In 1881, a young woman in Vienna discovered she had lost her native German tongue. She could speak nothing but English. Bertha Pappenheim was diagnosed by her doctor with hysteria. The symptoms included contractures, hallucinations, and aphasia ― the loss of basic functions such as language. They were resistant to conventional treatment; and so Pappenheim became the first ever patient of psychoanalysis. Her name, in one of the practice’s foundational texts, Studies on Hysteria, is Anna O.
The original patient of psychoanalysis was never treated by the father of psychoanalysis, Sigmund Freud; she was treated instead by its John the Baptist, Josef Breuer, who co-wrote Studies on Hysteria. “The discovery of Breuer’s,” wrote Freud of his colleague in 1917, “is still the foundation of psycho-analytical theory”. What Breuer discovered, and Freud later developed, was that neurotic conditions could be treated by a “talking cure”. By talking about her childhood experiences to the analyst, the patient can relieve herself of the disorders that burden her — and subsequently alleviate, with the help of the analyst, the physical manifestations of such disorders.
Psychoanalysis, then, is medical treatment by language. Adam Phillips, one of the leading psychoanalysts in England, writes that “Freud was as much, if not more, of writer than a doctor”. Like the Fin-de-Siècle writers who uncovered the dark undercurrents of bourgeois conventions, or the modernist writers who questioned coherent narratives, Freud was an integral part of the lively intellectual culture that witnessed the collapse of the Austro-Hungarian Empire and much of continental Europe. And it was very much a literary culture.
To briefly psychoanalyse: as a child Freud was gifted at languages, became familiar with Greek, Latin, Spanish, Italian, French and English. And yet it was medicine he ultimately studied at the University of Vienna: as the firstborn son, he wanted to be dutiful and serve his impoverished family.
All of which begs the question that haunts his legacy: did his treatment work?
Mikkel Borch-Jacobsen, in Freud’s Patients: A Book of Lives (out last month), thinks not. “Freud’s cures were largely ineffectual,” he writes, “when they were not downright destructive”. Borch-Jacobsen examines 38 patients Freud treated in his 50-year practice, but his book is concerned less with the efficacy of psychoanalysis and more with portraying, in selective but vivid detail, the individuals Freud treated. “We all know the characters described by Freud in his case studies,” he writes, “but do we know these illustrious pseudonyms?” His book is “an attempt to reconstruct the sometimes comical, most often tragic and always captivating stories of these patients who have long been nameless and faceless”.
Anna Von Lieben, referred to as Cäcilie M by Freud, was his most important patient for a period of six years, beginning in 1887. She was, Borch-Jacobsen writes, part of the “Viennese Jewish upper bourgeoisie”: brought up in a palace, where her family hosted Brahms, Strauss and Liszt. She was treated in Paris by Freud’s hero, Jean-Martin Charcot, otherwise known as the Napoleon of Neuroses. In Vienna, she was also a patient of Breuer.
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