
will be agreed that this instance is typical also of the behaviour
of a large number of neuropaths in regard to the therapeutic
procedures recommended by their physicians. The patient who
develops a symptom on a particular day - whether owing to unrest in
San Domingo or else where - is always inclined to attribute it to
his doctor’s latest advice. Of the two conditions necessary
for bringing about a false connection of this kind, one, mistrust,
seems always to be present; while the other, the splitting of
consciousness, is replaced by the fact that most neuropaths have in
part no knowledge of the true causes (or at any rate the releasing
causes) of their disorder, and in part deliberately avoid such
knowledge, because they are unwilling to be reminded of that share
of the causes for which they themselves are to blame.