Vol.7\1901-1905\Hysteria\Dora\therapeutic methods\sexaulity\treatment\theater\3 Essays on Sexualiy\
This is the famous case study of Dora. The analysis is centered around two dreams and therefore can be said to be, in part, the culmination of The Interpretation of Dreams. We find also in this article, further solutions of hysterical symptoms and considerations in terms of the sexual aetiology of the condition. Freud expected this article to cause all kinds of horrifying effects and considered it "The most subtle thing I have yet written." In this article we are presented glimpses of the autoerotic zones and the notion of bisexuality, ideas which are more fully revealed in Three Essays on Sexuality. Strachey notes that Freud withheld the publication of this text for at least four years. Thus there is absolutely no way of determining to what extent he may have revised it. Still Strachey suggests that very little of the original manuscript was revised. (3-6)
This section begins with an apologetics, of a sort, of the publication of the case history in terms of the nature of the therapy and concern for the patient. Freud, nonetheless, maintain that the purpose for this publication is to help substantiate the views expounded in Studies in Hysteria (vol. 1). (7-9)
Freud points out at the beginning of the text that sexual questions will be discussed with all possible frankness. (9) Again he warns the reader that is would be wrong to suppose that dreams and their interpretations occupy such a prominent position in all analysis as they do in this particular case. (11)
Freud follows by commenting that psychoanalytical technique has been revolutionized since the work explicated in Studies in Hysteria. During the period of Studies analysis began with symptoms and aimed at clearing them up one at a time. Since then Freud abandoned that technique because he found it to be inadequate for dealing with the finer structure of the neurosis. As evidence for this change of opinion, Freud writes: "I now let the patient himself choose the subject of the day's work, and in that way I start out from whatever surface his unconscious happens to be presenting to his notice at the moment." (12)
However, Freud notes, everything that deals with the clearing up of a particular symptom emerges piecemeal, woven into various contents and distributed over widely separated periods of time. For all the apparent disadvantages, Freud maintains that this new technique is far superior to the previous one. He further criticizes the older techniques by noting that a single cause cannot offer all the answers to the problems of hysteria. (12-13)
On page 16 Freud begins the analysis by asking the patient to relate the whole story of their life and illness. However, he notes this is never enough material with which to proceed. He likens this first account unto an unnavigable river whose path is blocked at one point and divided at yet another point. In fact Freud has critical words of those who present smooth case histories of hysterics as the patients themselves cannot even do so -- something which is said to be a characteristic of the neurosis. (16) To Freud this point is of great theoretical interest because:
Freud finds this state of affairs "a necessary correlate of the symptoms and one which is theoretically requisite." In the further course of treatment, the patient supplies facts, known all along, that had been kept back of had not occurred previously and gaps in memory are also filled. Thus, Freud concludes, it is only towards the end of analysis that a case history emerges that is intelligible, consistent and unbroken.
The practical aim of treatment, Freud suggests, it twofold: 1) the aim is to remove all possible symptoms and replace them with conscious thought; and, 2) secondarily, to repair all damage to the patients memory. The two aims, Freud says, are coincident. (18)
On pages 18-23 Freud begins to describe Dora`s case history by taking into account the personal and social circumstances of the patient and her family. In an nutshell, at 18 years old Dora has a family that consists of the parents and one brother. The father is depicted as being domineering and this therefore provides a framework by which one can understand the nature of Dora`s childhood and illness. Thus Freud points out that Dora, as child had nursed her father who was suffering from tuberculosis and yet was a very critical person. It is the case that Dora did not get on well with men.
On page 28 Freud makes several comments regarding his new technique of analysis. In this new technique Fred abandons the emphasis on the so called `hypnoid state,` which as supposed to appear in patients as a result of the trauma and to be foundation for all the psychologically abnormal events that subsequently took place in the individual's life. (see: Footnote #1 in the text). That is, Freud wishes to point out that it is often the case that the trauma of a person's past life is not enough to explain or determine the particular characteristics of the symptoms. In Dora`s case the trauma is said to have occurred at the age of 14, and thus it was necessary for Freud to look into her infantile memories.
