STUDIES ON HYSTERIA

Beginning in 1892, Sigmund Freud gradually abandoned the technique of hypnosis and began using the "method of cathartic abreaction" that had been described to him by his older colleague, Josef Breuer, ten years earlier. He became increasingly convinced of the sexual origin of neurotic disturbances in his patients and, uneasy over the work Pierre Janet had begun to publish (L 'État mental des hystériques, 1892-1894), convinced Breuer to join him in writing a book that, by situating the origin of their research in 1881, would assure them of priority in the world of scientific research.

A letter to Wilhelm Fliess on June 28, 1892, referred to Breuer's agreement. The two authors were going to contribute jointly to the volume. In the autumn of that year Freud began testing his new techniques of concentration on the symptom and placement of his hands on the forehead in an attempt to draw out Elisabeth von R.'s forgotten pathogenic memories, and by December he and Breuer had signed a "Preliminary Communication" that appeared in January 1893 (1893a). They attributed the cause of hysterical symptoms to the forgotten memory of a trigger incident that had not been "abreacted" and acted on the psyche as if it were a foreign body. The symptoms disappeared whenever the memory and its affect were awakened by providing them with a verbal outlet, which led to the famous maxim that "hysterics suffer primarily from reminiscences" (1895d, p. 7). For his part, Breuer insisted on the "tendency to a dissociation of consciousness" (1892-93a, p. 122) caused by daydreams. The "Preliminary Communication" aroused considerable interest in the international scientific community, as shown by a reference from Frederick W. H. Myers in Great Britain, only three months after its appearance.

However, the theory of sexual etiology began to appear increasingly convincing to Freud, which created a rift with the reticent Breuer. An 1894 article on the "Psychoneuroses of Defense" (1894a) enabled Freud to distinguish his theory from that of Pierre Janet and describe the concept of "conversion." At the same time he began to take an interest in dreams and, having written down his observations, in the spring of 1895 he wrote the preface and final chapter of Studies on Hysteria —during a period when he was still experiencing the disastrous consequences of Wilhelm Fliess's operation on Emma Eckstein.

The book appeared in May. The first chapter incorporated the "Preliminary Communication." The second was devoted to the case studies: Anna O., who was Breuer's patient, followed by "observations that read like novels and do not bear the stamp of seriousness typical of scientific writings." These were written by Freud and described his treatment of Emmy von N., Lucy R., Katharina, and Elisabeth von R. (and Frau Cäcille M., to whom reference is made throughout the book).

A third chapter by Breuer is devoted to theoretical issues. Here he describes the ideogenous nature of hysterical disturbances, the "unconscious or subconscious representations" of a primitive trauma that is primarily associated with sexual matters, and the recognition of mental hyperactivity in hysterics—the same individuals in whom Janet had found a "weakness," if not a constitutional mental inadequacy. He insisted on the presence of "hypnoidia" and the constancy of hypnoid states.

Freud wrote the last chapter, "The Psychotherapy of Hysteria." In it he describes the overdetermination of symptoms and the value of the cathartic method. The preliminary structure of what will become psychoanalysis is laid out: the patient on the couch, free association, the consideration of "false connections," and the disjunction mésalliance, which is the transference to the doctor of "the distressing ideas which arise from the content of the analysis" (1895d, p. 302). For Freud the psychic materials of hysteria appear to be arranged in strata, starting from a kernel of traumatic memories. This arrangement can be chronological—in which case, Freud writes, "it [is] as though we were examining a dossier that had been kept in good order"(p. 288)—or thematic, such themes being "stratified concentrically round the pathogenic nucleus" (p. 289). The goal of the analysis is to "penetrate . . . to the nucleus of the pathogenic organization" (p. 295), an operation that requires considerable effort on the part of the therapist, who must overcome the patient's resistance in order to unearth the buried memory that is the source of the problem. The means used to overcome this were still rudimentary, gentle, physical pressure applied to the points of the forehead, and an increasing barrage of questions intended to "extort" a patient's secrets. Even though the method was claimed to be successful, Freud concluded, "No doubt fate would find it easier than I do to relieve you of your illness. But you will be able to convince yourself that much will be gained if we succeed in transforming your hysterical misery into common unhappiness. With a mental life that has been restored to health you will be better armed against that unhappiness" (p. 305).

