Studies on Hysteria, Breuer and Freud (1895)
Preliminary Communication
Trauma happens. Throughout life people experience different traumatic events. Often, these events fade from our memories, while at other times they remain intense even years later. When the event fades, we often experience good mental health, but when it doesn’t, we become susceptible to hysteria.
Why some traumatic memories fade. Traumatic memories fade when there is initially “an energetic reaction to the event that provokes an affect.” Here’s an example that comes to my mind: A dog snarls at a child, deeply scaring the child, and the child immediately cries. Affects can also be reduced through language, through what the writers refer to as abreaction. Sometimes traumatic events can fade when they’re rectified by other ideas. For example, you remember that after an accident, someone came and rescued you; or after you were humiliated, you put the facts right by considering your own worth. “In this way a normal person is able to bring about the disappearance of the accompanying affect through the process of association.”
Hysteria defined. Hysterical patients still have intense memories of traumatic events. However, they’re no longer conscious of these memories. Put differently, there’s a splitting off of consciousness and the emergence of a dissociated or hypnoid state. In this hypnoid state, the traumatic memory is cut off from consciousness. A cut off memory may be associated with other ideas. It is only under hypnosis that the individual can become aware of this memory. During different times — e.g., times of acute stress — such an individual might have a hysterical attack in which physical symptoms appear.
Treatment. Breuer and Freud found that “each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which it was provoked and in arousing its accompanying affect, and when the patient had described that event in the greatest possible detail and had put the affect into words. Recollection without affect almost invariably produces no result. The psychical process which originally took place must be repeated as vividly as possible; it must be brought back to its status nascendi and then given verbal utterance. When what we are dealing with are phenomena involving stimuli (spasms, neuralgias and hallucinations) these reappear once again with the fullest intensity and then vanish forever.”
Why were these traumatic events never properly abreacted? There are two reasons. First, some people want to forget the event, and so the event is excluded from association. Second, some people experience the event when they’re not in the right emotional state to retain the event, to connect it with other associations, e.g., if someone’s in a state of fright or semi-hypnotized.
Trauma happens. Throughout life people experience different traumatic events. Often, these events fade from our memories, while at other times they remain intense even years later. When the event fades, we often experience good mental health, but when it doesn’t, we become susceptible to hysteria.
Why some traumatic memories fade. Traumatic memories fade when there is initially “an energetic reaction to the event that provokes an affect.” Here’s an example that comes to my mind: A dog snarls at a child, deeply scaring the child, and the child immediately cries. Affects can also be reduced through language, through what the writers refer to as abreaction. Sometimes traumatic events can fade when they’re rectified by other ideas. For example, you remember that after an accident, someone came and rescued you; or after you were humiliated, you put the facts right by considering your own worth. “In this way a normal person is able to bring about the disappearance of the accompanying affect through the process of association.”
Hysteria defined. Hysterical patients still have intense memories of traumatic events. However, they’re no longer conscious of these memories. Put differently, there’s a splitting off of consciousness and the emergence of a dissociated or hypnoid state. In this hypnoid state, the traumatic memory is cut off from consciousness. A cut off memory may be associated with other ideas. It is only under hypnosis that the individual can become aware of this memory. During different times — e.g., times of acute stress — such an individual might have a hysterical attack in which physical symptoms appear.
Treatment. Breuer and Freud found that “each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which it was provoked and in arousing its accompanying affect, and when the patient had described that event in the greatest possible detail and had put the affect into words. Recollection without affect almost invariably produces no result. The psychical process which originally took place must be repeated as vividly as possible; it must be brought back to its status nascendi and then given verbal utterance. When what we are dealing with are phenomena involving stimuli (spasms, neuralgias and hallucinations) these reappear once again with the fullest intensity and then vanish forever.”
Why were these traumatic events never properly abreacted? There are two reasons. First, some people want to forget the event, and so the event is excluded from association. Second, some people experience the event when they’re not in the right emotional state to retain the event, to connect it with other associations, e.g., if someone’s in a state of fright or semi-hypnotized.
Anna O.
Anna O had many, many, many problems. She fell ill when 21 years old, shortly after she began nursing her sick father, and experienced different phases of symptoms — e.g., bed-ridden for several months; speech problems (paraphasia); vision problems; paralysis in different body parts; would at times hallucinate and become naughty and throw cushions at those nearby.
