32

expressed it, that at least frequently even during her worst states
“there sat a keen and quiet observer somewhere in a little corner
of the brain, who watched this crazy stuff.” This continuous exist-
ence of clear thinking during the predominance of the psychosis
produced a very remarkable expression. When after the end of the
hysterical phenomena, the patient merged into a transitory depres-
sion, she alleged among other childish fears and self-reproaches, that
she was not sick and that everything was only simulated. Similar
things had apparently occurred many times.

After the disease has run its course and the two states of con-
sciousness have fused together, the patients then regard themselves
on retrospection, as uncured personalities, who have known all this
nonsense. And they believe that they could have prevented every-
thing if they had wanted to, that is, that they have intentionally
produced this nuisance. This persistence of normal thinking during
the second state might have fluctuated very much quantitatively, or
might not have existed most of the time.

The surprising fact that from the beginning to the end of the
disease all stimuli originating from the second state, as well as their
results, had been removed through talking in the hypnotic state I
have already described. I have nothing to add except the assurance
that it was not a discovery of mine, which I have suggested to the
patient, but that I was most surprised by it, and only after a series
of spontaneous adjustments took place, there developed from it a
therapeutic technique.

A few words should also be said about the final recovery from the
hysteria. It proceeded in the manner described, under considerable
disturbance of the patient and with an aggravation of her psychic
state. One had the distinct impression that a large number of prod-
ucts of the second state, hitherto dormant, now forced themselves
into consciousness, that they were recalled even though at first again
in the condition seconde, but that they burdened and disturbed the
normal state. One will have to take into consideration the question
whether a psychosis with which a chronic hysteria ends up has not
the same origin also in other cases.

OBSERVATION II. MRS. EMMY VON N. (FREUD)

On the first of May, 1889, I became physician to a woman of about
forty years of age, whose suffering, as well as her personality, inspired
me with so much interest that I devoted to her a large part of my
time and made it my task to cure her. She was hysterical, and as I

33

Case Histories

I discovered that she could very easily be put into a somnambulic state,
I decided to treat her by that method of investigation in a state of
hypnosis which I had learned from Breuer’s history of his first patient.
It was my first effort in the management of this therapeutic method.
I was still far from mastering it, and, as a matter of fact, I have had
neither enough practice in the analysis of morbid symptoms nor have
I pursued them sufficiently and schematically. I will perhaps succeed
best in illustrating the state of the patient as well as the medical pro-
cedure, if I reproduce the notes which I made every evening during
the first three weeks of the treatment. Any better understanding
subsequently acquired will be appended in notes and additional remarks.

May 1, 1889. I found a still youthful looking woman with fine, char-
acteristically delineated features lying on a divan, a leather pillow under
her neck; her face betrayed a tense, painful expression, her eyes were
deep-set, her look downcast; her forehead was deeply wrinkled, and her
naso-labial folds deeply grooved. She spoke with effort in a low voice,
sometimes interrupted by a spastic speech impediment, which almost
approached stuttering. At the same time her entwined fingers showed
an incessant athetoid fidgetiness. She also frequently showed tic-like
twitches in her face and in the muscles of her neck, whereby single
muscles, especially the right sterno-cleido-mastoid, plastically stood out.
Besides that, she frequently interrupted herself while speaking to
produce a peculiar smacking, which I cannot imitate.¹

What she said was entirely coherent and seemingly showed an
unusual education and intelligence. It was, therefore, the more strange
that every few minutes she suddenly stopped and contorted her face into
expressions of fear and disgust, pointing her hand with the extended
and curved fingers at me, and at the same time calling out with an
anxious voice the words: “Keep quiet,—don’t speak—don’t touch me!”
She was probably under the impression of a stereotyped terrifying
hallucination and warded off the interference of the stranger with this
formula.²

This intercalation stopped as abruptly as it started, and the patient
continued with her conversation, without spinning out the presently exist-
ing excitement and without excusing or explaining her behavior,
probably she herself did not notice the interruption.³

Concerning her family history, I found the following: Her family
came from mid-Germany, but had lived for two generations in the

¹This smacking consisted of many sound measures. Some colleagues who
were versed in hunting compared these sounds to the courting call of the
woodcock.

²The words really corresponded to a protective formula, which will be
explained later. I have observed such protective formulae since then in a
patient suffering from melancholia, who tried to control her painful thoughts
(wishes that something wrong might befall her husband, her mother, or
blasphemings, etc.) in this manner.

³It was a case of hysterical delirium, which alternated with the normal
state of consciousness, similar to an intercalation of a real tic into a voluntary
motion, without disturbing it or fusing with it.

34

STUDIES IN HYSTERIA

Russian Baltic Provinces, where they had a large estate. There were
14 children, of whom the patient was the thirteenth, but only four were
living. She was carefully, but very compulsively brought up by an
extremely over-active and strict mother. At the age of twenty-three,
she married a highly endowed, capable man, who won for himself a
prominent position as an industrialist, but who was much older than
she. Shortly after the marriage, he died suddenly of heart failure. This
event, as well as the rearing of her two girls, now 16 and 14 years old,
who were sickly most of the time, having suffered from nervous dis-
turbances, she gave as the cause of her disease. Since the death of
her husband 14 years ago, she has been continuously ill in varying degrees
of fluctuating intensity. Four years ago massage and electric baths
afforded her transitory alleviation; otherwise, all her efforts to regain
her health were in vain. She had traveled much and had numerous
active interests in life. At the present time she lived on an estate in
the Baltic near a large city. Having again suffered severely for months,
during which she had been depressed, sleeplesss, and tortured by pain,
she sought in vain alleviation in Abbazia. For the last six weeks she
had been in Vienna under the treatment of a prominent physician.
Without a word of objection she followed my suggestion to separate
from her two girls, who had a governess, and enter a sanitarium where
I could see her daily.

On the evening of May 2d, I visited her in the sanitarium. It struck
me that whenever the door was unexpectedly opened, she always became
severely frightened. I, therefore, ordered that visiting physicians, as
well as nurses, should knock on the door, and not enter until they heard:
“Come in!” In spite of that, she made grimaces and trembled whenever
anybody entered.

Her chief complaint referred today to a cold sensation and pains in
the right leg, which emanated from the back, above the crest of the
ilium. I prescribed warm baths and massage twice daily. She was an
excellent subject for hypnosis. I held my finger before her and called
out, “Sleep!” and she sank down with an expression of stupefaction
and confusion. I suggested sound sleep and an improvement of all the
symptoms, etc. She listened with closed eyes, but with unmistakably
tense attention, but her features gradually became smoother and assumed
a friendly expression. After the first hypnosis, there remained a vague
memory of my words, and after the second, there already appeared a
perfect somnambulism (and amnesia). I announced to her that I would
hypnotize her and she assented without any resistance. She had never
been hypnotized before, but I assumed that she must have read about
it, although I did not know what impressions she had concerning the
hypnotic state.⁴

⁴On awakening from hypnosis, she always looked around as if confused,
and then turned her eyes to me; she seemed to have regained consciousness, put
on glasses which she had taken off before she fell asleep, and again became
cheerful and herself. In the course of the treatment which was given during

35

This treatment—warm baths twice daily, massage and hypnotic sug-
gestions—was continued during the following days. She slept well and
visibly recuperated, and spent the greater part of the day quietly in bed.
She was not prohibited from seeing her children, reading, or taking
care of her correspondence.

During the morning of May 8th, she entertained me in an apparently
normal manner by telling me harrowing animal stories. She read in
the paper, which lay in front of her on the table, that an apprentice
tied up a boy and stuck a white mouse into his mouth, and that the
resulting fright killed the boy. Dr. K. told her that he sent a box full
of white rats to Tiflis. At the same time she showed the most plastic
signs of horror. She clenched her hands and said: “Keep quiet, don’t
talk, don’t touch me!—if such an animal should be in bed (horrified)
just think if that were uncovered! There is a dead rat among them,
one that was chew-
ed!”

