Freud - Complete Works (8 page)

Studies On Hysteria

32

   It was interesting here, too, to
observe the way in which these revived psychical stimuli belonging
to her secondary state made their way over into her first, more
normal one. It happened, for instance, that one morning the patient
said to me laughingly that she had no idea what was the matter but
she was angry with me. Thanks to the diary I knew what was
happening; and, sure enough, this was gone through again in the
evening hypnosis: I had annoyed the patient very much on the same
evening in 1881. Or another time she told me there was something
the matter with her eyes; she was seeing colours wrong. She knew
she was wearing a brown dress but she saw it as a blue one. We soon
found that she could distinguish all the colours of the visual
test-sheets correctly and clearly, and that the disturbance only
related to the dress-material. The reason was that during the same
period in 1881 she had been very busy with a dressing-gown for her
father, which was made with the same material as her present dress,
but was blue instead of brown. Incidentally, it was often to be
seen that these emergent memories showed their effect in advance;
the disturbance of her normal state would occur earlier on, and the
memory would only gradually be awakened in her
condition
seconde
.

Studies On Hysteria

33

   Her evening hypnosis was thus
heavily burdened, for we had to talk off not only her contemporary
imaginative products but also the events and
‘vexations’¹ of 1881. (Fortunately I had already
relieved her at the time of the imaginative products of that year.)
But in addition to all this the work that had to be done by the
patient and her physician was immensely increased by a third group
of separate disturbances which had to be disposed of in the same
manner. These were the psychical events involved in the period of
incubation of the illness between July and December, 1880; it was
they that had produced the whole of the hysterical phenomena, and
when they were brought to verbal utterance the symptoms
disappeared.

   When this happened for the first
time - when, as a result of an accidental and spontaneous utterance
of this kind, during the evening hypnosis, a disturbance which had
persisted for a considerable time vanished - I was greatly
surprised. It was in the summer during a period of extreme heat,
and the patient was suffering very badly from thirst; for, without
being able to account for it in any way, she suddenly found it
impossible to drink. She would take up the glass of water she
longed for, but as soon as it touched her lips she would push it
away like some one suffering from hydrophobia. As she did this, she
was obviously in an
absence
for a couple of seconds. She
lived only on fruit, such as melons, etc., so as to lessen her
tormenting thirst. This had lasted for some six weeks, when one day
during hypnosis she grumbled about her English lady-companion whom
she did not care for, and went on to describe, with every sign of
disgust, how she had once gone into that lady’s room and how
her little dog - horrid creature! - had drunk out of a glass there.
The patient had said nothing, as she had wanted to be polite. After
giving further energetic expression to the anger she had held back,
she asked for something to drink, drank a large quantity of water
without any difficulty and woke from her hypnosis with the glass at
her lips; and thereupon the disturbance vanished, never to
return. A number of extremely obstinate whims were similarly
removed after she had described the experiences which had given
rise to them. She took a great step forward when the first of her
chronic symptoms disappeared in the same way - the contracture of
her right leg, which, it is true, had already diminished a great
deal. These findings - that in the case of this patient the
hysterical phenomena disappeared as soon as the event which had
given rise to them was reproduced in her hypnosis - made it
possible to arrive at a therapeutic technical procedure which left
nothing to be desired in its logical consistency and systematic
application. Each individual symptom in this complicated case was
taken separately in hand; all the occasions on which it had
appeared were described in reverse order, starting before the time
when the patient became bed-ridden and going back to the event
which had led to its first appearance. When this had been described
the symptom was permanently removed.

  
¹
[In English in the original.]

Studies On Hysteria

34

   In this way her paralytic
contractures and anaesthesias, disorders of vision and hearing of
every sort, neuralgias, coughing, tremors, etc., and finally her
disturbances of speech were ‘talked away’. Amongst the
disorders of vision, the following, for instance, were disposed of
separately: the convergent squint with diplopia; deviation of both
eyes to the right, so that when her hand reached out for something
it always went to the left of the object; restriction of the visual
field; central amblyopia; macropsia; seeing a death’s head
instead of her father; inability to read. Only a few scattered
phenomena (such, for instance, as the extension of the paralytic
contractures to the left side of her body) which had developed
while she was confined to bed, were untouched by this process of
analysis, and it is probable, indeed, that they in fact had no
immediate physical cause.

   It turned out to be quite
impracticable to shorten the work by trying to elicit in her memory
straight away the first provoking cause of her symptoms. She was
unable to find it, grew confused, and things proceeded even more
slowly than if she was allowed quietly and steadily to follow back
the thread of memories on which she had embarked. Since the latter
method, however, took too long in the evening hypnosis, owing to
her being over-strained and distraught by ‘talking out’
the two other sets of experiences - and owing, too, to the
reminiscences needing time before they could attain sufficient
vividness - we evolved the following procedure. I used to visit her
in the morning and hypnotize her. (Very simple methods of doing
this were arrived at empirically.) I would next ask her to
concentrate her thoughts on the symptom we were treating at the
moment and to tell me the occasions on which it had appeared. The
patient would proceed to describe in rapid succession and under
brief headings the external events concerned and these I would jot
down. During her subsequent evening hypnosis she would then, with
the help of my notes, give me a fairly detailed account of these
circumstances.

Studies On Hysteria

35

   An example will show the exhaustive
manner in which she accomplished this. It was our regular
experience that the patient did not hear when she was spoken to. It
was possible to differentiate this passing habit of not hearing as
follows:

   (
a
) Not hearing when
someone came in, while her thoughts were abstracted. 108 separate
detailed instances of this, mentioning the persons and
circumstances, often with dates. First instance: not hearing her
father come in.

