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Fragment of an analysis of a case of hysteria ['Dora']

Freud, Sigmund 1905e [1901], 'Fragment of an analysis of a case of hysteria' ['Dora'], SE 7: 1-122; Penguin 1977, Freud Library Vol. 8. Completed first draft 24 January 1901 as 'Traum und Hysterie,' first published 1905 as 'Bruchstück einer Hysterie-Analyse' in Mschr. Psychiat. Neurol, 18 (4, 5), Oct., Nov., 285-310, 408-67. Other editions 1909, GS 1924, 1932, 1942, Collected Papers 1925, SE 1953, Penguin 1977, repr. in Penguin Freud Library 1990.

Prefatory Remarks. Penguin 35-43. (Mostly concerned with medical discretion.)
1 The clinical picture 15-63 Penguin 44-98
2 The first dream 64-93 Penguin 99-132
3 The second dream 94-111 Penguin 133-52
4 Postscript 112-122 Penguin 153-64

Indeed, I have not yet succeeded in solving the problem of how to record for publication the history of a treatment of long duration. As regards the present case, two circumstances have come to my assistance. In the first place the treatment did not last for more than three months; and in the second place the material which elucidated the case was grouped around two dreams (one related in the middle of the treatment and one at the end). The wording of these dreams was recorded immediately after the session, and they thus afforded a secure point of attachment for the chain of interpretations and recollections which proceeded from them. The case history itself was only committed to writing from memory after the treatment was at an end, but while my recollection of the case was still fresh and was heightened by my interest in its publication. Thus the result is not absolutely—phonographically—exact, but it can claim to possess a high degree of trustworthiness. 38

Precisely that portion of the technical work [41-42] which is most difficult never came into question with the patient; for the factor of 'transference', which is considered at the end of the case history [157 ff.] did not come up for discussion during the short treatment. (41-42)

1 The clinical picture Penguin 44-98

… the dream is one of the roads along which consciousness can be reached by the psychical material … ' 44

The dream, in short, is one of the détours by which repression can be evaded … 15 Penguin 44

I begin the treatment, indeed, by asking the patient to give me the whole story of his life and illness, but even so the information I receive is never enough to let me see my way about the case. The first account may be compared to an un-navigable river whose stream is at one moment choked by masses of rock and at another divided and lost among shallows and sandbanks. 16 P 45 I cannot help wondering how it is that the authorities can produce such smooth and precise histories in cases of hysteria. As a matter of fact the patients are incapable of giving such reports about themselves. P 45

… patients consciously and intentionally keep back part of what they ought to tell … 46

paramnesias 46

It is only towards the end of the treatment that we have before us an intelligible, consistent, and unbroken case history. 47

… we are obliged to pay as much attention in our case histories to the purely human and social circumstances of our patients as to the somatic data and the symptoms of the disorder. … family circumstances … 47

… eighteen-year-old girl … father was the dominating figure … late forties … his daughter … took all the more offence at many of his actions and peculiarities. 48

… unmistakably neurotic … sister … elder brother … hypochondriacal bachelor … mother … 'housewife's psychosis' 49

… brother … model … father and daughter on the one side and the mother and son on the other. 51

… 'Dora' neurotic symptoms … chronic dyspnoea … unilateral headaches 51 … migraine … tussis nervosa … loss of voice … hydrotherapy … local application of electricity … it was only her father's authority which induced her to come to me at all. … sixteen feverish disorder … appendicitis. 52

… Vienna 53 … letter in which she took leave of them … no serious suicidal intentions … first attack of loss of consciousness—an event which was subsequently covered by an amnesia … 53

It was merely a case of 'petite hystérie' … dyspnoea, tussis nervosa, aphonia, and possibly migraines, together with depression, hysterical unsociability, and a taedium vitae which was probably not entirely genuine. 54

… abundance of cases of hysteria … In not a single one of them have I failed to discover the psychological determinants which were postulated in the Studies, namely, a psychical trauma, a conflict of affects, and—an additional factor which I brought forward in later publications—a disturbance in the sphere of sexuality. It is of course not to be expected that the patient will come to meet the [54-55] physician half-way with material which has become pathogenic for the very reason of its effects to lie concealed; nor must the inquirer rest content with the first "no" that crosses his path. 54-55