In the hypnosis I made an effort to drive away these animal halluci-
nations. While she slept, I picked up the newspaper; I actually found
a story of an abuse by an apprentice, but there was nothing about mice
or rats. She evidently added these deliriously while she was reading.
In the evening I told her about our conversation concerning the white
mice. She knew nothing about it, was very surprised, and laughed
heartily.⁵

In the afternoon she had a so-
called “neck-cramp,” ⁶ but “it was
short, lasting only two hours.”

On the evening of May 8th, I requested her to talk of hypnosis,
which she succeeded in doing after some effort. She spoke quietly and
thought for a moment every time before she answered. The change in
her features corresponded to the content of her story—they became calm
as soon as my suggestions put an end to the impression of the story.
I put the question why she became frightened so easily. She answered:
“Those are memories from my early youth.” “When?” “The first
one at the age of five when my brothers and sisters threw dead animals
at me. I then had my first fainting attack with convulsions, but my
aunt said that this was disgusting, that one must not have such attacks,
 

this year over a period of seven weeks, and the next year for eight weeks,
although we talked about everything possible, and I put her to sleep twice
almost daily, she, nevertheless, put no question or observation concerning
hypnosis, and in her waking state she seemed to ignore the fact that she was
being hypnotized.

⁵Such a sudden intercalation of a delirium in the waking state was nothing
unusual in her case, it often repeated itself during my observation. She used
to complain in conversation that she often gave the most distorted answers, so
that people could not understand her. During the first interview, to the ques-
tion of how old she was, she answered quite seriously: “I am a woman of the
past century.” Weeks later, she explained that she thought at that time, in her
delirium of a beautiful old cabinet which she acquired while traveling, as she
was a collector of antique furniture. Being questioned about her age stimulated
the idea of time. Her answer really referred to the age of this cabinet.

⁶A sort of migraine.

36

and they then stopped. Then at the age of seven, when I unexpectedly
saw my sister in her coffin; then at the age of eight, when my brother
so often frightened me by wrapping himself in white sheets and pre-
tending he was a spook, then at the age of nine, when I saw my aunt
in her coffin, and—suddenly—her lower jaw fell.”

The series of traumatic events which she gave me in answer to my
question, why she was so terrified, seemingly were already in her
memory. In the short moment between my question and her answer
she would not have been able to formulate so quickly the occasions from
chronologically different periods of her life. At the end of every section
of her story, she showed general twitchings, and her features expressed
fear and horror; after the last one she gasped for breath. The words
which described the terrifying content of her experiences were brought
forth with effort and gasping. After that her features became calm.

In reply to my question, she asserted that during her recital of the
scenes she visualized them plastically in their natural colors. She thought
of these experiences quite frequently, thought of them again only in
the last few days, but whenever she thinks of them, she always sees
them in front of her with all the vividness of reality.⁷ I now under-
stand why she so frequently entertained me with animal scenes and
images of dead bodies. My therapy consisted of wiping away these
images so that she should no longer have them before her eyes. To
fortify the suggestion, I stroked her a number of times over the eyes.

May 9th. Without any suggestion she slept well, but in the morn-
ing complained of stomach aches. She had felt them yesterday, in the
garden when she had spent too much time with her children. She was
satisfied when I restricted the visit of her children to two and a half
hours. A few days before she had reproached herself for neglecting
the children. I found her today somewhat irritable, she wrinkled her
forehead, kept on smacking her lips, and showed impediments in her
speech. During the massage she related to us that the governess of
her children had brought an atlas on the history of civilization, and
that she was severely frightened by some of its pictures, which rep-
resented Indians dressed as animals. “Just think, if they were living!”
(Horrified.)

In the hypnosis I asked her why those pictures frightened her so
much when she no longer was afraid of animals? The pictures reminded
her of visions she had had during the death of her brother (at 19 years
of age). I left this recollection for a later discussion. I then asked
her whether she always talked in this stuttering manner, and how long
she had had the tic or the peculiar smacking.⁸ The stuttering was a
pathological manifestation, and the tic she had had for five years since
she once sat at the sickbed of her very sick daughter and wanted to

⁷ We also obtained recollections in vivid visual images from other hysterical
patients, and they were especially accentuated in pathogenic memories.

⁸ In the waking state she replied to my question about the origin of the tic,
that she did not know, but that she had had it for a long time.

37

CASE HISTORIES

remain very quiet. I attempted to weaken the significance of this
memory by saying, that after all, nothing had happened to her daughter.
She added that these disturbances repeat themselves whenever she is
anxious or frightened. I told her not to be afraid of the Indian pic-
tures, but rather to laugh heartily over them and show them to me.
This actually took place after she awakened; she looked for the book
and asked me whether I had already seen it, opened the page and laughed
heartily at the grotesque pictures. There was not the least anxiety or
tenseness in her features. Dr. Breuer called unexpectedly and was
accompanied by the family physician. She became frightened and began
to smack her lips so that both soon left. She explained her excitement
by saying that whenever anyone appeared with the family physician she
experienced a feeling of discomfort.

I also removed the stomach aches through hypnosis, by stroking and
saying that she will probably expect the return of the aches after eating,
but that they will not come.

Evening. For the first time she was cheerful and talkative and
showed a sense of humor which I would not have expected in this
serious-
minded woman, and with a full assurance of her improvement
she made merry, among other things, over the treatment of my medical
predecessor. For some time she had the intention of giving up this
treatment, but could not find any excuse for it, until a casual observa-
tion of Dr. Breuer, who once visited her, gave her this axcuse. As I
expressed surprise at this information, she became frightened and
reproached herself violently for having committed an indiscretion. How-
ever, I was seemingly able to calm her. There were no pains in the
stomach despite her expectation of them.

In the hypnosis I asked about other experiences, which subsequently
frightened her. She then reproduced a second series from her later
youth just as promptly as the first, and again assured me that she
visualized all these scenes frequently and vividly with all their colors.
When she saw her cousin taken to an insane asylum (at the age of 15)
she wanted to call out for help, but could not. She lost her speech
until that evening. As she frequently spoke so much about insane
asylums in her waking state, I interrupted her and asked if she recalled
other occasions in which insane people were concerned. She then
related that her own mother was at one time in an insane asylum, and
then they had once a servant whose wife spent a long time in an insane
asylum, and who used to tell her terrible stories of how patients were
bound to their chairs, were punished, and similar experiences. While
talking, she clenched her hands with horror and saw all these things
right before her eyes. I made an effort to correct her ideas about mental
hospitals without associating them with herself. Her features were
relaxed.

She continued to relate her frightful memories: How she found her
mother who had had a stroke, lying on the floor (at the age of 15),
she lived four years longer, and then at the age of 19 she came home

38

one day and found her mother dead with a distorted face. It was nat-
urally more difficult to obliterate these memories. After a lengthy dis-
cussion I assured her that this picture, too, she would only see again
blurred and dimmed. She then recounted how at 19, on lifting up a
stone, she found a toad, and as a result, she lost her speech for hours.⁹⁾

I became convinced during this hypnosis that she knew everything
that had taken place during the previous hypnoses, but that she knew
nothing about it in her waking state.