But talking about the problems helped. Breuer discovered this early in her treatment. She had been “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 someone suffering from hydrophobia… 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.”
At one point she refused to speak for two weeks. When Breuer realized that she had become offended about a specific topic, he pressured her to talk about it, and when she did so, she resumed talking. Moreover, the paralysis she had had on the left side of her body went away.
This treatment continued. Breuer would visit her in the evenings and find that her symptoms had flared up and she was in a state of auto-hypnosis. He would get her to talk, and her symptoms would subside. She called this the “talking cure” and jokingly called it “chimney sweeping.” Each of Anna O’s symptoms “was taken separately,” and she would describe every occasion in which the symptom appeared, “going back to the event which had led to its first appearance. When this had been described the symptom was permanently removed.”
Other Examples. He would visit her in the evenings and find her in a state of auto-hypnosis. At one point she stopped speaking German and would only speak English. Once she was in this state, her eyes shut, repeating, “tormenting, tormenting.” Someone near her “repeated one of the phrases of hers while she was complaining about the tormenting.’ She at once joined in and began to paint some situation or tell some story, hesitatingly at first and in her paraphasic [paraphasia is a type of speech impediment which involved switching a word in a sentence with an incorrect word] jargon; but the longer she went on the more fluent she became, till at last she was speaking quite correct German.”
Other Examples, cont’d. Her stories were always sad. “As a rule, their starting-point or central situation was of a girl anxiously sitting by a sick-bed… A few moments after she had finished her narrative she would wake up, obviously calmed down. During the night she would again become restless, and in the morning, after a couple of hours’ sleep, she was visibly involved in some other set of ideas. If for any reason she was unable to tell me the story during her evening hypnosis she failed to calm down afterwards, and on the following day she had to tell me two stories in order for this to happen.”
Other Examples, cont’d. She focused on her father’s illness and death. Breuer eventually realized that “every evening during the hypnosis [in 1882] she talked through whatever it was that had excited her on the same day in 1881.” One morning she said that she was angry with Breuer but had no idea why; he consulted her mother’s diary from the previous year and found “I had annoyed the patient very much on the same evening in 1881.”
Anna O had many, many, many problems. She fell ill when 21 years old, shortly after she began nursing her sick father, and experienced different phases of symptoms — e.g., bed-ridden for several months; speech problems (paraphasia); vision problems; paralysis in different body parts; would at times hallucinate and become naughty and throw cushions at those nearby.
But talking about the problems helped. Breuer discovered this early in her treatment. She had been “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 someone suffering from hydrophobia… 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.”
At one point she refused to speak for two weeks. When Breuer realized that she had become offended about a specific topic, he pressured her to talk about it, and when she did so, she resumed talking. Moreover, the paralysis she had had on the left side of her body went away.
This treatment continued. Breuer would visit her in the evenings and find that her symptoms had flared up and she was in a state of auto-hypnosis. He would get her to talk, and her symptoms would subside. She called this the “talking cure” and jokingly called it “chimney sweeping.” Each of Anna O’s symptoms “was taken separately,” and she would describe every occasion in which the symptom appeared, “going back to the event which had led to its first appearance. When this had been described the symptom was permanently removed.”
Other Examples. He would visit her in the evenings and find her in a state of auto-hypnosis. At one point she stopped speaking German and would only speak English. Once she was in this state, her eyes shut, repeating, “tormenting, tormenting.” Someone near her “repeated one of the phrases of hers while she was complaining about the tormenting.’ She at once joined in and began to paint some situation or tell some story, hesitatingly at first and in her paraphasic [paraphasia is a type of speech impediment which involved switching a word in a sentence with an incorrect word] jargon; but the longer she went on the more fluent she became, till at last she was speaking quite correct German.”
Other Examples, cont’d. Her stories were always sad. “As a rule, their starting-point or central situation was of a girl anxiously sitting by a sick-bed… A few moments after she had finished her narrative she would wake up, obviously calmed down. During the night she would again become restless, and in the morning, after a couple of hours’ sleep, she was visibly involved in some other set of ideas. If for any reason she was unable to tell me the story during her evening hypnosis she failed to calm down afterwards, and on the following day she had to tell me two stories in order for this to happen.”
Other Examples, cont’d. She focused on her father’s illness and death. Breuer eventually realized that “every evening during the hypnosis [in 1882] she talked through whatever it was that had excited her on the same day in 1881.” One morning she said that she was angry with Breuer but had no idea why; he consulted her mother’s diary from the previous year and found “I had annoyed the patient very much on the same evening in 1881.”