In looking at Dora`s symptomatology, Freud points out that her symptoms are characterized by a reversal of effect. That is, there was a case in which a man (Herr K) is said to have kissed the patient when she was a young girl and the result was that Dora`s sexual excitement was reversed into feelings of displeasure. (28) Freud also points to an instance of displacement related to this trauma. That is, instead of reacting to the kiss with genital excitement, Dora`s mucus membranes secreted fluid and thus helped cause the aforementioned displeasurable sensations. (29)
Freud continues by noting that three symptoms were created through one traumatic instance. These three symptoms include the following:
On page 35 we find Freud making more comments regarding patient behaviour while in analysis. He notes that when a patient brings up a sound and incontestable argument during analysis, it soon becomes apparent that the patient is using thoughts of this kind for the purpose of cloaking other thoughts, which are said to be anxious to avoid criticism and consciousness. That is, such argumentation is an instance of defense. Freud also notes that "a string of reproaches against other people leads one to suspect the existence of a string of self-reproaches with the same content. In such instances, Freud suggests, all that is necessary is to turn such reproaches back onto the patient. This is a particularly interesting point, as we know in paranoids self-reproaches are projected onto others with there being no alteration in the content.
On page 40 Freud comments that hysterical symptoms require the participation of both an individual's somatic and psychical sides. In terms of cleaning up a symptom, he notes that the analyst is more interested in the patient's psychical symptoms. (41) In terms of self- reproaches, the analyst, Freud says, is usually faced with the task of guessing and filling n what the analysis offers to him or her in the shape of hints and allusions. (42)
In terms of the motives of the illness, Freud comments that the primary motive does not share in the formation of the illness and is not present at the beginning of the illness. (see: footnote 1: Freud comments that falling ill serves the function of economic, i.e., it saves the individual from psychical effort when there is mental conflict). The secondary motives, conversely, are said to be of an external nature. That is, some psychical current or event finds use of the motive and thus a resistance develops. (42)
Motives for becoming ill are said to begin in childhood. What Freud means by this is that a child quickly learns that illness is a means of eliciting the parents` love. Thus, Freud concludes that as soon as there is enough psychical material for the child to make use of, then the child will use that means of manipulation. Freud makes a characteristically sexist statement when he suggests that this is the basis of a female's manipulative behaviour as an adult and this behaviour is said to be transferred into the marriage situation. In such instances, says Freud, a state of ill health will in every appearance seem involuntary and objective. Therefore, the patient find themselves not required to feel any guilt or remorse as a result of the successful use of such means to gain attention that were learned in childhood. From this Freud concludes that illnesses of this kind (e.g., Dora`s case) are the result of the intention to gain attention. Such intentions are said to be leveled at a particular person and the illness is reported to vanish when that individual departs the scene. I is important to note, however, that such intentions are largely unconscious behaviors and to overlook this motivation of illness is only permissible in relations to children. Freud continues to comment that combating motives of illnesses is the weak point in every kind of therapeutic treatment of hysteria. Therefore, he concludes, the analyst need only remove the motive and the result might possibly be a permanent cure. (44-45)
Freud continues to make some last comments regarding motives of illnesses. He states that motives that support the patient in being ill are probably to be found in all fully developed cases of hysteria. (46) Freud notes that he has found it to be the case that at least one meaning of every hysterical symptom signifies the representation of a phantasm with a sexual content. That is, such meanings refer to a sexual situation (yet there may also be other meanings). (47)
On page 48f Freud argues for the propriety of sexual discourse in analytical treatment of the neuroses. He say that the analyst is not in a position to condemn the sexual phantasies of an individual. "The sexual life of each one of us," he writes, "extends to a slight degree-- now in this direction, now in that -- beyond the narrow lines imposed as a standard of normality." (49) That is, Freud wishes to point out that perversions are neither bestial nor degenerate in the emotional sense of the word. Rather, they are the development of germs contained in the undifferentiated sexual deposits of the child, which by being suppressed are diverted or sublimated to higher, asexual aims. They are "...destined to provide the energy for a great number of our cultural achievements." From this point of view, a person doe not become a gross pervert, rather he or she remains one. That is, the person exhibits a certain stage of inhibited development. "Psychoneuroses are," Freud concludes, "so to speak, the negative of perversions." (49) That is, they are the result of the disturbed development of normal sexuality.