May 10th, morning. Today, for the first time she took a bran bath
instead of a warm one. I found her with a peevish wrinkled face, her
hands wrapped in a shawl, complaining of cold and pain. On being
asked what happened, she stated that it was uncomfortable to sit in this
short bathtub, she got pains from it. During the massage she repeated
that she still felt badly about yesterday’s betrayal of Dr. Breuer. I
calmed her with the pious lie that I knew all about it from the beginning,
and thus, I removed her excitement (her smacking and facial contor-
tions). My influence was always already noticeable during the massage,
when she became quieter and clearer, and even without hypnosis she
always could give reasons for her moodiness. Nor was the conversa-
tion which we had during the massage as unintentional as it seemed.
On the contrary it contained almost a complete reproduction of the
memories and the new impressions which had influenced her since the
last conversation, and frequently it went quite unexpectedly to patho-
genic reminiscences which she related without being requested to do so.
It seemed as if she had mastered my technique and had utilized the
apparently unforced and casually conducted conversations to supplement
the hypnosis. Thus, for example, she began to talk today about her
family, and through all sorts of by-paths she came to the history of her
cousin, who was a narrow-minded eccentric and whose parents caused
him to have a number of his teeth pulled at the same time. This story
was accompanied by gestures of fright, and by many repetitions of her
protective formula: “Keep quiet—don’t talk—don’t touch me!” Follow-
ing this, her features relaxed, and she looked cheerful. Thus, her
conscious behavior was directed by her experiences of the somnambulic
state, concerning which she knew nothing in the waking state.

In the hypnosis I repeated the question of what made her moody,
and received the same answer, but in the reverse order. First, her
blabbering of yesterday, and second, the pains from her uncomfortable
posture in the bathtub. I also asked her today for the meaning of the
formula, “Keep quiet . . . etc.” She explained that whenever she
had thoughts of anxiety, she was afraid of being interrupted in the stream
of thought because everything would then become confused or still
worse. The expression, “Keep quiet . . . ” referred to the fact
that the animal images, which appeared to her in her bad periods, assumed
motion in front of her. Finally, the admonition, “Don’t touch me”

⁹⁾The toad was in all probability connected with a definite symbolism, which
regretfully I made no attempt to investigate.

39

CASE HISTORIES

originated from the following experience: As her brother was so sick
from too much morphine, and had such terrible attacks (at the age of
19) he frequently seized her. Furthermore, an acquaintance once went
insane in her house and grabbed her by the arm (a third similar case
which she could not precisely recall), and finally when her little girl
was so sick (at the age of 28) she grabbed her so vehemently in her
delirium that she almost choked her. Despite the marked differences in
time she related these four cases in one sentence and in quick succes-
sion, as if she wished to construct one single event into four acts. All
her information of such grouped traumas began with the word, “as,”
and the individual partial traumas were connected by “and.” When I
became aware that the protective formula constituted a defense against
the return of similar experiences, I removed her fear by suggestion, and
I actually never again heard the formula from her.

In the evening, I found her very cheerful. She laughingly related
that she got frightened in the garden by a little dog, who barked at
her. Her face was still slightly drawn, and there was an inner excite-
ment which disappeared only after she asked me if I took amiss a remark
she made during the morning’s massage and I answered in the negative.
The menses reappeared today after scarcely a two weeks’ pause. I
promised to regulate it through hypnotic suggestion, and suggested in
the hypnosis an interval of twenty-eight days, which actually occurred.

In the hypnosis I also asked her whether she remembered what she
told me last; in doing this I had in mind a task which still remained
from last evening. She, however, began more correctly with the “Don’t
touch me” of the forenoon hypnosis. I consequently led her back to
yesterday’s theme. I asked her how this stuttering originated and she
answered: “I do not know.”¹⁰ I, therefore, requested her to recall
it for today’s hypnosis. Today, she answered without any further
reflection, but with great excitement and in a spastically difficult
language: The horses once bolted with the carriage which held her
children, and on another occasion while she was driving with her chil-
dren in a storm, a tree was struck by lightning in front of the horses;
the horses shied and the thought flashed through her mind, “Now, you
must keep very quiet; otherwise, you will frighten the horses still more
through your crying and then the coachman will not be able to control
them.” It was at this time that the stuttering appeared. This recital
had unusually excited her. I also discovered from her that the stuttering
appeared immediately after the first of these two events, but disappeared
after a short time, only to reëstablish itself permanently after the second
similar event. I wiped out the plastic memory of these scenes, but
requested her to bring them to consciousness once more. She seemed

¹⁰The answer: “I don’t know” may be correct, but it may also signify the
displeasure of talking of these causes. In other cases I have later had the
experience, that the more difficult it was for patients to recall things in hypnosis
the more effort they had to use to force the event in question into their
consciousness.

40

STUDIES IN HYSTERIA

to make an effort, but remained calm, and henceforth, she spoke in the
hypnosis without the slightest spastic impediment.¹¹

As she felt disposed to give information, I questioned her further as
to what events in her life frightened her to such an extent as to leave
in her a plastic memory of the same. She answered with a collection
of such experiences. A year after the death of her mother she was at the
home of a friendly French woman who sent her with another girl into
the next room for an encyclopedia, and there she saw a person rise
from the bed, who looked exactly like the woman she had just left.
She remained rigid, as if rooted to the spot. Later, she heard that it
was just a doll. I explained this apparition as an hallucination, and
appealed to her to explain it further, and her face relaxed.

She then related how she nursed her sick brother, who, as a result
of morphine addiction, lapsed into frightful attacks during which he
frightened her by grabbing her. I noticed that she had already related
this experience this morning, and to test her, I asked when this “grab
bing” took place. To my pleasant surprise she now reflected for quite
a while, and finally asked haltingly: “The little one?” About the two
other aforementioned events she could not remember anything. My com-
mand to wipe out the memories had, therefore, had its effect. She
continued telling how she nursed her brother, and suddenly her aunt
appeared and stretched her pale head over a transom; she had come
to convert him to the Catholic faith. I noticed that I, thereby, came
upon the root of her constant fear of surprises, and I asked when other
such experiences took place. She went on: How she had a friend in
her home who liked to sneak very quietly into the room and suddenly
there he stood: How after the death of her mother she was so sick
that she went to a spa, and there an insane woman mistakenly came
to her room at night, on many occasions right to her bed, and finally,
how on her journey here from Abbazia a strange man four times sud-
denly opened the door of her compartment and always stared at her
very rigidly. This frightened her so much that she called the conductor.

I wiped out all these memories, and I then awakened her and assured
her that tonight she would sleep well, after I had omitted giving her
this very suggestion in the hypnosis. A sign of general improvement
was shown in the remark that she had read nothing today, that she
was living in a happy dream, she, who always had to do something on
account of her inner restlessness.

May 11th, Morning. Today we had an appointment with a gyne-
cologist, Dr. N., who was to examine her oldest daughter on account
of menstrual difficulties. I found Mrs. Emmy quite restless, but it now
showed itself in lighter physical signs than before. From time to time,

¹¹As was found, the patient’s tic-like smacking and the spastic stuttering
represented two symptoms which originated through similar causations and
through an analogous mechanism. I have described this mechanism in a small
essay: “Ein Fall von hypnotischer Heilung nebst Bemerkungen über den
hysterischen Gegenwillen,” Zeitschrift für Hypnotismus, Bd. I. At all events
I shall return to it again.

41

CASE HISTORIES

she also exclaimed: “I’m afraid, so afraid, I believe I must die.” What
she was afraid of, whether it was of Dr. N., she did not know; she
was just afraid. I put her in hypnosis before the consultant arrived,
and she confessed that she was afraid that she had insulted me by the
remark she made yesterday during the massage; it seemed to her
impolite. Moreover, she was afraid of everything new and consequently,
was afraid of the new Dr. N. She was readily calmed, and although
she was startled now and then by Dr. N., she otherwise behaved well
and showed neither the smacking nor the speech impediment. After
he left, I again put her into hypnosis in order to remove the remnants
of excitement resulting from his visit. She, herself, was satisfied with
her behavior, and she put a great deal of hope in his treatment. I
tried to show her by this example that one should not fear anything
new, that it may also contain something good.¹²⁾

In the evening she was very jolly and disburdened herself of many
scruples expressed in the conversation before the hypnosis. In the
hypnosis I asked her what event of her life had left the most lasting
effect and returned most frequently in her memory. The death of her
husband—I made her relate this experience with all its details, which
she did with signs of the deepest emotion, but all of it without any
smacking or stuttering.