… intimate friendship with a married couple … Frau K. had nursed him during his long illness … Herr K. had always been most kind to Dora. …
Dora had taken the greatest care of the K.'s two little children, and been almost a mother to them. 55

… lakes … Herr K. had had the audacity to make a proposal while they were on a walk after a trip upon the lake. … Herr K. had heard … that she took no interest in anything but sexual matters, and that she used to read Mantegazza's Physiology of Love and books of that sort … It was most likely, he [Herr K.] had added, that she had been over-excited by such reading ["Mantegazza's Physiology of Love and books of that sort"] and had merely 'fancied' the whole scene she had described. 56

"I myself [Dora's father] believe that Dora's tale of the man's immoral suggestions is a phantasy that has forced its way into her mind; and besides I am bound to Frau K. by ties of honourable friendship and I do not wish to cause her pain. The poor woman is most unhappy with her husband, of whom, by the by, I have no very high opinion. …" 56

You already know that I get nothing out of my own wife. 57

The experience with Herr K.—his making love to her … psychical trauma 57

58 When the first difficulties of the treatment had been overcome, Dora told me of an earlier episode with Herr K., which was even better calculated to act as a sexual trauma. She was fourteen years old at the time. Herr K. had made an arrangement with her and his wife that they should meet him one afternoon at his place of business in the principal square of B-- so a to have a view of a church festival. He persuaded his wife, however, to stay at home, and sent away his clerks, so that he was alone when the girl arrived. When the time for the procession approached, he asked the girl to wait for him at the door which opened on to the staircase leading to the upper storey, while he pulled down the outside shutters. He then came back and, instead of going out by the open door, suddenly [58-59] clasped the girl to him and pressed a kiss upon her lips. This was surely just the situation to call up a distinct feeling of sexual excitement in a girl of fourteen who had never before been approached. But Dora had at that moment a violent feeling of disgust, tore herself free from the man, and hurried past him to the staircase and from there to the street door. She nevertheless continued to meet Herr K. Neither of them ever mentioned the little scene; and according to her account Dora kept it a secret till her confession during the treatment. For some time afterwards, however, she avoided being alone with Herr K. The K.s had just made plans for an expedition which was to last for some days and on which Dora was to have accompanied them. After the scene of the kiss she refused to join the party, without giving any reason.
In this scene -- second in order of mention, but first in order of time -- the behaviour of this child of fourteen was already entirely and completely hysterical. I should without question consider a person hysterical in whom an occasion for sexual excitement elicited feelings that were preponderantly or exclusively unpleasurable; and I should do so whether or no the person were capable of producing somatic symptoms. The elucidation of this reversal of affect is one of the most important and at the same time one of the most difficult problems in the psychology of the neuroses. 58-9

In order to particularize Dora's case it is not enough merely to draw attention to the reversal of affect; there has also been a displacement of sensation. Instead of the genital sensation which would certainly have been felt by a healthy girl in such circumstance, Dora was overcome by the unpleasurable feeling which is proper to the tract of mucous membrane at the entrance to the alimentary canal—that is by disgust. 60

… another factor in operation. [Freud's footnote at this point mentions that Herr K. was 'still quite young and of prepossessing appearance. 60n.]

It is worth remarking that we have here three symptoms—the disgust, the sensation of pressure on the upper part of the body, and the avoidance of men engaged in affectionate conversation … 61

The pressure of the erect member probably led to an analogous change in the corresponding female organ, the clitoris; and the excitation of this second erotogenic zone was referred by a process of displacement to the simultaneous pressure against the thorax and became fixed there. 61

… always connected with her father. … could not forgive her father for continuing his relations with Herr K. and more particularly with Frau K. 63

true character of this 'friendship' 64

pretexts for seeing his friend again 65

When she was feeling embittered she used to be overcome by the idea that she had been handed over to Herr K. as the price of his tolerating the relations between her father and his wife; and her rage at her father's making such a use of her was visible behind her affection for him. At other times she was quite well aware that she had been guilty of exaggeration in talking like this. 66