On page 51 Freud writes the following: "The motive forces leading to the formation of hysterical symptoms draws their strength not only from repressed normal sexuality but also from unconscious perverse activities." He notes that it is often the case that a single symptom corresponds to several meanings simultaneously and/or in succession.(53)
Supervalent thoughts, like obsessions, are said to be symptomatic of melancholia and can be cleared up through psycho- analysis. Such thought consist of excessively intense trains of thought that must owe their reinforcement to the unconscious and are often directly contrary to a repressed thought. The relation between these two types of thoughts, repressed and supervalent, is said to be an affect of the process of repression. That is, repression is often achieved through excessive reinforcement of the held contrary to the one repressed. This called active reinforcement. Thoughts which assert themselves with excessive intensity and cannot be removed are conversely called reactive thoughts. Reactive thoughts keep objectionable thoughts (i.e., repressed) under repression through the surplus of intensity and therefore are themselves `dampened` and proof against conscious thoughts. (55)
In terms of Dora`s case, Freud points out that Dora wants to judge her father but is prevented from doing so because of the repressing force of such thoughts. In terms of the oedipal situation, Freud comments that he looks to such love relationships such as Dora`s as a result of the unconscious revival of feelings from infancy. (56) Thus in cases of denial, as in Dora`s, "The `no` uttered by a patient after a repressed thought has been presented to his [sic] conscious perception for the first time does no more than register the existence of a repression and its severity; it acts, as it were, as a gauge of the repression's strength." (58) In such situations, `no` means `yes.` (59) In this context Freud reminds us of the axiom: "Overdetermination is the rule." (60) Dora`s aetiologies, Freud notes, often had to do with her being loved only on account of her father and being `sacrificed` by such individuals for their own loves or lovers. (62)
The reader is advised to refer to the dream directly. This dream is said to be of a recurring nature. It is said to have to do with
(64) Freud asks the reader to compare this dream to the mechanisms described in The Interpretation of Dreams. He notes the following:
On page 69 Freud points out in a footnote that Dora`s reply of "I don't know" is a regular formula by which she confessed to anything that had been repressed.
Returning to dreams, we find Freud commenting that
"A regularly formed dream stands, as it were, upon two legs, one of which is in contact with the main and current exciting cause, and the other with some momentous event in the years of childhood. The dream sets up a connection between those two factors -- the event in early childhood and the event of the present day -- and it endeavors to re-shape the present in the model of the past. For the wish which creates the dream always springs from the period of childhood; and it is continually trying to summon childhood back into reality and to correct the present day by the measure of childhood." (71)
Freud continues the discussion by dealing with what he considers to be anticipated criticisms of his dream theory. (74ff)
On 110 Freud makes further comments as to the nature of the neurosis. He writes:
"[The] incapacity for meeting a real erotic demand is one of the most essential features for a neurosis. Neurotics are dominated by an opposition between reality and phantasm. If what they long for the most intensely in their phantasies is presented to them in reality, they nonetheless flee, from it; and they abandon themselves to their phantasies the most readily when [?] they need no longer fear to see them realized."
Nevertheless, the barriers caused by repression can fall before the onslaught of violent emotional excitements caused by a real event -- thus it is possible for a neurotic to be overcome by reality.
