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Freud's Early Therapy Experiences

Freud initially did not want to try Breuer's talking cure on his own patients. For one thing, he knew that Bertha Pappenheim had not been cured.

Freud's wife ran into Bertha five years after Breuer stopped treating her. Bertha said she was still having hallucinations at night plus other serious symptoms. Breuer himself said he wondered if she might be better off dead.

How did Freud know the "talking cure" had not produced a lasting cure? How was Bertha honored later in life?

Over the long run, Bertha Pappenheim improved, and she went on to lead a productive life. She started the first orphanage for Jewish girls in Germany.

Her image appeared on a German postage stamp honoring her for this achievement. This was years before anybody realized she was the patient called "Anna O."

However, when Freud first heard about the case, the talking cure appeared to have failed. Bertha herself (in later life) offered scathing opinions about psychoanalysis, Freud's technique, which she regarded as ineffective.

Freud kept using the methods he had been taught in medical school. These included massage, sedative drugs, rest, and a technique called electrotherapy, in which mild electric current was applied to the body.

As Freud gained experience, he increasingly suspected that none of his techniques had a genuine healing effect. What really helped his patients when they appeared to improve, he suspected, was the belief they were going to get well.

Today we would call this a placebo effect or suggestion. It is a powerful effect–basically the same thing as hypnosis–but Freud wanted a technique that could do more than suggestion by itself.

In 1889, Freud decided to try Breuer's talking cure. He tried to hypnotize his patients and lead them back in their memories to see if some traumatic incident might underlie the symptoms of hysteria.

Following Breuer's model, Freud encour­aged his patients to relive traumatic incidents from early life with a great flood of emotion. Sure enough, he was able to rid his patients of hysterical symptoms, using this technique.

What is abreaction? Catharsis?

Freud called the act of emotional recollection abreaction. The ancient Greeks called it catharsis.

Catharsis means a cleansing in Greek. It occurs when people pour out their emo­tions, then feel better. Cathar­sis is implied by the expression "a good cry."

Aristotle used the concept to explain why theater audiences enjoyed tragedies and sad music. He said they identified with the tragedies shown onstage, sympathized with the emotions, and experienced the same cleansing effect from expressing their emotions.

How did Freud know about catharsis? What was the "new wrinkle" in Freud's cathartic method?

Catharsis was a popular concept in Vienna during Freud's time, assuming "the proportions of a craze" (Sulloway, 1978). Freud's wife had an uncle who wrote about catharsis, and his work inspired over 140 German-language publications on catharsis.

This was all before Freud began using his cathartic method. The systematic search for early memories, in order to relate them to current symptoms and eliminate those symptoms, was a new wrinkle in Freud's therapy.

In his early theories, for the first fifteen years or so of his career, Freud theorized that psychic energy (what he later called libido) was tied up in keeping down or repressing traumatic memories. Freud viewed catharsis as a way of releasing that energy so the patient could regain normal strength and energy.

Freud found that he had difficulty hypno­tizing some patients, but he could get similar results without hypnosis. He had patients relax in a dimly-lit room, facing away from him to avoid distraction.

He assured patients they could remem­ber long-lost traumatic episodes of their lives. If they protested that they had no such memories, Freud urged them to try harder, to look for little scraps or pieces of memory and use these to retrieve larger and larger segments. Given plenty of time and encouragement, people could always remember events that explained their hysterical symptoms.

Freud Discovers Childhood Sexual Abuse

In Freud's opinion, his new method produced longer-lasting relief than hypnosis. His patients retained a clear memory of the therapy itself. They could think about what they learned while they were away from the doctor. Because the technique did not require hypnosis, it could be used on anybody.

With uncanny reliability, the procedure revealed traumatic incidents responsible for the first symptoms of hysteria. For example, an eighteen-year-old girl who was troubled by anxiety attacks and shortness of breath lost her symp­toms when (with great out­pouring of emotion) she remem­bered her father's attempt to seduce her when she was fourteen.

Another patient, secretly in love with her sister's husband, was cured when she remembered standing at her dying sister's bedside and thinking a forbidden thought: "Now he is free again and I can be his wife." When she remembered the incident, her anxiety symptoms became worse for a time, then her symptoms went away.

By 1896, Freud claimed to see a definite pattern in memories his patients ex­pressed during cathartic episodes. They always involved sex.

What pattern did Freud claim to have found, by 1896?