… danger … companionship of a man who had no satisfaction from his own wife … Dora was still a child and was treated as a child by K. But as a matter of fact things were in a position in which each of the two men avoided drawing any conclusions from the other's behaviour which would have been awkward for his own plans. It was possible for Herr K. to send Dora flowers every day for a whole year while he was in the neighbourhood, to take every opportunity of giving her valuable presents, and to spend all his spare time in her company, without her parents noticing anything in his behaviour that was characteristic of love-making. 66

A string of reproaches against other people leads one to suspect the existence of a string of self-reproaches with the same content. All that need be done is to turn back each particular reproach on to the speaker himself. There is something undeniably automatic about this method of defending oneself against a self-reproach by making the same reproach against some one else. 67

But Dora herself had done precisely the same thing. she had made herself an accomplice in the affair … 67

… her last governess, an unmarried woman, no longer young, who was well-read and of advanced views. … suddenly Dora became hostile to her and insisted on her dismissal. 68

She saw that the governess was in love with her father. 68

… inference … that she had all these years been in love with Herr K. 69

Dora realized that the presence of the husband had the effect of making his wife ill, and that she was glad to [70-71] be ill so as to be able to escape the conjugal duties which she so much detested. 70-1

(It is a rule of psychoanalytic technique that an internal connection which is still undisclosed will announce its presence by means of a contiguity—a temporal proximity—of associations; just as in writing, if 'a' and 'b' are put side by side, it means the syllable 'ab' is to be formed out of them.) 71 [quoted by Derrida in 'Freud and the scene of writing'?]

The length of the attacks would then remain as a trace of their original significance. 71 [Derrida would have noticed this 'trace'.]

The hysterical symptom does not carry this meaning with it, but the meaning is lent to it, soldered to it, as it were … 73

I will pass over the details which showed how entirely correct all of this was … 75

Let us suppose then that a miracle-worker comes along and promises him to make his crooked leg straight and capable of walking. It would be unwise, I think, to look forward to seeing an expression of peculiar [76-77] bliss upon the man's features. 76-7

And yet illnesses of this kind are the result of [unconscious] intention. 77

No sooner had she grasped Herr K.'s intention than, without letting him finish what he had to say, she had given him a slap in the face and hurried away. Her behaviour must have seemed as incomprehensible to the man after she had left him as to us, for he must long before have gathered from innumerable small signs that he was secure of the girl's affections. In our discussion of Dora's second dream we shall come upon the solution of this riddle … 79

According to a rule which I had found confirmed over and over again by experience, though I had not yet ventured to erect [!] it into a general principle, a symptom signifies the representation—the realization—of a phantasy with a sexual content, that is to say, it signifies a sexual situation. 80

Anyone who takes up psychoanalytic work will quickly discover that a symptom has more than one meaning and serves to represent several unconscious mental processes simultaneously. And I should like to add that in my estimation a single unconscious mental process of phantasy will scarcely ever suffice for the production of a symptom. 80

Certain details of the way in which she expressed herself (which I pass over here, like most other purely technical parts of the analysis) … led me to see … 80

… her father, as a man, was without means, was impotent. 80

… spasmodic cough … exciting stimulus to a tickling in her throat, she pictured to herself a scene of sexual gratification per os between the two people … 81

J'appelle un chat un chat. 82 [Then why does he say it in French: because he doesn't?]