Freud cites several reason for not including the case material in this article. These reasons includes the following:
Freud comments that the technique alone was psychological, while the theory includes an organic basis in terms of the neurosis. (113)
Freud points out two objectives to this study, which are the following: 1) he wished to supplement The Interpretation of Dreams by showing how an art can be turned to account for the discovery of the hidden and repressed parts of mental life; and 2) Freud also wished to stimulate interest in the scientific world as a whole in a group of phenomena, which could only be brought about through this method. A final point is that he wanted to show that sexuality does not operate as a dues ex machina, on one singular occasion, but that it provides the motive power for every single symptom, and every single manifestation of a symptom. He writes, as evidence, the following: "The symptoms of the disease are nothing else than the patient's sexual activity. (114-115)
TRANSFERENCES: Transferences are defined here as follows: they are new editions of the impulses and phantasies, which arise and are made conscious during the progress of the analysis; but with a peculiarity which is characteristic of this species -- i.e., they replace some earlier person with the person of the physician. In other words, the earlier fixation is replaced by a later one upon the analyst. Thus, in the transference, "A whole series of psychical experiences are revived, not as belonging to the past, but as applying to the person of the physician at the present moment." (116)
Some transferences are said to proceed with no modification of content except the substitution of the object. In other cases, which are more ingeniously constructed, the content of the fixation is subjected to a modifying influence -- sublimation -- and may even become conscious by cleverly taking advantage of some real peculiarity in the doctor's person or circumstances and attaching themselves to that. Such transferences are called `revised editions.`
Freud points out the fact that transferences is an inevitable necessity in analyses. Practical experience shows that there is no way of avoiding the transference and that this criterion of the disease must be combated like al other manifestations of the neurosis. Still, Freud notes, that the peculiar setting of the transference makes it particularly difficult to work through. (116) "Psycho-analytic treatment," he writes, "does not create transferences, it merely brings them to light, like so many other hidden psychical features." (117) Thus transference can be the analyst's most powerful ally "if its presence can be detected each time and explained tot he patient." (117) That is, transference is the cause of all the patient's tendencies in the analysis (including hostile ones), which are aroused and then called into to account for purposes of analysis by being made conscious. Thus the transference is constantly being destroyed. (117)
Freud provides an example of the transference in Dora`s case. At one point the patient wanted to stop the treatment (the physical manifestation being a desire to leave). Freud explains this situation of an associative memory of the man involved in her trauma (Herr K) being reflected in the person of Freud. Thus she transferred this association onto Freud. Freud then comments upon his own failure to picked up on this transference which would have provided him an instance in which he may have resolved not only the transference but also the "problem" with Herr K as well as provide access to new memories which probably dealt with the actual events leading up to Dora`s illness. (118-119)
This text is considered to be one of Freud`s most original and momentous contributions, following The Interpretation of Dreams. It is also the second most modified text that Freud has produced. In fact the entire sections on the sexual theories of children and pregenital organizations of the libido (both in the second essay) were added 15 years after its first publication. Again there were some sections on the libido in the third essay that were rewritten in the 1920`s in relation to new thoughts as to the bio-chemical processes and sexuality. (126)
In 1897 Freud abandoned the seduction theory and almost simultaneously discovered the Oedipal complex through self-analysis. This development led inevitably to the realization that sexual impulses operated normally in the youngest children without any need of external stimulation. It is through "this realization Freud`s sexual theory was in fact completed." (128) Nonetheless, it took some time before Freud was entirely reconciled to this theory.
1914 EDITION (3RD): It is stated that it is impossible for the Three Essays to contain anything but what psychoanalysis makes it necessary or possible to be established, Therefore it is out of the question that they could ever be extended into a complete `theory of sexuality` and it is natural that there is a number of important problems to sexual life not dealt with by these theories. (130)
Freud points out that in the following essays various factors are placed in a particular order of precedence, which is as follows:
Freud writes, in explanation, "Ontogenesis may be regarded as a recapitulation of phylogenesis, in so far the latter has not been modified by more recent experience." (131) This makes it evident that the research herein is deliberately independent of the findings from the biological sciences. Instead, Freud writes "My aim has rather been to discover how far psychological investigation can throw light upon the biology of the sexual life of man [sic]." (131)
1920 EDITION (4TH): After the second world war much of Freud`s theories (e.g., repression, the unconscious, mechanisms involved in the formation of symptoms, etc.) had been generally accepted. Nonetheless, Freud`s theories on sexuality still had not been widely received. In defense of his theories on sexuality, Freud writes the following:
It must be remembered, however, that some of what this book contains -- its insistence in the importance of sexuality in all human achievements and the attempt that it makes at enlarging the concept of sexuality -- has from the first provided the strongest motives for the resistance against psycho-analysis. People have gone so far in their search for high sounding catch-words as to talk of the `pan-sexualism` of psycho-analysis and to raise the senseless charge against it for explaining `everything` by sex. We might be astonished by this, if we ourselves could forget the way in which emotional factors make people confused and forgetful. (134)
This section's title suggests an assumption of a sexual instinct. Freud begins the essay with two definitions: 1) sexual object: the person from whom sexual attraction proceeds; and 2) sexual aim: the act towards what the sexual instinct tends. (135-136) Freud points out that a number of deviations occur in respect to both the sexual object and aims.
