STUDIES ON HYSTERIA is the fascinating account of the invention of the first scientific method for analyzing the human mind. Leaving aside the question of what share of the book should be attributed to each author, we can follow the first steps in the invention of free-association psychoanalysis as the method was developed and as its originators overcame the obstacles that questioned its validity. The five case histories illustrate these obstacles and the manner in which Breuer and Freud developed the tools of psychoanalysis as a way to treat hysteria.
The first part of STUDIES ON HYSTERIA is the essay “on the Psychical Mechanism of Hysterical Phenomena: Preliminary Communication,” which first appeared in 1893. This is a consideration of the nature of hysteria. The authors say that they have sought the cause of the illness and have found that it lies in the subject’s past even though the subject is unable to recollect it unless he is under hypnosis. Each symptom of the illness, however varied, is related to that event in the subject’s life and forms a clearly evident connection to it. Any experience which calls up distressing effects may be the type of psychical trauma that is a cause of later hysteria. The particular type that interests Breuer and Freud is the one that the subject represses; because he has forced it into his unconscious, it persists and, unlike conscious recollections, is a cause of hysteria. The psychologists were greatly surprised when they discovered that the hysterical symptoms immediately and permanently disappeared the moment that the original event and its accompanying affect were recognized by the subject. These psychical events, in other words, no longer cause hysteria when the patient has discharged the affects.
Because such events are completely absent from the subject’s mind when he is in a normal psychical state, the analysts used hypnosis; under the effects of hypnosis the subject can remember things that he has repressed, thereby making reaction possible. Hypnosis can do so because it splits the subject’s consciousness, the basic phenomenon of neurosis. It allows the subject to articulate the strangulated effect and, by introducing it into his consciousness, to remove it by the physician’s suggestion.
The second part of STUDIES ON HYSTERIA is the five case histories in which the remarks of the first part are illustrated. The first case history (Breuer’s patient, Fraulein Anna O.) demonstrated the amnesia characteristic of hysteria and the realization that behind the conscious mind there lay an unconscious mind. The way to get into this unconscious mind was hypnotic suggestion: the analyst got the patient to begin talking and then listened to the patient’s ramblings without interrupting. But the case history of Frau Emmy von N. (Freud’s patient) shows the obstacles in this approach: (1) Freud was not adept at hypnotism, and (2) the patient often resisted treatment. Herein lay the seeds for Freud’s entire career. The third case history, Miss Lucy R., was analyzed in a normal state of consciousness because Freud was unable to hypnotize her; this important case was the beginning of psychoanalysis as Freud was to develop it during the remainder of his career. The fourth case history, Katharina, is little more than a conversation, but through it Freud discovered that in the case of hysteria based on sexual traumas pre-sexual impressions were of utmost importance. The fifth case history, Fraulein Elisabeth von R., concerns what we would now call a psychosomatic condition, paralysis caused by psychical trauma. This was a case of symbolism: the patient had symbolically expressed her painful thoughts in her legs.
The third part of STUDIES ON HYSTERIA, written by Breuer, is a further discussion of the ideas introduced in Part I. Breuer divided this essay into six sections, each of which carries his considerations deeper than the previous one. The first section—“Are All Hysterical Phenomena Ideogenic?”—deals with the origin and determination of hysteria. Breuer and Freud differ from the then current thought that all pathological phenomena are caused by ideas because they feel that some of the phenomena of hysteria are caused by physical mechanism and...
(The entire section is 1750 words.)