She told how she was in a place on the Riviera, which both of
them loved. Once while crossing a bridge, he got a heart attack. He
suddenly sank down, lay a few minutes as if lifeless, and then arose
as if quite well. How shortly thereafter, while she was still in her
confinement bed with her little girl, her husband, who was eating break-
fast and reading the paper at a little tea table in front of her bed, sud-
denly arose, looked at her peculiarly, walked a few steps, and then
dropped dead. She jumped out of bed, the physicians who responded
to her call made every effort to revive him; she could hear it from
the other room, but it was all in vain. She continued to relate how the
child, who at that time was a few weeks old, became very sick and
remained so for six months, during which she herself was sick with a
high fever. And now her complaints against this child followed in
chronological order, she forced them out with angry facial expressions
like talking of someone of whom one is tired. For some time this child
was peculiar. She always cried and did not sleep, she then developed
a paralysis of the left leg, the recovery from which was considered hope-
less. At the age of four she had visions, she did not begin to walk
and talk until quite late, so that for some time she was considered idiotic.
According to the physicians, she had suffered from cerebro-
spinal meningitis, or what not. Here, I interrupted her and pointed out that this
same child was now normal and blooming, and I then removed all pos-
sibilities of her seeing again these sad things by wiping away not only
the plastic memories, but also the whole reminiscence, as if it had never

¹²⁾All such instructive suggestions failed with Mrs. Emmy, as shown by the
results.

42

been a part of her. I promised her that this would result in a cessation
of the feeling of anticipated misfortunes, which constantly annoyed her,
as well as of the pains of her whole body, of which she complained
particularly during the present recital, after she had mentioned nothing
of it for many days.¹³⁾

To my surprise, immediately after this suggestion she began to talk
about Prince L., whose escape from an insane asylum was widely dis-
cussed at the time. She produced new ideas of anxiety concerning insane
asylums, stating that people were treated there with ice cold douches
on the head, that they were put into an apparatus and swung around
until they kept quiet. Three days before, while she first complained
of insane asylums after telling that patients were bound to chairs, I
inter-
rupted her. I now realized that I gained nothing by it, that one
cannot possibly spare himself from listening to every point to the very
end. After this additional recital, I removed also this frightful new
picture. I appealed to her intelligence, saying that she really ought to
believe me rather than that foolish girl who told her such frightful
stories about happenings in mental hospitals. As I still heard some
stuttering in this last recital, I asked her again whence this came. No
answer— “Don’t you know?” — “No” — “Why not?” — “Why? Because
I’m not allowed.” (The last came out forcefully and angrily. I saw
in these utterances the success of my suggestion, but she also expressed
a wish to be awakened from the hypnosis, which I refused.)¹⁴⁾

May 12th. Contrary to my expectation, she again slept poorly. I
found her in great anxiety, but at least without its usual physical signs.
She refused to tell what was wrong except that she had had bad dreams,
and that she still saw the same things. “How horrible if they should
be alive.” During the massage she settled some thing through ques-
tioning, and then cheered up. She spoke about her social relations on
her estate on the Baltic, of the important men from the neighboring city
whom she was wont to invite as her guests, etc.

Hypnosis. She had terrifying dreams that the legs of the chairs

¹³⁾This time my energy carried me a little too far. A year and a half later
when I saw Mrs. Emmy again in relatively fine health she complained that it
was remarkable that certain very important events of her life she could only
recall vaguely. She saw in this a proof of her failing memory. I had to guard
against giving her a special explanation for this amnesia. The striking success
of the therapy in this point was probably also due to the fact that I made her
relate this memory in great detail, more detailed than these notes show, when
ordinarily I was satisfied with a mere mention of the facts.

¹⁴⁾This little scene I understood only the next day. Her untamed nature,
which revolted in the waking state as well as in the artificial sleep against
every force, made her angry because I took her story as completed, and inter-
rupted her through my last suggestion. I have many other proofs for the fact
that she critically watched my work in her hypnotic consciousness. It is
probable that she wished to reproach me for the fact that I disturbed her story
today just as I disturbed her before in her lunatic asylum horrors; she did not,
however, trust herself to do so, but produced instead these additional thoughts,
as it were, inde-
pendently, without betraying the associated mental trend. The
next day my mistake was disclosed to me through a hidden remark.

43

CASE HISTORIES

as well as the backs of stools were all snakes; a monster with a hawk’s
beak struck at her and bit her all over the body, then other wild animals
sprang at her, etc. This immediately led to other animal deliria, which
she, however, distinguished by adding that this was real and no dream.
She also told how once desiring to grasp a ball of wool, it turned out
to be a mouse, which scampered away. How once while taking a walk
a large toad sprang at her, etc. I observed that my general prohibi-
tion had no effect and that I must remove individually every impres-
sion of anxiety.¹⁵ By some path I came to the question of the origin
of her stomach aches. I believed that stomach aches accompanied every
attack of zoöpsia. Her quite unwilling answer was that she did not
know. I gave her the task to recall it by the next morning. She then
said rather morosely that I should not always ask her whence this and
that came, but that I should let her recount what was in her mind. I
agreed, and she continued without any introduction: “When they car-
ried him out, I could not believe that he was dead.” (She again referred
to her husband, and I then recognized the cause of her depression, which
she suppressed by withholding the rest of the story.) Following his
death, she hated the child for three years, because she said to herself
that she could have nursed her husband to health if she had not had
to remain in bed on account of the child. And after her husband’s death,
she had nothing but annoyances and excitement. His relatives, who
were always against the marriage, and were chagrined because the mar-
riage turned out happily, spread rumors that she poisoned her husband,
and they even thought of demanding an inquest. Through a nasty,
shyster lawyer the relatives imposed upon her all sorts of legal processes.
This scoundrel sent out agents to annoy her. He put abusive articles
about her in the local papers, and then sent her the clippings. This
treatment gave origin to her shyness of people and her hatred of strange
men. After the calming words which I added to her story, she claimed
that she felt serene.

May 13th. Again, she slept little on account of her stomach pains.
Yesterday, she took no supper. She also complained of pains in the
right arm. Her disposition, however, was good; she was cheerful, and
since yesterday she treated me with special distinction. She asked my
opinion concerning the most varied things which seemed to her impor-
tant, and lapsed into a most disproportionate excitement when I, for
example, had to look for her daughters who were needed at the massage.
She also showed some smacking and grimacing.

Hypnosis. Last evening it suddenly flashed through her mind why
the little animals, which she visualized, grew so gigantically. This hap-
pened to her for the first time at a theatrical performance in D., where

¹⁵Unfortunately I have failed to investigate in this case the meaning of the
zoöpsia, and I have not attempted to distinguish the primary fear of animals,
which is common to many neuropaths from childhood, from the symbolic.

44

a giant-
like lizard was on the stage. This memory tortured her also
very much yesterday.¹⁶

The return of the smacking was due to the fact that yesterday she
had abdominal aches and made an effort not to betray them through
sighing. Concerning the actual cause of the smacking (see p. 46), she
knew nothing. She also recalled that I gave her the task to discover
whence the stomach aches originated, but she did not know, and begged
me to help her. I suggested that she might have at some time forced
herself to eat after marked excitement. That turned out to be true.
After the death of her husband, she lacked for a long time any desire
for food, and ate only as a matter of duty. She then began to talk
spontaneously about what most affected her: “I have said that I did
not like the little one. I must add, however, that this was not noticed
in my behavior. I have done everything that was necessary. Even
now I reproach myself that I am fonder of the older one.”