1) DEVIATIONS IN RESPECT TO SEXUAL OBJECT
A) INVERSION:
I) THE BEHAVIOUR OF INVERTS: (homosexuals) is characterized by the following three points: i) there are no absolute inverts in which the sexual object is exclusively the same sex. ii) There exist what are called amphigenic inverts -- those that are psychosexual hermaphrodites, bisexuals. iii) there are also what are known as contingent inverts. Such individuals are said to be capable of taking as a sexual object someone of the other sex and deriving satisfaction through sexual intercourse with them. (136-137)
Freud then follows to provide some thoughts of inverts upon inversion. These thoughts are as follows: i) some see inversion as a natural tendency. ii) Others tend to believe that inversion is a pathological condition. That is, there are all kinds of variation in terms of the inception of inversion, the practice and so on. As a rule these different kinds of variations are found side by side and independent of one another. It is safe to assume that those who are the most inverted probably became as such at an early age. (137)
i) DEGENERACY: Freud points out that this is not a good word to use. To expound upon this position, he writes: "it seems wiser only to speak of it where (1) several serious deviations from the normal are found, and (2) the capacity for efficient functioning and survival seem to be severely impaired." (138) Freud even goes so far as to note that the facts show that inverts cannot be regarded as degenerate. The reasoning is as follows: 1) inversion is found in people who exhibit no other serious deviations from the norm; 2) inversion is similarly found in people whose efficiency is not impaired and who are, indeed, distinguished by specifically high intellectual development and ethical culture; and, 3) in the final analysis, two factors further make it impossible to regard inversion as degenerate: a) inversion was a frequent phenomena among peoples of antiquity, and b) inversion is remarkably widespread among many `savage` [sic] and primitive races, whereas the concept of degeneracy is usually restricted to the states of `higher civilization.` (139)
Thus we can see that it is Freud`s opinion, based upon the above criterion, that innate inversion is non-existent. Therefore Freud claims that inversion can only be explained as a frequent variation of the sexual instinct, which can be determined by a number of circumstances in a person's life. However, as Freud points out, many people are subjected to such experiences without ever becoming inverted or without remaining so permanently. Thus, Freud concludes, the distinction between innate and acquired inversion is not as exclusive as thought, because these distinctions do not cover all the issues involved in inversion. (140)
From the above Freud reaches two conclusions, which are as follows: 1) a bisexual disposition is somehow concerned in inversion (though we do not know in what that disposition consists) beyond anatomical structure; and 2) we must deal with the disturbances that affect the social instinct in the course of its development. (143-144)
Freud states that we are not in a position to base a satisfactory explanation of the origin of inversion upon the material thus far presented to us. Through a statement characteristic of later objects relations theory, Freud writes: "It seems probable that the sexual instinct is in the first instance independent of its object; nor is it origin likely to be due to its object's attractions." (148)
Freud characterizes this section with the statement that persons who make such object choices are usually considered to be sporadic aberrations. Still, it is important to note that the nature of the sexual instinct permits much variation in its objects and, as such, a cheapening of them. That is, we cannot ascribe to those into bestiality or to those who chose children as sexual objects to be insane. That is, experience shows that disturbances of the sexual object among the insane are not sufficiently different from the so- called `sane`. "The insane," writes Freud, "merely exhibit any such aberration to an intensified degree; or, what is particularly significant, it may become exclusive and replace normal sexual satisfaction completely." (148-149) Freud is inclined to believe that sexual variations are explicable by the fact that sexual impulses are the least controllable by the higher mental functions. To this end he writes the following:
In my experience anyone who is in any way, whether socially or ethically, abnormal mentally is invariably abnormal also for his sexual life. But many people are abnormal in their sexual life who in every other aspect approximate the average, and have, along with the rest, passed through the process of human cultural development, in which sexuality remains the weak spot. (149)
The normal sexual aim is coitus, which is said to lead to a release of sexual tension and a temporary extinction of the sexual instinct. (149) Perversions, conversely, are sexual acts which either: 1) extend, anatomically, beyond regions of the body are designed for sexual union; or, 2) linger over the intermediate relations to the sexual object which should not normally be traversed rapidly on the path towards the final sexual aim. (150)
Note: Freud`s usage of the term perversion is very specific. Any sexual activity, he claims, that does not function to aid reproduction is considered to be a perversion. Thus any sexual activity other than coitus is considered to be perverted.