The right attitude is: 'pour faire une omelette il faut casser des œufs.' 82

… normal sexual life … 83

The sexual life of each one of us extends to a slight degree—now in this direction, now in that—beyond the narrow lines imposed as the standard of normality. The perversions are neither bestial nor degenerate in the emotional sense of the word. They are a development of germs all of which are contained in the undifferentiated sexual disposition of the child, and which, by being "sublimated" —are destined to provide the energy for a great number of our culture achievements. When, therefore, any one has become a gross and manifest pervert, it would be more correct to say that he has remained one, for he exhibits a certain stage of inhibited development. 84

The motive forces leading to the formation of hysterical symptoms draw their strength not only from [84-85] repressed normal sexuality but also from unconscious perverse activities. 84-5

… my experience in the clearing-up of hysterical symptoms has shown that it is not necessary for the various meanings of symptoms to be compatible with one another, that is, to fit together into a connected whole. It is enough that the unity should be constituted by the subject-matter which has given rise to all the various phantasies. 87

We have already learnt that it quite regularly happens that a single symptom corresponds to several meanings simultaneously. We may now add that it can express several meanings in succession. 87

These remarks would make it seem that the somatic side of a hysterical symptom is the more stable of the two and the harder to replace, while the psychical side is a variable element for which a substitute can more easily be found. 88

Contrary thoughts are always closely connected with each other and are often paired off in such a way that the one thought is excessively intensely conscious while its counterpart is repressed and unconscious. 89

She felt and acted more like a jealous wife—in a way which would have been comprehensible in her mother. … she was in love with him. [with her father] 90

I have shown at length elsewhere [1900a] at what an early age sexual attraction makes itself felt between parents and children, and I have explained that the legend of Œdipus is probably to be regarded as a poetical rendering of what is typical in these relations. 90-1

… the girl had brought forward and reinforced her old affection for her father in order to avoid any further necessity for paying conscious attention to the love which she had felt in the first years of her girlhood and which had now become distressing to her. 92

… a fact which I did not fail to us against her. 94

I must now turn to consider a further complication to which I should certainly give no space if I were a man of letters engaged upon the creation of a mental state like this for a short story, instead of being a medical man engaged upon its dissection. The element to which I must now allude can only serve to obscure and efface the outlines of the fine poetic conflict which we have been able to ascribe to Dora This element would rightly fall a sacrifice to the censorship of a writer, for he, after all, simplifies and abstracts when he appears in the character of a psychologist. But in the world of reality, which I am trying to depict here, a complication of motives, an [94-95] accumulation and conjunction of mental activities—in a word, overdetermination—is the rule. 94-95

Frau K. … feeling … which had that lady as it object … 95

… I have never yet come through a single psychoanalysis of a man or a woman without having to take into account a very considerable current of homosexuality. 95

… governess 95

… obliged the governess to leave 96

Frau K. … I then found that the young woman and the scarcely grown girl had lived for years on a footing of the closest intimacy. 96

We shall not be so far from solving it when we realize that thoughts in the unconscious live very comfortably side by side, and even contraries get on together without disputes—a state of things which persists often enough even in the conscious. 96

When Dora talked about Frau K., she used to praise her 'adorable white body' in accents more appropriate to a lover [96-97] than to a defeated rival. 96-97

2 The first dream Penguin 99-132

Here is the first dream as related by Dora: 'A house was on fire. My father was standing beside my bed and woke me up. I dressed quickly. Mother wanted to stop and save her jewel-case; but Father said: "I refuse to let myself and my two children be burnt for the sake of your jewel-case." We hurried downstairs, and as soon as I was outside I woke up.'

I argued in my book, The Interpretation of Dreams (1900a), that every dream is a wish which is represented as fulfilled, that the representation acts a disguise if the wish is a repressed one, belonging to the unconscious, and that except in the case of children's dreams only an unconscious wish or one which reaches down in the unconscious has the force necessary for the formation of a dream. 103

[Freud] 'I will explain that to you presently. …' 105

[Dora] 'I knew you would say that.' [that jewel-case = female genitals] 105

… and that you have decided to give up the treatment—to which, after all, it is only your father who makes you come. 106n

… they are warned not to "play with fire" … antithesis of "water" and "fire" … they will dream of fire and then try and put it out with water. I cannot say exactly. 107

Smoke, of course, fitted in well with fire, but it also showed that the dream had a special relation to myself … I would often say by way of rejoinder: 'There can be no smoke without fire!' … passionate smokers—as I am too, for the matter of that. … Herr K. had rolled a cigarette for her before he began his unlucky proposal. 109