May 14th. She is well and cheerful, she slept until 7:30 A.M., and
complains only of slight pains in the radial regions of her hand, and
of aches in the head and face. The conversation before the hypnosis
gained increasingly in significance. Today she had almost nothing
frightful to discuss; she complained of pains and lack of feeling in the
right leg and reflected that in 1871 she went through a pelvic inflamma-
tion, and when she scarcely recovered from it, she had to nurse her
sick brother, and it was then that she got these pains, which at times
produce a paralysis of the right foot.

During the hypnosis I asked her whether she was now able to mix
with people, or whether she was still overcome with anxiety. She
believed that she still felt unpleasant if someone stood behind her or
close to her, and in this connection related other cases of unpleasant
surprises through the sudden appearance of people. Thus, once when
she took a walk with her daughters, two suspicious looking individuals
appeared from behind a bush and insulted her. While in Abbazia dur-
ing an evening’s walk, a beggar suddenly appeared from behind a rock
and knelt down before her. He probably was a harmless lunatic. She
then told how someone broke into her isolated castle, which frightened
her very much.

One could easily see that this fear of people was connected with
the persecution to which she had been subjected after the death of her
husband.¹⁷

¹⁶The visual memory of the large lizard attained this importance only
through the temporal connection with the large affect to which she must have
been subjected during this theatrical performance. But in the therapy of this
patient, as I have already admitted, I was often satisfied with superficial find-
ings, and in this case, too, I have not investigated any further. To be sure, one
thinks here of hysterical macropsia. Mrs. Emmy had a high degree of short-
sightedness and astigmatism and her hallucinations might have been provoked
through the indistinctness of her visual perceptions.

¹⁷At that time, I was inclined to interpret all the symptoms of this hysteria
on the basis of psychic origin. Today I would explain the tendency to anxiety
in this woman who lived a continent life as neurotic (anxiety neurosis).

45

Evening. Apparently very cheerful, yet she received me with the
exclamation: “I’m dying of fear, oh, I can hardly tell it to you, I hate
myself.” I finally discovered that Dr. Breuer paid her a visit, and as
he arrived, she became frightened. When he noticed it, she assured him
that it only happened this time, and that she was very sorry for my
sake, that she had to betray now this remnant of her former anxiety!
As a matter of fact, I had occasion to observe during the last few days
how strict she was to herself; how ready she was to blame herself for
the smallest negligence, as for example, if the sheets for the massage
were not in the same place, or if the newspaper which I was to read
while she was asleep was not spread out right before my eyes. After
the first superficial strata of annoying reminiscences had been removed,
her moral sensitiveness with a tendency to depreciation of her burdened
personality came to the surface. Both in the waking state, as well as
in the hypnosis, I preached to her a paraphrasing of the old saying,
“minima non curat praetor,” that between the good and the evil there
was a very large group of indifferent little things for which no one
should reproach himself. I believe, however, that these precepts made
no deeper impression on her than on some ascetic monk of the middle
ages, who saw the finger of God and the temptation of the Devil in
every little experience that concerned him, and who was not in any
position to view the world for a little while or from some small angle
without associating everything with his own personality.
In the hypnosis she brought up individual supplements to her fright-
ful images; thus, in Abbazia she saw gory heads on every wave. I
made her repeat those precepts which I imparted to her in her waking
state.

May 15th. She slept until 8:30, but became restless towards morn-
ing. She received me with a slight tic, some smacking, and some speech
impediment. “I die of fear.” On being questioned, she related that
the Pension in which her children were living is on the fourth floor,
which is reached by a lift (elevator). She requested yesterday that the
children use the elevator also for descending, and now she reproached
herself because she thought the elevator was not absolutely safe. The
owner of the Pension himself said so. She wanted to know if I knew
the history of Countess Sch., who was killed in Rome in just such an
accident. I was well acquainted with the Pension and knew that the
elevator was the private property of the proprietor, and it seemed hardly
possible that this man, who boasted of this elevator in advertisements,
should have warned against its use. I felt that we dealt here with
an illusion of memory inspired by anxiety. I imparted my opinion to
her, and without much effort she laughed over the improbability of her
fear. Just for that reason I could not believe that that was the cause
of her anxiety, and decided to question her about it in the hypnotic
state. During the massage, which was resumed today after many days
of interruption, she related a number of loosely connected stories, which
might, however, have been true. As for example, about a toad which

46

was found in the cellar of an eccentric mother, who took care of her
child in a peculiar manner, about a woman who had to be locked up
in an insane asylum on account of melancholia. In this way, she showed
the kind of reminiscences that went through her mind when she was
dominated by one of her uncomfortable moods. After she had disbur-
dened herself in these recitals, she became very cheerful, talked about
her life on her estate, about the relations she entertained with the most
prominent men of German-
Russia, and North Germany, and I found
it quite hard to reconcile this enormous activity with the idea of a very
nervous woman.

In the hypnosis, I, therefore, asked her why she had been so restless
this morning. Instead of discussing her worry about the elevator, she
informed me she was afraid that her menses might return and put a
stop to the massage.¹⁸

¹⁸ The origin of this was as follows: When she awoke in the morning she
was in a state of anxiety, and in order to explain this state of mind she seized
upon the nearest idea of anxiety which presented itself. On the afternoon of the
previous day there was some talk about the elevator in the house where her
children lived. The habitually worried mother asked the governess whether the
older daughter, who could not walk very well because of the pain in the right
ovary and right leg, was using the lift for descending. A memory deception
permitted her then to connect the anxiety, of which she was conscious, with the
idea of the lift. The actual reason for her anxiety she did not then find in her
consciousness; that came out only after much hesitation when I questioned her
about it in the hypnosis. It was the same process which Bernheim and others
after him have studied in persons who perform post-
hypnotically a command
imparted to them in a state of hypnosis. As for example, Bernheim suggested
to a patient that after awakening he would stick both his thumbs into his
mouth. The patient actually did this, but excused himself by saying that since
he bit himself the day before during an epileptic attack he felt pain in his
tongue. Obeying a suggestion, a girl attempted to murder a court official, an
absolute stranger to her. Having been caught and asked to explain her reason,
she invented a story about some annoyance imposed upon her, which demanded
revenge. There seems to be a need to bring psychic phenomena of which one
is not conscious into casual relationships with others that are conscious. When
ever the real causation of the perception is withdrawn from consciousness, one
strives unconsciously for another connection in which one believes, although it
is false. It is quite clear that an existing splitting of the content of conscious-
ness must markedly assist such false connection.

I wish to tarry a little longer at the above mentioned example of false
connection because it may be designated as a model in more than one way.
Above all, it is an illustration of the patient’s behavior, which in the course of
the treatment gave me repeated opportunities, to solve by means of the hypnotic
explanations such false connections and the affects emanating from them. I
wish to relate such a case in detail because it illuminates crassly enough the
psychological situation in question. I proposed to Mrs. Emmy that instead
of the customary lukewarm bath she should try a cool half-
bath, which I
thought would make her feel more refreshed. She implicitly obeyed this medical
order, but always with the worst kind of suspicion. I have already reported
that medical treatment had almost never given her relief. My suggestion to
take cool baths was not given so authoritatively as to prevent her from muster-
ing up courage to express such doubts as: “Every time, and as often as I have
taken a cool bath, I have been melancholic throughout the whole day. But I

47

I made her tell me the history of the pain in her leg. The beginning
of it was the same as yesterday, but there followed a long series of
various cases of painful and irritating experiences, at the time that she
had the pain in her leg, and through which influence it became more
and more aggravated to the extent of a two-sided paralysis of the legs

will try it again if you wish. Please do not believe that I do not do what you
tell me.” For appearance’s sake I waived my suggestions, but in the next
hypnosis I suggested that she, herself, might propose the cool bath, now that
she thought of it she might venture another trial, etc. Exactly what hap-
pened. She, herself, brought up the idea of taking cool baths, and in the next
hypnosis sought to win me for this idea by many arguments. I gave in without
much struggle. But on the day after this half-bath, I actually found her in
deep depression. “Why do you feel this way today?—I really knew it
beforehand. The cold baths always make you feel this way.—But you,
yourself, asked for them. Now we know that you cannot tolerate them and we
shall therefore return to lukewarm baths.” In the hypnosis I then asked her:
“Was it really the cool baths that depressed you so much?”—“Oh, the
cool bath has nothing to do with it,” was the answer, “but I read this morning
in the paper that a revolution broke out in Santo Domingo. When there is
unrest there, I always feel it here, because I have a brother in Santo Domingo
who has given us a great deal of worry, and now I am worried that something
might happen to him.” Thus, the situation was settled between us. The next
morning she took her cool half-bath as though it were self-evident, and con-
tinued to take it throughout many weeks without ever showing any depression.