Returning to the discussion on disgust, Freud points out that "Disgust seems to be one of those forces which have lead to a restriction of the sexual aim." However i is the sexual instinct, notes Freud, which tends to enjoy overriding this disgust.
In fetishism is seems that some degree of diminution in the urge towards the normal sexual aim is necessary. What usually follows is an over-valuation of the object which invariably extends to everything that is associated with it. Fetishized situations are said to be pathological only when the following conditions are present: 1) the longing for the fetish passes beyond the point of merely being a necessary condition attached to a sexual object and thus takes the place of the aim itself; and 2) when the fetish become detached from a particular individual and becomes the sole sexual object. (154) Freud states that the replacement of an object by a fetish is determined by symbolic connections of though to which a person is usually not conscious.
1) APPEARANCE OF NEW AIMS: Any external or internal factors that hinders or postpones attainment of the normal sexual aim will lend support to the tendency to linger over predatory actions to turn and take new sexual aims in replacement. (155)
2) TOUCHING AND LOOKING: Both can be scarcely considered to be perversions so long as in the long run the sexual act is carried out. (156) Conversely, scopophilia becomes a perversion when the following conditions apply: 1) it is restricted exclusively to the genitals; 2) it is connected to an overriding disgust; or, 3) it supplants the normal sexual aim. (157)
3) SADISM AND MASOCHISM: These are said to be the most common and significant of the perversions. Sadism is said to be active in nature, while masochism is said to be passive. The roots of sadism are said to be the following: 1) there is an element of aggressiveness (especially in the male) which is characterized as an desire to subjugate. Therefore sadism is said to correspond to a component sexual instinct which has become independent and exaggerated. It is through a displacement that sadism is said to usurp the leading position of the sexual instinct.
Conversely masochism is described to be the situation in which satisfaction is conditional upon suffering, either physically or mentally, at the hands of the sexual object. (157) Masochism, Freud points out, is nothing more than an extension of sadism turned upon the subject's self, which then takes the place of the sexual object. (158) The most remarkable feature of this perversion, says Freud, is that its active and passive forms are habitually found to occur together in the same individual. In other words, it is often the case that one person is capable of experiencing both aspects. Freud writes: "A sadist is always at the same time a masochist." This is so even if the active/passive dichotomy is strongly developed. (159) Therefore, Freud concludes, it is often the case that impulses to perversions often appear in pairs. Such correspondences in one person, he continues, may be due to the bisexuality of humans. (160)
A) VARIATION AND DISEASE: Perversion, Freud notes, are not cases of degeneracy nor disease. That is, these extensions are constituents which are rarely absent from the sexual life of normal people and are judged by them as not different from other intimate events. (160) Freud notes that the particular character in perversions are found to not lie in the content of the new sexual aim but in its relations to the normal. A perversion therefore is pathological if it has the characteristics of exclusiveness and fixations (over the normal sexual aim). (161)
THE MENTAL FACTOR IN PERVERSION: It is with the most repulsive perversion, Freud notes, that the mental factor enters into the transformation of the sexual instinct. (161)
PSYCHO-ANALYSIS: Psychoanalysis is described as a means to gaining information that is not false. The contributions of the energy from the sexual instinct (libido) is said to be the most constant source of energy in neurosis. Therefore the sexual life of such people is expressed by such symptoms. (163) The removal of hysterical symptoms proceeds through the assumption that such symptoms are substitutes for a number of emotionally cathected mental processes, wished and desires, which, through repression, have been prevented discharge in terms of psychical activity that is admissible by consciousness. (164)
FINDINGS OF PSYCHO-ANALYSIS: Therefore the symptoms of a neurotic represent a substitute for the impulses whose source is the strength of the sexual instinct. (164) Psychoanalysis can clear up the hysteric's predominantly developed sexual instinct by revealing the pair of opposites by which it is characterized. One such pair of opposites, for example, might include an exaggerated sexual craving and an excessive aversion to sexuality. Thus, the hysteric, caught between the pressures of the sexual instinct and the neurotic antagonism to sexuality, that "illness offers...a way to escape." (165) This is accomplished by the transformation of libidinal impulses into symptoms of the neurosis.