By the following October, Freud would publicly abandon Breuer's theory of hypnoid states and affirm that hysteria arises from seduction early in life, a "pre-sexual sexual fright" (letter to Fliess, October 15, 1895).

But the book went out into the world and Freud, already known for his neurological work, became recognized as a "psychologist." Although Adolf Trümpell sharply criticized the book (letter to Fliess, February 6, 1896), an event that deeply affected Breuer, Havelock Ellis praised it, as did Théodore Flournoy and a number of French authors. Eugen Bleuler himself wrote, in 1896, that it was "one of the most important recent additions to the field of normal and pathological psychology." The success of the Studies on Hysteria did come at a price, however. For a number of years the book was considered, by those who did not have access to Freud's later writings, to contain the essence of his theory and practice. Even Pierre Janet, in his critiques of psychoanalysis in 1907 and 1913, did not appear to look any deeper for an understanding of Freudian theory.

Although Sándor Ferenczi, in a letter to Freud on March 2, 1909, described it as the "germ of everything we now know," Freud had mixed feelings about the book and struggled against the ongoing references to theories he believed to be outdated. As early as 1901 he wrote, "Ever since we wrote the Studies, psychoanalytic technique has undergone a fundamental transformation. The work had symptoms as its point of departure and their successive resolution as its goal. Since then I have abandoned this technique, for I found it unsuited to the delicate structure of the neurosis." Freud even minimized his contribution to the book in his On theHistory of the Pyscho-Analytic Movement (1914d) and especially in An Autobiographical Study : "As regards the theory put forward in the book, I was partly responsible, but to an extent which it is to-day no longer possible to determine. That theory was in any case unpretentious and hardly went beyond the direct description of the observations. It did not seek to establish the nature of hysteria but merely to throw light upon the origin of its symptoms. . . . The theory of catharsis had not much to say on the subject of sexuality. In the case histories which I contributed to the Studies sexual factors played a certain part, but scarcely more attention was paid to them than to other emotional excitations. . . . It would have been difficult to guess from the Studies on Hysteria what an importance sexuality has in the aetiology of the neuroses" (1925d, p. 22). Freud did not include the book in the first edition of his collected works, the Gesammelte Schriften.

In 1925 Freud added, "The practical results of the cathartic procedure were excellent. Its defects, which became evident later, were those of all forms of hypnotic treatment. There are still a number of psychotherapists who have not gone beyond catharsis as Breuer understood it and who still speak in its favor" (p. 22).

At a time when psychoanalytic practice, for reasons of pseudo-efficiency, risks incorporating psychotherapeutic techniques dating from before the Studies on Hysteria, the study of this key work is more relevant than ever. This is undeniably important, if only to situate its ideas as a historical step, simple but important, in the trajectory that would lead Freud, over the next ten years, to modify his theory and practice, thereby defining the framework of psychoanalytic therapy as it has come to be known.

Alain de Mijolla

See also: Cathartic method.

Source Citation

Freud, Sigmund, and Breuer, Josef. (1895d). Studien über hysteria. Vienna; GW, 1, 75-312; Studies on hysteria. SE,2.

Bibliography

Ellenberger, Henri F. (1970). The discovery of the unconscious: The history and evolution of dynamic psychiatry. New York: Basic Books.

Freud, Sigmund. (1893a). On the psychical mechanism of hysterical phenomena: preliminary communication. SE, 2: 1-17.

——. (1914d). On the history of the psycho-analytic movement. SE, 14: 1-66.

——. (1925d). An autobiographical study. SE, 20: 1-74.

Freud, Sigmund, and Breuer, Josef. (1950a [1887-1902]). Extracts from the Fliess papers. SE, 1: 173-280.

Ellenberger, Henri F. (1970). The discovery of the unconscious: The history and evolution of dynamic psychiatry. New York: Basic Books.

Grubrich-Simitis, Ilse. (1995). Urbuch der psychoanalyse. Hundert jahre studien über hysterie von Josef Breuer und Sigmund Freud. Frankfurt am Main: S. Fischer.