One will have to admit that this example is also typical of the behavior of
other neurotics when it is a question of suggestive therapy by a physician.
Whether there is restlessness at Santo Domingo or elsewhere which evokes
on a definite day a certain symptom, the patient is always inclined to trace the
symptom back to the last influence of the physician. Of the two determinants
which are required for associating such false connection, one, the suspicion,
always seems to be present; the other, the splitting of consciousness, is sub-
stituted by the fact that most neurotics have in part no knowledge of the real
reasons of their suffering (or at least the causal reason), and in part they
intentionally do not wish to take cognizance of it because they are unwilling to
be reminded of that which bears their own guilt.

One could suppose that the psychic determinants of not-knowing or of inten-
tional neglect, which are rendered prominent in neurotics outside of hysteria,
must be more favorable for the origin of a false connection than the existence
of a splitting of consciousness, which in any case withdraws from consciousness
the material for causal relation. Still, this splitting is rarely pure, and in most
cases fragments of unconscious ideation lapse into everyday consciousness, and
precisely these give occasion for such disturbances. Usually, it is the general
sensation connected with the complex, the mood of anxiety, or of mourning,
which, as in the above example, is consciously perceived, and for which a
connection must be established in a consciously existing ideational complex, in
the manner of a “compulsion to association.” (Cf. the mechanism of com-
pulsive ideas, which I have given in the Neurolog. Centralblatt, Nos. 10–11,
1894. Also, Obsessions et Phobies, Revue Neurologique, No. 2, 1895.)

Of the force of such an obsession to association, I have recently become
convinced through an observation in another sphere. For a number of weeks
I had to exchange my usual bed for another of a harder texture, upon which I
probably dreamed more, or more actively, perhaps it was only difficult to attain
the normal depth of sleep. I remembered all the dreams of the night during
the first quarter of an hour after awakening, and I took the trouble to write
them down in order to make an effort to interpret them. I succeeded in tracing

48

STUDIES IN HYSTERIA

with a loss of feeling. This same was true of the pains in the arm,
which also began during her nursing, simultaneously with a cramp in
the neck. Concerning these “cramps in the neck” I discovered only the
following: They have taken the place of the peculiar states of restless-
ness with moodiness, which had existed before, and now consisted of
an “icy pack” in the neck with stiffness and painful coldness in all

these individual dreams to two factors: (1) to the need of elaborating such
ideas, at which I lingered only fleetingly during the day so that they were only
touched but not settled, and (2) to the compulsion of connecting the things
existing in the same state of consciousness with others. The senseless and
contradictory part of the dreams could be traced to the free play of the last
factor.

That the feeling which belongs to an experience with its content can regu-
larly be brought in indirect relationship to the primary consciousness, I have
learned from another patient, Mrs. Cecilia M., whom I studied more thoroughly
than other patients mentioned here. From this lady I have collected the most
numerous and convincing proofs of such a psychic mechanism of hysterical
phenomena which concerns us in this work, but unfortunately I am prevented
for personal reasons from giving a detailed account of this patient’s history,
to which I am now and then referring. Mrs. Cecilia M. was recently in a
peculiar hysterical state, which is surely not unusual, although I do not know
whether it has ever been recognized. It could be designated as an “hysterical
annihilation psychosis.” The patient had experienced numerous psychic
traumas and suffered long years from a chronic hysteria with manifold mani-
festations. The causes for all these states were unknown to her and to others,
and her excellently equipped memory showed the most striking gap: She
herself complained that her life was as if broken up into fragments. One day
there suddenly emerged an old reminiscence of the most plastic delineation with
fresh and new feelings, and from then on she lived through anew for almost
three years all the traumas of her life which were believed to have been long
forgotten, and some that really were never recalled. All of them were accom-
panied by a frightful expenditure of suffering, and with a return of all the
symptoms that she ever had. This “wiping out of old debts” embraced a
period of thirty-three years and enabled us to recognize all her states, which
often were very complicatedly determined. She could only get alleviation if
she had the opportunity to talk away in the hypnosis the reminiscence with all
the feeling and bodily manifestation that tortured her at the time. And when I
was prevented from being present, and she was forced to talk to a person of
whom she was ashamed, it happened a number of times that she related to that
person everything very quietly, but subsequently reproduced the same thing in
hypnosis before me with all the crying, weeping, and manifestations of despair
that should have accompanied the story in the first place. After such a
catharsis in the hypnosis, she was quite well and in touch with everything for a
number of hours. In a short time the next reminiscence in order appeared, but
the feelings belonging to it she sent to the surface hours before. She became
irritable and anxious or despairing, without ever thinking that this feeling did
not belong to the present, but to the state which would befall her next. During
this transitional period she regularly made false connections, to which she held
obstinately until the hypnosis. Thus, for example, she once received me with
the question: “Am I not an outcast; is this not a sign of the deepest degra-
dation that I told you this yesterday?” What she told me yesterday was not
in any way appropriate for the justification of this condemnation; after a short
discussion she could see it quite well, but the next hypnosis brought to the
surface a reminiscence with which she deeply reproached herself twelve years
ago, to which, to be sure, she no longer adhered.

49

CASE HISTORIES

the extremities, inability to talk and complete prostration. They usually
lasted from six to twelve hours. My efforts to unravel this symptom
complex on the basis of a reminiscence failed. The questions pointing
to it, namely whether the brother whom she nursed once grabbed her
by the neck in a delirium, were answered in the negative. She did
not know whence these attacks came.¹⁹

Evening. She was very cheerful and developed a very delightful
sense of humor. As to the elevator, it was not really as she told it to
me, it was only a pretense that it was not to be used for descending.
She asked many questions which showed nothing morbid. She had
very annoying aches in her face, in the hand along the thumb, and in
the leg. She felt stiffness and pains in the face when she sat quietly
for a long time, or stared at a point. Lifting a heavy object caused
pains in the arms.—The examination of the right leg showed fairly
good sensibility on the upper part of the thigh, deep anesthesia in the
lower part of the leg and foot, less in the gluteal and loin regions.

In the hypnosis she stated that she still had occasional ideas of
anxiety, that something might happen to her children, that she could
become ill, or that she might die, or that something might happen to
her brother, who was now on his honeymoon, or that his wife might
die because the married life of all siblings had been very short. No

¹⁹On subsequent reflection, I had to admit that this “neck cramp” might
have been organically determined, analogous to the states of migraine. In
practice one sees many of these states, which have not been described, and
which have such striking resemblance to classic attacks of hemicrania that one
would wish to broaden the latter concept, and to put the localization of the
pain in the second place. It is well known that many neurotic women combine
many hysterical attacks, such as twitching and deliria with their migraine
attacks.

