In 1905 Sigmund Freud wrote his ‘Fragment of an Analysis of Hysteria (Dora)’, as a case study hoping to substantiate his earlier theory of hysterical symptoms and their psychical/sexual basis.
His chosen case study was Dora, who we now know to be Ida Bauer (1882-1945), and his analysis with her lasted a grand total of 3 months before she ended it.
Though I want to be a clinical psychologist, not a psychoanalyst, psychoanalytic theory has contributed major insights for all forms of psychotherapy, so of course I had to read Freud. These days people don’t take everything he said very seriously, but some of his insights have seeped thoroughly into the cultural mindset and are pretty much taken for granted. We all know what a ‘Freudian slip’ is, and aren’t too shocked by the idea that people might unwittingly ‘marry their mothers/fathers’.
But when I read this case I was horrified. So much of it felt completely wrong, misguided, and to a truly dangerous extent. I felt overwhelmingly sorry for Dora having to listen to him and having to suffer his arrogant and all-knowing tone, disregarding her account of the events and her experience of her problems so entirely.
Reading the case made me vow to be a better, more open-minded, flexible, clinical psychologist in the future, and make sure that no client is ever treated so badly as Dora was by Freud. The case of Dora is also an example of something else I feel very strongly about – the problem that society seems to have with believing women’s accounts of sexual assault and trauma. I will write a separate post about that issue, but alongside my work as a psychologist I always want to work at improving the situation of sexual assault survivors, and finding ways that we can better listen to their experiences and learn how to help them.
Back to the case.
While there is a lot that is still worthy of interest in the study, i.e. the psychosomatic explanation of her physical symptoms, and his first explanation of transference; I think mainly the study is interesting in a ‘how not to be a psychologist’ way.
Freud was called in by Dora’s father to treat his daughter of her hysterical symptoms. Freud understood Dora’s physical symptoms as stemming from unresolved psychical and sexual trauma, which he first posited as resulting from Dora’s father’s friend (Herr K) declaring his love to Dora and trying to kiss her when she was 14. This was especially traumatic because Dora’s father was having an affair with Herr K’s wife (Frau K), and so Dora’s father joined Herr K in denying that the sexual assault ever happened in the first place, because in supporting Herr K he would himself be allowed to continue his illicit affair with Frau K. Dora’s father essentially chose his new mistress over his daughter.
Hearing this story we are probably likely to agree that his situation would cause Dora some distress, which of course could reveal itself as physical symptoms! (I like the case for how it connects the psychological with the physical). But Freud twists it further and further, unable to let Dora remain ‘innocent’ in the events. He says that she was only negatively affected by the proposition from Herr K because she actually loved him, and was pleased by his advances. Freud writes: ‘That was surely a situation that should have produced a clear sensation of sexual excitement in a fourteen-year-old girl who had never been touched by a man.’ (452).
Because Freud can’t believe that Dora wouldn’t have been sexually excited by Herr K’s advances, he claims that ‘affective reversal’ must have happened, which served to hide her enjoyment of the situation. He goes on to say that Dora was complicit in wanting Herr K’s affection, because she actually had homosexual feelings for Frau K (linked to her wanting to be Frau K and gain her father’s affection), and then even adds himself into the mix and says that Dora had sexual feelings for him too which was why she disagreed with his interpretation of the events and her underlying issues.
Another frustrating part of the case: Freud even has the temerity to write, ‘I shall pass over the details which proved all these hypotheses completely correct…’ and then just expects us to take his word for it.
But, unfortunately, though he seems to me to get all of Dora’s ‘motives’ wrong, I think his suggestion that physical illnesses can sometimes have a psychological motive to be an interesting one. I am not wholly against the idea that at least some of her physical symptoms were cries for help or attention, in a world where no one seemed to be taking her account of the events seriously. No one believed her when she said she wasn’t sexually attracted to Herr K, Frau K, her father, and Freud. Instead they (mainly Freud) fabricated all sorts of elaborate sexual fantasies for her, and made it impossible for her to deny any of them. In that kind of situation it seems to make intuitive sense that she might have developed some kinds of physical ailments which might have been ‘medically unexplained’. If words can’t speak for her, perhaps her body might be able to?
So when Freud writes: ‘illness becomes the only weapon with which she can assert herself in life’ (466), I can’t help but agree with him, but I think he was horribly and painfully clueless about what Dora might have been trying to assert. She clearly found that the case too, and I hope we are now as a world much better at listening to women and taking their trauma stories and physical complaints seriously.