Lucy R.
Lucy was depressed and smelt things that weren’t there. She had lost her sense of smell but had two subjective olfactory smells; also depressed.
Freud couldn’t hypnotize her. I could not hypnotize her, therefore did therapy with her being awake. “I soon began to tire of issuing assurances and commands such as: ‘You are going to sleep!...sleep!’ and of hearing the patient, as so often happened when the degree of hypnosis was light, remonstrate me with: ‘But, doctor, I’m not asleep.’” If hypnosis didn’t work with he patient, he stopped trying and only asked for concentration, ordering the patient “to lie down and deliberately shut his eyes as a means of achieving this ‘concentration.’”
But it didn’t really matter. He worried that by forgoing hypnotism, his patients would not have catharsis, for that depended upon them accessing certain memories. But he then learned that the memories that come during hypnosis “are only apparently forgotten in the waking state and can be revived by a mild word of command and a pressure with the hand intended to indicate a different state of consciousness.”
Freud used suggestion. Freud would ask patients, “How long have you had this symptom?” or “What was its origin?” If they said they didn’t know, he would place his hand on the patient’s forehead or take her head between his hands and say, “You will think of it under the pressure of my hand. At the moment at which I relax my pressure you will see something in front of you or something will come into your head. Catch hold of it. It will be what we are looking for.” If the patient said that nothing came to mind, he would continue to exert pressure and ask again. Patients would often tell him that they knew the memory the first time but just didn’t want to say anything or hoped it wouldn’t be true.
Burnt pudding, part 1. Freud asked Lucy if she remembered when she first had smelt burnt pudding. She had been a governess two months earlier, and one day she was playing with the children when she noticed that a letter from her mother had arrived for her in the mail. Lucy reached for the letter, but the children wouldn’t let her, saying it must be for her birthday and they would keep it. She then smelt the burnt pudding.
Lucy explained that she had been intending to go back to her mother’s, and the thought of leaving the children made her sad. She wanted to leave the house because the other employees in the house thought she had been acting haughtily and said negative things about her to the children’s grandfather. Lucy told Freud that leaving was so distressing because she had promised the children’s mother on her death-bed that she would never abandon them.
Burnt pudding — it’s really about sex. Freud felt there was more to the story, however. He had previously learned that when an individual suffers from hysteria, they repress an idea from consciousness, and through conversion this idea then takes on a physical manifestation. Put differently, the patient represses an idea, and the repressed idea then “takes its revenge…by becoming pathogenic.” Consequently, Freud believed that Lucy had tried to repress an idea and left this idea out of her narrative.
Freud made an interpretation: “I believe that you are really in love with your employer… though perhaps without being aware of it yourself, and that you have a secret hope of taking their mother’s place. Lucy admitted that this was true. Freud then asked that if this were true why didn’t she tell him. Lucy: I didn’t know — or rather I didn’t want to know. I wanted to drive it out of my head and not think of it again. Why was this idea distressing? Because he was her employer, and I don’t feel the same complete independence towards him that I could towards anyone else. And then I am only a poor girl and he is such a rich man of good family. People would laugh at me if they had any idea of it.”
Cigar smoke. After a while Lucy stopped smelling the burnt pudding but instead started smelling something resembling cigar smoke. Freud asked her on what important occasion she had smelt cigar smoke. L: “People smoke every day in our house, and I really don’t know whether the smell I notice refers to some special occasion.” F insisted that she try to remember under the pressure of his hand. At his insistence, a picture started to emerge. She was waiting in the house with the children for the gentlemen to return from lunch. L: “But that’s like what happens every day.” F: “Go on looking at the picture; it will develop and become more specialized.” Lucy recalled a guest, an old man. As the children said good bye to the old man, he tried to kiss them. This enraged Lucy’s employer who yelled at the old man. This event happened before the event involving the burnt pudding.
An even earlier memory. They still couldn’t understand why this second event had bothered Lucy so much, and so under the pressure of Freud’s hand, Lucy recalled an even earlier memory. A lady had been visiting the house and upon leaving kissed the children on the mouth. After the lady left, the children’s father yelled at Lucy and said that if she ever allowed that to happen again he would fire her. At the time Lucy had thought that the father loved her, and this event crushed her hopes.