… transference on to me—since I am a smoker too—I came to the conclusion that the idea had probably occurred to her one day during a session that she would like to have a kiss from me. This would have been the exciting cause which led her to repeat the warning dream and to form her intention of stopping the treatment. 110

Bed-wetting … likely cause … masturbation, a habit whose importance in the aetiology of bed-wetting in general is still insufficiently appreciated. … an admission that she had masturbated in childhood. 111

… father … handed on his venereal disease to her mother … gonorrhoea 112

… in my view the occurrence of leucorrhoea in young girls pointed primarily to masturbation, and I considered that all the other causes which were commonly assigned to that complaint were put in the background by masturbation. 112

'symptomatic act' 113

When I set myself the task of bringing to light what human beings deep hidden within them, not by the compelling power of hypnosis but by observing what they say and what they show, I thought the task was a harder one than it really is. He that has eyes to see and ears to hear may convince himself that no mortal can keep a secret. [78] If his lips are silent, he chatters with this finger-tips; betrayal oozes out of him at every pore. And thus the task of making conscious the most hidden recesses of the mind is one which it is quite possible to accomplish. 114 [Cf. Sherlock Holmes]

It is well know that gastric pains occur especially often in those who masturbate. According to a personal communication made to me by Wilhelm Fliess, it is precisely gastralgias of this character which can be interrupted by an application of cocaine to the "gastric spot" discovered by him in the nose, and which can be cured by the cauterization of the same spot. 115

Hysterical symptoms … form a substitute for masturbatory satisfaction … 116

… grain of sand around which an oyster forms its pearl. 120

The pride taken by women in the appearance of their genitals is quite a special feature of their vanity; and disorders of the genitals which they think calculated to inspire feelings of repugnance or even disgust have an incredible power of humiliating them, of lowering their self-esteem, and of making them irritable, sensitive, and distrustful. An abnormal secretion of the mucous membrane of the vagina is looked upon as a source of disgust. 121

The element of "jewel-case" was more than any other a product of condensation and displacement, and a compromise between contrary mental currents. 130

I may here add a few supplementary interpretations to those that have already been given. Penguin 145: n 1; beginning of the long footnote, which ends actually on page 146.

Behind the almost limitless series of displacements which were thus brought to light, it was possible to divine the operation of a single simple factor—Dora's deep-rooted homosexual love for Frau K. Penguin 145: n 1 (actually on page 146)

"You gave me a fortnight's notice, just like a governess." [Freud to Dora] 148

… Dora's father … had given his support to the treatment so long as he could hope that I should "talk" Dora out of her belief that there was something more than a friendship between him and Frau K. His interest faded when he observed that it was not my intention to bring about that result. I knew Dora would not come back again. Her breaking off so unexpectedly, just when my hopes of a successful termination of the treatment were at their highest, and her thus bringing those hopes to nothing—this was an unmistakable act of vengeance on her part. Her purpose of self-injury also profited by this action. No one who, like me, conjures up the most evil of those half-tamed demons that inhabit the human breast, and seeks to wrestle with them, can expect to come through the struggle unscathed. Might I perhaps have kept the girl under my treatment if I myself had acted a part, if I had exaggerated the importance to me of her [151] staying on, and had shown a warm personal interest in her—a course which, even after allowing for my position as her physician, would have been tantamount to providing her with a substitute for the affection she longer for? I do know not. Since in every case a portion of the factors that are encountered under the form of resistance remains unknown, I have always avoided acting a part, and have contented myself with practising the humbler arts of psychology. In spite of every theoretical interest and of every endeavour to be of assistance as a physician, I keep the fact in mind that there must be some limits set to the extent to which psychological influence may be used, and I respect as one of these limits the patient's own will and understanding. 150-1

Incapacity for meeting a real erotic demand is one of the most essential features of a neurosis. Neurotics are dominated by the opposition between reality and phantasy. 151