Concerning the pains in the arm and leg, I believe that we dealt here with
a case of a not very interesting, but nevertheless a more frequent type of deter-
mination through accidental coincidence. She had such pains during the
emotional period of nursing, which she felt more in consequence of the
exhaustion, and these pains, which originally were only accidentally associated
with these experiences, were then repeated in her memory as a physical symbol
of the complex of associations. I shall be able to demonstrate this process by
many more examples. The pains were probably originally of a rheumatic
nature; to give this very abused word a definite sense, that is to say, pains,
which are mainly located in the muscles in which one can demonstrate definite
pressure feelings and change of consistency in the muscles. They manifest
themselves mostly after prolonged rest or fixating of the extremity—that is, in
the morning. They improve by exercising the painful part and can be made
to disappear by massage. These myogenous pains, which are frequently found
in many people, assume great significance in neurotics. Physicians who are not
in the habit of testing the muscles by pressure of the finger also assume that
these pains are of nervous origin, and thus add material for many indefinite
hysterical neuralgias and for the so-called sciatics, etc. I shall here only
briefly refer to the relations of these pains to gouty disposition. The mother
and two sisters of my patient suffered very much from gout or chronic
rheumatism. Some of the pains of which she complained at the time might
have been of that nature; I do not know. I did not at that time have any
practice in diagnosing this state of the muscles.

50

other anxieties could be elicited. I removed her worriment, for which
there was no cause. She promised to stop it “because you want it.”
I also gave her other suggestions for the pain in her legs, etc.

May 16th. She slept well, still complained of pains in the face, arms
and legs, but was very cheerful. The hypnosis proved to be quite
unfruitful. I administered Faradism for her anesthetic leg.

Evening. She became frightened as soon as I entered.—“It is a
good thing you came. I am so frightened.”—At the same time she
showed all signs of fear, stuttering, and tic. I first let her tell me in
the waking state what happened, whereby she excellently represented the
fright with her curbed fingers and extended hands. While in the garden
an enormously big mouse suddenly ran over her hand and disappeared as
suddenly. It really scampered continuously to and fro (an illustration
of a moving shadow?). On the trees there sat nothing but mice.—
“Don’t you hear the horses in the circus stamping? Nearby a man
is groaning, I believe he suffers pain after the operation. Am I in
Rügen, did I have such an oven there?”—She was evidently confused
by the numberless thoughts which crossed her mind, and her effort to
return to the present. Questioned about the present situation, as e.g.,
whether her daughters had been here today, she could give no answer.

I then tried to unravel this condition in a state of hypnosis.

Hypnosis. “What were you afraid of?”—She repeated the story of
the mice with all signs of terror. It seemed that when she went across
the stairs there lay an abominable animal that immediately disappeared.
I explained it as an hallucination. I told her not to be afraid of mice,
that such fear is only seen in drunkards (whom she abhorred). I told
her the story of Bishop Hatto, with which she was familiar, but she
listened with the greatest of terror. “How did you happen to mention
the circus?”—She heard distinctly close by how the horses stampeded in
the stables, and thus became entangled in the harness, which could injure
them. John was always in the habit of going out and untying them.—
I disputed her statement concerning the nearness of the stables and the
groaning of the neighbors. I asked her whether she knew where she was.
She knew, but shortly before she imagined she was in Rügen.—How did
she happen to remember this? “You said in the garden it was so hot in
one place.” This recalled to her the shadowless terrace in Rügen. What
sad memories she had of her sojourn in Rügen.—She reproduced a series
of them. There she got the most frightful pains in the arm and leg, she
was very often out in fogs on excursions so that she lost her way. Twice
while taking a walk she was chased by a bull, etc.—How did she come
to this thought today? Yes, how?—She had written a great many letters.
She wrote for three hours, which gave her a dull head.—I could, there-
fore, assume that the exhaustion brought on this attack of delirium, and
that the contents of it were determined by such allusions as the shadowless
place in the garden, etc. I repeated all the precepts which I was in the
habit of giving to her, and left her sleeping.

May 17th. She slept very well. In the bran-
bath, which she took

51

today, she cried out many times because she mistook the bran for little
worms. I heard this from the nurse. She herself did not like to tell it
to me. She was almost exaggeratedly cheerful, but interrupted herself
repeatedly with the exclamation, “Whee-
ee,” made grimaces which
expressed terror and showed more stuttering than during the last days.
She related that she dreamed last night that she was walking on nothing
but leeches. The night before, she had terrifying dreams, she had to
decorate so many dead people and lay them out in their coffins, but she
would at no time put the cover on the top—apparently reminiscence of
her husband (v.s.). She continued to tell that during her life she had
experienced a great many adventures with animals, the most harrowing
of all with a bat which entangled itself in her bedroom cupboard and
which caused her to run out of the room undressed. To cure her of this
anxiety her brother presented her with a beautiful brooch in the form
of a bat, but she could not wear it.

In the hypnosis she stated: Her fear of worms had its origin in the
fact that she once received a present of a beautiful needle-
pillow and
when she wished to use it, a swarm of little worms crept out of it, prob-
ably because it was filled with bran, which had not been quite dry.
(Hallucination? Perhaps a fact.) I asked her for more animal stories.
Once she took a walk with her husband in a park in St. Petersburg, and
the whole path to the lake was strewn with toads, so that she had to turn
back. She had gone through periods during which she could not shake
hands with anyone for fear that her hand might turn into an abominable
animal, a feeling which she had often experienced. I attempted to rid
her of the animal fears by questioning her about each animal separately,
whether she was afraid of it. To one, she answered, “No”; to another
she said, “I must not be afraid of it.”²⁰ I asked why she had twitched
and stuttered so much today and yesterday. She always does that when
she is afraid.²¹—But why was she so frightened yesterday?—In the
garden all kinds of thoughts occurred to her which oppressed her. First
of all, how could she stop herself from accumulating more things after
the discharge from the treatment—I repeated to her again the three
fundamental consolations, which I had already given her in the waking
state: First, as a matter of fact, she has now become healthier and more
capable of resistance. Second, she will get the habit of expressing herself
against any offensive person. Third, a great many things which have
hitherto oppressed her she will, henceforth, consider with indifference.—

²⁰The method which I pursued was not very good as I did not follow it
up exhaustively enough.

²¹On tracing back the two initial traumas the stuttering and smacking did
not completely disappear, although both symptoms showed a striking decrease
since then. The explanation for the incompleteness of the success was given
by the patient herself (cf. p. 43). She became accustomed to smack and stutter
whenever she became frightened. These symptoms, therefore, finally became
connected not only with the initial traumas, but with a long chain of asso-
ciated memories, which I failed to remove. It is a case which one sees fre-
quently enough and which always spoils the elegance and completeness of the
therapeutic results through the cathartic method.

52

Moreover, she was oppressed by the fact that she did not thank me for
coming to her at such a late hour. She was afraid that her last relapse
would make me lose patience with her. She was very much affected and
frightened by the fact that the family physician had asked the gentleman
in the garden whether he now had the courage to be operated on. His
wife sat near by and she herself must have thought that this would be
this poor man’s last evening. With this last information, the depression
seemed to have vanished.²²

In the evening she was very cheerful and contented. The hypnosis,
however, furnished no results. I occupied myself with the treatment of
the muscular pains and the restoration of sensibility in the right leg, in
which I was quite successful, although the restored sensation partially dis-
appeared again after awakening. Before I left her, she expressed her
surprise at the fact that she had had no cramp in the neck for so long a
time when usually it appeared with every change of weather.

May 18th. She slept last night as she has not in many years, but
since she had taken the bath, she complained of coldness in her neck
and of a drawing feeling in the face, hands, and feet. Her features were
tense and her hands were clenched. Hypnosis showed no psychic content
for the “cramp in the neck,” which later improved through massage in
the waking state.²³

²²I learned here something for the first time, which I could confirm later in
numerous cases : namely, that in hypnotic solutions of a new hysterical delirium
the information obtained from the patient runs chronologically in the reverse
order. He repeats first the impressions and streams of thought which came
last and are least important, and only towards the end does he come back to
the primary and most important causal impression.