Lucy was depressed and smelt things that weren’t there. She had lost her sense of smell but had two subjective olfactory smells; also depressed.
Freud couldn’t hypnotize her. I could not hypnotize her, therefore did therapy with her being awake. “I soon began to tire of issuing assurances and commands such as: ‘You are going to sleep!...sleep!’ and of hearing the patient, as so often happened when the degree of hypnosis was light, remonstrate me with: ‘But, doctor, I’m not asleep.’” If hypnosis didn’t work with he patient, he stopped trying and only asked for concentration, ordering the patient “to lie down and deliberately shut his eyes as a means of achieving this ‘concentration.’”
But it didn’t really matter. He worried that by forgoing hypnotism, his patients would not have catharsis, for that depended upon them accessing certain memories. But he then learned that the memories that come during hypnosis “are only apparently forgotten in the waking state and can be revived by a mild word of command and a pressure with the hand intended to indicate a different state of consciousness.”
Freud used suggestion. Freud would ask patients, “How long have you had this symptom?” or “What was its origin?” If they said they didn’t know, he would place his hand on the patient’s forehead or take her head between his hands and say, “You will think of it under the pressure of my hand. At the moment at which I relax my pressure you will see something in front of you or something will come into your head. Catch hold of it. It will be what we are looking for.” If the patient said that nothing came to mind, he would continue to exert pressure and ask again. Patients would often tell him that they knew the memory the first time but just didn’t want to say anything or hoped it wouldn’t be true.
Burnt pudding, part 1. Freud asked Lucy if she remembered when she first had smelt burnt pudding. She had been a governess two months earlier, and one day she was playing with the children when she noticed that a letter from her mother had arrived for her in the mail. Lucy reached for the letter, but the children wouldn’t let her, saying it must be for her birthday and they would keep it. She then smelt the burnt pudding.
Lucy explained that she had been intending to go back to her mother’s, and the thought of leaving the children made her sad. She wanted to leave the house because the other employees in the house thought she had been acting haughtily and said negative things about her to the children’s grandfather. Lucy told Freud that leaving was so distressing because she had promised the children’s mother on her death-bed that she would never abandon them.
Burnt pudding — it’s really about sex. Freud felt there was more to the story, however. He had previously learned that when an individual suffers from hysteria, they repress an idea from consciousness, and through conversion this idea then takes on a physical manifestation. Put differently, the patient represses an idea, and the repressed idea then “takes its revenge…by becoming pathogenic.” Consequently, Freud believed that Lucy had tried to repress an idea and left this idea out of her narrative.
Freud made an interpretation: “I believe that you are really in love with your employer… though perhaps without being aware of it yourself, and that you have a secret hope of taking their mother’s place. Lucy admitted that this was true. Freud then asked that if this were true why didn’t she tell him. Lucy: I didn’t know — or rather I didn’t want to know. I wanted to drive it out of my head and not think of it again. Why was this idea distressing? Because he was her employer, and I don’t feel the same complete independence towards him that I could towards anyone else. And then I am only a poor girl and he is such a rich man of good family. People would laugh at me if they had any idea of it.”
Cigar smoke. After a while Lucy stopped smelling the burnt pudding but instead started smelling something resembling cigar smoke. Freud asked her on what important occasion she had smelt cigar smoke. L: “People smoke every day in our house, and I really don’t know whether the smell I notice refers to some special occasion.” F insisted that she try to remember under the pressure of his hand. At his insistence, a picture started to emerge. She was waiting in the house with the children for the gentlemen to return from lunch. L: “But that’s like what happens every day.” F: “Go on looking at the picture; it will develop and become more specialized.” Lucy recalled a guest, an old man. As the children said good bye to the old man, he tried to kiss them. This enraged Lucy’s employer who yelled at the old man. This event happened before the event involving the burnt pudding.
An even earlier memory. They still couldn’t understand why this second event had bothered Lucy so much, and so under the pressure of Freud’s hand, Lucy recalled an even earlier memory. A lady had been visiting the house and upon leaving kissed the children on the mouth. After the lady left, the children’s father yelled at Lucy and said that if she ever allowed that to happen again he would fire her. At the time Lucy had thought that the father loved her, and this event crushed her hopes.
Cured. At the following session, Lucy was happy; she no longer had hopes of marrying the father but it didn’t bother her like it had before.
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