   (
b
) Not understanding when
several people were talking. 27 instances. First instance: her
father, once more, and an acquaintance.

   (
c
) Not hearing when she
was alone and directly addressed. 50 instances. Origin: her father
having vainly asked her for some wine.

   (
d
) Deafness brought on by
being shaken (in a carriage, etc.). 15 instances. Origin: having
been shaken angrily by her young brother when he caught her one
night listening at the sick room door.

   (
e
) Deafness brought on by
fright at a noise. 37 instances. Origin: a choking fit of her
father’s, caused by swallowing the wrong way.

   (
f
) Deafness during deep
absence
. 12 instances.

   (
g
) Deafness brought on by
listening hard for a long time, so that when she was spoken to she
failed to hear. 54 instances.

   Of course all these episodes were
to a great extent identical in so far as they could be traced back
to states of abstraction or
absences
or to fright. But in
the patient’s memory they were so clearly differentiated,
that if she happened to make a mistake in their sequence she would
be obliged to correct herself and put them in the right order; if
this was not done her report came to a standstill. The events she
described were so lacking in interest and significance and were
told in such detail that there could be no suspicion of their
having been invented. Many of these incidents consisted of purely
internal experiences and so could not be verified; others of them
(or circumstances attending them) were within the recollection of
people in her environment.

Studies On Hysteria

36

   This example, too, exhibited a
feature that was always observable when a symptom was being
‘talked away’: the particular symptom emerged with
greater force while she was discussing it. Thus during the analysis
of her not being able to hear she was so deaf that for part of the
time I was obliged to communicate with her in writing. The first
provoking cause was habitually a fright of some kind, experienced
while she was nursing her father - some oversight on her part, for
instance.

   The work of remembering was not
always an easy matter and sometimes the patient had to make great
efforts. On one occasion our whole progress was obstructed for some
time because a recollection refused to emerge. It was a question of
a particularly terrifying hallucination. While she was nursing her
father she had seen him with a death’s head. She and the
people with her remembered that once, while she still appeared to
be in good health, she had paid a visit to one of her relatives.
She had opened the door and all at once fallen down unconscious. In
order to get over the obstruction to our progress she visited the
same place again and, on entering the room, again fell to the
ground unconscious. During her subsequent evening hypnosis the
obstacle was surmounted. As she came into the room, she had seen
her pale face reflected in a mirror hanging opposite the door; but
it was not herself that she saw but her father with a death’s
head. - We often noticed that her dread if a memory, as in the
present instance, inhibited its emergence, and this had to be
brought about forcibly by the patient or physician.

Studies On Hysteria

37

   The following incident, among
others, illustrates the high degree of logical consistency of her
states. During this period, as has already been explained, the
patient was always in her
condition seconde
- that is, in
the year 1881 - at night. On one occasion she woke up during the
night, declaring that she had been taken away from home once again,
and became so seriously excited that the whole household was
alarmed. The reason was simple. During the previous evening the
talking cure had cleared up her disorder of vision, and this
applied also to her
condition seconde
. Thus when she woke up
in the night she found herself in a strange room, for her family
had moved house in the spring of 1881. Disagreeable events of this
kind were avoided by my always (at her request) shutting her eyes
in the evening and giving her a suggestion that she would not be
able to open them till I did so myself on the following morning.
The disturbance was only repeated once, when the patient cried in a
dream and opened her eyes on waking up from it.

   Since this laborious analysis for
her symptoms dealt with the summer months of 1880, which was the
preparatory period of her illness, I obtained complete insight into
the incubation and pathogenesis of this case of hysteria, and I
will now describe them briefly.

   In July, 1880, while he was in
the country, her father fell seriously ill of a sub-pleural
abscess. Anna shared the duties of nursing him with her mother. She
once woke up during the night in great anxiety about the patient,
who was in a high fever; and she was under the strain of expecting
the arrival of a surgeon from Vienna who was to operate. Her mother
had gone away for a short time and Anna was sitting at the bedside
with her right arm over the back of her chair. She fell into a
waking dream and saw a black snake coming towards the sick man from
the wall to bite him. (It is most likely that there were in fact
snakes in the field behind the house and that these had previously
given the girl a fright; they would thus have provided the material
for her hallucination.) She tried to keep the snake off, but it was
as though she was paralysed. Her right arm, over the back of the
chair, had gone to sleep and had become anaesthetic and paretic;
and when she looked at it the fingers turned into little snakes
with death’s heads (the nails). (It seems probable that she
had tried to use her paralysed right arm to drive off the snake and
that its anaesthesia and paralysis had consequently become
associated with the hallucination of the snake.) When the snake
vanished, in her terror she tried to pray. But language failed her:
she could find no tongue in which to speak, till at last she
thought of some children’s verses in English and then found
herself able to think and pray in that language. The whistle of the
train that was bringing the doctor whom she expected broke the
spell.

Studies On Hysteria

38

   Next day, in the course of a
game, she threw a quoit into some bushes; and when she went to pick
it out, a bent branch revived her hallucination of the snake, and
simultaneously her right arm became rigidly extended. Thenceforward
the same thing invariably occurred whenever the hallucination was
recalled by some object with a more or less snake-like appearance.
This hallucination, however, as well as the contracture only
appeared during the short
absences
which became more and
more frequent from that night onwards. (The contracture did not
become stabilized until December, when the patient broke down
completely and took to her bed permanently.) As a result of some
particular event which I cannot find recorded in my notes and which
I no longer recall, the contracture of the right leg was added to
that of the right arm.