What are transferences? They are new editions or facsimiles of the impulses and phantasies which are aroused and made conscious during the progress of the analysis; but they have this peculiarity, which is characteristic of their species, that they replace some earlier person by the person of the physician. SE 7: 116 Penguin 157

Transference, which seems ordained to be the greatest obstacle to psychoanalysis, becomes its most powerful ally, if its presence can be detected each time and explained to the patient. 159

I have been obliged to speak of transference, for it is only by means of this factor that I can elucidate the peculiarities of Dora's analysis. Its great merit, namely, the unusual clarity which makes it seem so suitable as a first introductory publication, is closely bound up with its great defect, which led to its being broken off prematurely. I did not succeed in mastering the transference in good time. Owing to the readiness with which Dora put one part of the pathogenic material at my disposal during the treatment, I neglected the precaution of looking out for the first signs of transference, which was being prepared in connection with another part of the same material—a part of which I was in ignorance [sic]. At the beginning it was clear that I was replacing her father in her imagination, which was not unlikely, in view of the difference between our ages. She was even constantly comparing me with him consciously, and kept anxiously trying to make sure whether I was being quite straightforward with her, for her father "always preferred secrecy and roundabout ways." But when the first dream came, in which she gave herself the warning that she had better leave my treatment just as she had formerly left Herr K.'s house, I ought to have listened to the warning myself. "Now," I ought to have said to her, "it is from Herr K. that you have made a transference on to me. Have you noticed anything that leads you to suspect me of evil intentions similar (whether openly or in some sublimate form) to Herr K.'s? Or have you been struck by anything about me or got to know anything about me which has caught your fancy, as happened previously with Herr K.?" 160

… because of the unknown quantity in me which reminded Dora of Herr K., she took her revenge on me as she wanted to take her revenge on him, and deserted me as she believed herself to have been deceived and deserted by him. Thus she acted out an essential part of her recollections and phantasies instead of reproducing it in the treatment. What this unknown quantity was I naturally cannot tell. I suspect that it had to do with money, or with jealousy of another patient who had kept up relations with my family after her recovery. 161

The treatment, she had thought, was too long for her; she would never have the patience to wait so long. And yet in the first few weeks she had had discernment enough to listen without making any such objections when I informed her that her complete recovery would require perhaps a year. Her refusing in the dream to be accompanied, and preferring to go alone, also originated from her visit to the gallery at Dresden, and I was myself to experience them on the appointed day. What they meant was, no [162/120] doubt: "Men are so detestable that I would rather not marry. This is my revenge."
If cruel impulses and revengeful motives, which have already been used in the patient's ordinary life for maintaining her symptoms, become transferred on to the physician during treatment, before he has had time to detach them from himself by tracing them back to their sources, then it is not to be wondered at if the patient's condition is unaffected by his therapeutic efforts. For how could the patient take a more effective revenge than by demonstrating upon her own person the helplessness and incapacity of the physician? Nevertheless, I am not inclined to put too low a value on the therapeutic results even of such a fragmentary treatment as Dora's. 162

For four or five weeks after stopping the treatment she had been "all in a muddle", as she said. A great improvement had then set in; her attacks had become less frequent and her spirits had risen. 163

From the husband she drew an admission of the scene by the lake which he had disputed, and brought the news of her vindication home to her father. Since then she had not resumed her relations with the family. 163

Footnote 3 to Penguin page 163.
In the editions of 1909, 1912 and 1921 the following footnote appeared at this point: 'This, as I afterwards learnt, was a mistaken notion.' [end of Dora]

Superfluity of meanings: over-over-determination
multidirectional sexuality

service: two weeks notice: who is in whose service?

What remains untheorised in Freud's account is the relationship of power between him and Dora.

husbands-wives; fathers-mothers; employees-governesses [sic], maidservants etc.

Dora's father—Freud—Dora

Dora reverses the power relationship be giving Freud a fortnight's notice. She does not wish to be reinserted into a corrupt and inequitable system—the system MC of Freud's time and class.

New: 17 May, 2015 | Now: 17 May, 2015 | Garry Gillard | garrygillard[at]