In fact, with a little prodding, every one of his patients could remember being victimized by seduction attempts during childhood. Freud wrote:

The event of which the subject has retained an unconscious memory is a precocious [unusually early] experience of sexual relations with actual excitement of the genitals, resulting from sexual abuse committed by another person; and the period of life at which this fatal event takes place is earliest youth–the years up to the age of eight or ten, before the child has reached sexual maturity. A passive sexual experience before puberty: this then is the specific aetiology [cause] of hysteria.

...In some eighteen cases of hysteria I have been able to discover this connection in every single case and, where the circumstances allowed, to confirm it by therapeutic success. (1962/1896, p.199)

What did Freud think was the specific cause of hysteria?

Then Freud changed his mind. In a decision still hotly debated, Freud declared that many of these memories were phantasies or confabulations (false memories) rather than actual recollec­tions of seduction attempts.

It did not matter to Freud if the memories of sexual abuse in childhood were accurate or not; they reflected what he believed was a universal emotional drama of childhood. Repression, Freud decided, was not an attempt to avoid actual painful memories; it was a way of fighting off forbidden impulses or phantasies of the id.

Some present-day psychologists think Freud was probably correct that many memories produced by his early therapy efforts were confabulations. People confabulate readily under states similar to hypnosis, and leading questions cause false memories that are later mistaken as real.

Freud was encouraging particular types of memories under a state resembling hypnosis. Therefore he probably did produced confabulations or perhaps a mix of true and false memories.

However, advocates for victims of child abuse tend to think Freud made a huge mistake in dismissing all eighteen early memories of sexual abuse. Childhood sexual abuse does occur and can cause troubling effects later in life.

The accuracy of memories recovered in therapy is always debatable. They are like memories retrieved under hyp­nosis. Some are detailed and accurate. Some are detailed and false. It is hard to tell them apart, unless a memory includes objective facts that can be checked.

Psychologist Linda Meyer Williams found that 38 of 100 women with a history of childhood sexual abuse documented in their hospital records could not remember the incidents as adults (Bower, 1993). However, memory for all life events is full of gaps. Elizabeth Loftus, a prominent memory expert, cited data showing memories of sexual abuse were forgotten (and remembered) at rates no different from other life experiences (Loftus, 1993).

Why did Freud change his mind and decide his patients were fabricating their memories? We cannot know for sure, but some scholars suggest Freud was influenced by his "nineteenth patient"–himself.

Freud carried out a very thorough (Freudians said "heroic") self-analysis in 1897. During that time, Freud decided he and his brothers and sisters all showed signs of hysterical behavior.

If these symptoms were linked to actual childhood sexual experiences, it would imply Freud's father molested his chil­dren. That was unthinkable, so (accord­ing to this theory) Freud decid­ed his patients' early recollections were phan­tasies. That let his father off the hook.

How might his "19th patient" have influenced Freud?

There is other evidence that Freud had a hang-up about guilty fathers. Florence Rush, who researched the topic for her book, The Best Kept Secret, pointed out that Freud went to extraordinary lengths to avoid blaming fathers in print, even when it meant changing the facts. Freud referred to seductions by governesses, sisters, brothers, aunts and uncles, but never fathers.

One case described earlier–the 18-year-old who was molested at age 14–was initially published in an article where Freud blamed her uncle. Only 30 years later, in 1925, did Freud reveal that the "uncle" was actually her father.

What is evidence that Freud avoided blaming fathers?

Perhaps some of Freud's patients retrieved genuine memories and others were having false memories because of Freud's probing questions. It seems unlikely all 18 were making up their memories, but it also seems unlikely that 18 patients in a row suffered from the same problem.

What did Freud eventually decide?

With time, Freud started to put less emphasis on recollections. Eventually Freud stopped trying to eliminate symptoms one by one and concentrated on long-lasting change in the whole person (a goal he never achieved, according to some critics–Freud only published a handful of case histories, and none showed consistent long-term improvement).

Freud never minimized the impor­tance of catharsis. He wrote in 1924:

The cathartic method was the immediate precursor of psycho-analysis; and, in spite of every extension of experience and every modification of theory, is still contained within its nucleus. (Freud, 1924)

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References:

Bower, B. (1993) Sudden recall. Science News, 144, 184-186.

Freud, S. (1924) A Short Account of Psychoanalysis. In The Standard Edition of the Works of Sigmund Freud, Vol. 19. J. Strachey (Ed.) London: Hogarth Press.

Freud, S. (1962/1896). Further remarks on the neuro-psychoses of defense. In The Complete Psychological Works of Sigmund Freud: The Standard Edition, vol. 3. J. Strachey (Ed.) London: Hogarth Press.

Loftus, E. F. (1993). The reality of repressed memories. American Psychologist, 48, 518-537.


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