Pages 11-14. There is much to ponder here, and many insights to win.
The ambition of Charcot’s followers was to surpass his work by demonstrating the causes of hysteria. Each wanted to be the first to make the great discovery. In pursuit of their goal, these investigators found that it was not sufficient to observe and classify hysterics. It was necessary to talk with them. For a brief decade men of science listened to women with a devotion and a respect unparalleled before or since.
These investigations bore fruit. By the mid 1890’s both Janet in France and Freud in Vienna had arrived independently at strikingly similar formulations: hysteria was a condition caused by psychological trauma. Unbearable emotional reactions to traumatic events produced an altered state of consciousness, which in turn induced the hysterical symptoms. Janet called this alteration in consciousness “dissociation” and Freud and Breuer “double consciousness.”
Both Janet and Freud recognized the essential similarity of altered states of consciousness induced by psychological trauma and those induced by hypnosis. Janet believed that the capacity for dissociation or hypnotic trance was a sign of psychological weakness and suggestibility. Breuer and Freud argued, on the contary, that hysteria, with its associated alterations of consciousness, could be found among “people of the clearest intellect, strongest will, greatest character, and highest critical power”.
Both Freud and Janet recognized that the somatic symptoms of hysteria represented disguised representations of intensely distressing events which had been banished from memory. Janet described his hysterical patients as governed by “subconscious fixed ideas”, the memories of traumatic events. Breuer and Freud, in an immortal summation, wrote that “hysterics suffer mainly from reminiscences.”
By the mid 1890’s these investigators had also discovered that hysterical symptoms could be alleviated when traumatic memories, as well as the intense feelings that accompanied them, were recovered and put into words. This method of treatment became the basis of modern psychotherapy.. .
In spite of an ancient clinical tradition that recognized the association of hysterical symptoms with female sexuality, Freud’s mentors, Charcot and Breuer, had been highly skeptical about the role of sexuality in the origins of hysteria. Freud himself was initially resistant to the idea: “When I began to analyze the second patient . . .the expectation of a sexual neurosis being the basis of hysteria was fairly remote from my mind. I had come fresh from the school of Charcot, and I regarded the linking of hysteria with the topic of sexuality as a sort of insult–just as the women patients themselves do.
This empathic identification with his patients reactions is characteristic of Freud’s early writings on hysteria. His case studies reveal a man possessed of such passionate curiosity that he was willing to overcome his own defensiveness, and willing to listen. What he heard was appalling. Repeatedly his patients told him of sexual assault, abuse, and incest. Following back the thread of memory, Freud and his patients uncovered major traumatic events of childhood concealed beneath the more recent, often relatively trivial experiences that had triggered the onset of hysterical symptoms. By 1896 Freud believed he had found the source. In a report on on 18 case studies, entitled “The Aetiology of Hysteria”, he made a dramatic claim: “I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurences which belong to the earliest years of childhood, but which can be reproduced through the work of psycho-analysis in spite of the intervening decades. I believe that this is an important finding, the discoverty of a caput Nili in neuropathology.”
A century later, this paper still rivals contemporary clinical descriptions of the effects of childhood sexual abuse. It is brilliant, compassionate, eloquently argued, closely reasoned document. Its triumphant title and exultant tone suggest Freud viewed his contribution as the crowning achievement in the field.
Instead, the publication of “The Aetiology of hysteria” marked the end of this line of inquiry. Within a year, Freud had privately repudiated the traumatic theory of the origins of hysteria. His correspondance makes clear that he was increasingly troubled by the radical social implications of his hypothesis. Hysteria was so common among women that if his patients stories were true, and if his theory were correct, he would be forced to conclude that what he called “perverted acts against children” were endemic, not only among the proletariat of Paris, where he had studied hysteria, but also among the respectable bourgeois families of Vienna, where he had established his practice. This idea was simply unacceptable. It was beyond credulity.
Faced with this dilemna, Freud stopped listening to his female patients. The turning point is documented in the famous case of Dora. This, the last of Freud’s case studies on hysteria, reads more like a battle of wits than a cooperative venture. The interaction between Freud and Dora has been described as “emotional combat”. In this case, Freud still acknowledged the reality of his patient’s experience: the adolescent Dora was being used as a pawn in her father’s elaborate sexual intrigues. Her father had essentially offered her to his friends as a sexual toy. Freud refused, however, to validate Dora’s feelings of outrage and humilitation. Instead he insisted on exploring her feelings of erotic excitement, as if the exploitative situation were a fulfillment of her desire. In an act that Freud viewed as revenge, Dora broke off treatment.
The breach of their alliance marked the bitter end of an era of collaboration between ambitious investigators and hysterical patients. For close to a century these patients would again be scorned and silenced. Freud’s followers held a particular grudge against the rebellious Dora, who was later described by a disciple as “one of the most repulsive hysterics he had ever met”.
Out of the ruins of the traumatic theory of hysteria, Freud created psychoanalysis. The dominant theory of the next century was founded in the denial of women’s reality. [emphasis mine]