²³Her surprise of the evening before, that she had had no cramp in the
neck for so long, was, therefore, a premonition of the coming state, which had
already been in the process of developing, and known to her unconsciously.
This remarkable form of premonition was something quite usual in the above
mentioned Mrs. Cecilia M. Whenever she was in her best state of mind and
said something like: “It is now a long time since I have feared witches at
night,” or: “How pleased I am that my eye-aches have stayed away so long,”
I was quite sure that next evening we would have to cope with the worst fears
of witches, or that the next state would begin with the dreaded pains in the
eyes. It was always as if that which was already lying fully completed in the
unconscious was shining through and the unsuspecting “official” consciousness
(to use Charcot’s expression) elaborated the idea which came to the surface
as a sudden thought into an expression of gratification, a lie which was quickly
called my attention to the fact that such occurrences might have given rise to
the familiar superstitions of fearing to mention some ailment lest it might
appear. One must not boast of any fortune without “knocking on wood,”
neither should one “paint the devil on the wall,” lest he really come. As a
matter of fact, one only boasts of fortune when misfortune already lurks, and
one perceives the premonition in the form of a boast because the content of the
reminiscence appears here earlier than the feeling belonging to it, because in
consciousness there exists a pleasant contrast.

53

CASE HISTORIES

I hope that this abstract from the chronicle of the first three
weeks will suffice to give an illustrative picture of the patient’s state,
of the mode of my therapeutic effort, and of its success. I shall now
proceed to complete the history of the patient.

The hysterical delirium described last represented also the last
marked disturbance in the behavior of Mrs. Emmy von N. As I
did not originally look for morbid symptoms and their determination,
but waited until something showed itself, or until the patient uttered
some apprehensive thoughts, the hypnosis soon became unfruitful
and was utilized mainly to impart some precepts that should always
remain fresh in her mind, so as to protect her from merging into new
and similar states at home. I was at that time entirely under the
spell of Bernheim’s book on suggestion, and expected more from
such instructive influences than I would today. The health of my
patient improved so markedly in a short time that she assured me
that she had not felt like this since the death of her husband. I
discharged her after altogether seven weeks of treatment to go to her
home in the Baltic.

Not I, but Dr. Breuer, received information from her after seven
months. Her good health continued for many months and then
succumbed to new psychic shock. Her oldest daughter, while still
in Vienna, imitated her mother’s neck cramp and lighter hysterical
states. She suffered above all from pains in walking as a result of
a uterine retroflexion, and was treated at my suggestion by Dr. N.,
one of our most prominent gynecologists. He corrected this
deformity through massage, so that she was free from all complaints
for many months. When these symptoms reappeared at home, the
mother consulted a gynecologist of a nearby university city, who
prescribed a combined local and therapeutic procedure, which led,
however, to a serious nervous break-
down of the child. In all proba-
bility this already showed the pathological disposition of this seven-
teen year old girl, which became manifest a year later in a change of
character. The mother, who entrusted the child to the physician
with her usual mixture of yielding and suspicion, hurled the most
severe reproaches at herself after the unfortunate issue of this treat-
ment. By a train of thought, which I have not investigated, she came
to the conclusion that both of us, Dr. N. and myself, were to blame
for her child’s illness, because the serious illness of her child was
rather lightly presented to her. Through an act of will she abrogated
more or less the effect of my treatment and soon lapsed back into

54

the state from which I freed her. A prominent physician from her
city, to whom she appealed, and Dr. Breuer, with whom she cor-
responded, were able to make her see the innocence of the two
defendants, but the aversion that she worked up towards me remained
as an hysterical remnant after the explanation, and she declared that
it would be impossible for her to put herself again under my care.
Following the advice of that medical authority, she entered a sani-
tarium in North Germany, and at the request of Dr. Breuer I
imparted to the physician in charge of the sanitarium whatever modi-
fication of hypnotic therapy proved effective in her case.

This attempt to transfer her to another physician failed com-
pletely. From the beginning, there was a misunderstanding between
her and the physician, which culminated in resistance towards any
thing he had undertaken with her. She became worse, suffered from
loss of sleep and lack of appetite, and recovered only after one of her
friends, who visited her in the hospital, secretly abducted her to her
home and nursed her there. Shortly thereafter, exactly one year
after her first meeting with me, she was back in Vienna and put
herself in my hands.

I found her much better than I imagined from the correspond-
ence; she was flexible and free from anxiety, which showed that much
remained of what I constructed before. The chief complaint was a
frequent confusion, a “storm in the head,” as she called it. Besides
that, she suffered from insomnia, was subject to hours of crying,
and became depressed at a definite hour of the day, at five o’clock.
It was the time during which she was allowed to visit her daughter
in the sanitarium during the winter. She stuttered and smacked
very much, rubbed her hands together as if in a rage, and when I
asked her if she saw any animals, her only answer was “Oh, keep
quiet.”

During the first attempt to put her in a hypnosis she clenched her
fists and cried: “I want no antipyrin injection, I’d rather have my
pains. I do not like Dr. R. I find him antagonistic.” I recognized
that she was in the midst of a reminiscence of a hypnosis while in
the sanitarium, and I calmed her when I brought her back into the
present situation.

In the very beginning of the treatment, I made an instructive
discovery. I asked her since when the stuttering had returned, and
she answered (in hypnosis) hesitatingly that she had noticed it since
the fright that she had experienced during the winter at D. A waiter

55

of the hotel in which she lived hid himself in her room. In the dark-
ness she thought that this object was an overcoat, and when she got
hold of it, the man suddenly “shot into the air.” I removed this
memory image, and from that time she actually hardly ever stuttered
tangibly either in hypnosis or in the waking state. I do not know
what induced me to put her to the test of this success. When I
returned in the evening, I asked her apparently quite innocently what
I should do to close the door in such a way that when I left her
room, while she was asleep, no one could steal in. To my surprise,
she became extremely frightened. She ground her teeth and rubbed
her hands together, indicating in this way that she had been violently
frightened, but I could not induce her to tell the story. I noticed
that she had in mind the same story that she had told in the hypnosis
in the forenoon, which I imagined I had wiped away. In the next
hypnosis she related everything circumstantially and truthfully. In
her excitement during that evening she kept on walking to and fro,
and finding herself at the open door of her chambermaid’s room,
she wished to enter and sit down. The chambermaid attempted to
bar her way, but she insisted on going in, and as she stepped in, she
noticed something dark against the wall, which turned out to be a
man. It was apparently the erotic factor of this small adventure
which first caused her to give this untruthful description. But
experience had taught me that an incomplete recital in hypnosis had
no remedial effect, and I, therefore, got into the habit of considering
a story incomplete if it did not give any results. I gradually learned
to read from the patient’s mien whether she did or did not keep from
me an essential part of the confession.

The work which I now took up with her consisted in the hypnotic
adjustment of the unpleasant impressions which she received during
the treatment of her daughter, and of her own sojourn in that sani-
tarium. She was full of suppressed rage against the physician who
caused her to spell in hypnosis t-o-a-d, and she made me promise
never to apply that word to her. I allowed myself a slight joke, the
only quite harmless abuse of hypnosis of which I was guilty in this
case, by suggesting in a rather humorous way that whenever she
desired to pronounce the name of the sanitarium, which ended in
“thal” (valley), she would get lost between the mountain, valley,
forest, etc. . . . Precisely so it happened, and very soon the only
speech impediment she showed was the uncertainty when she came
to this name. Gradually, she was also freed of this paramnesia.

56

But I had to struggle much longer with the state she designated
as “storm in the head” than with the remnant of this experience.
When I first saw her in this state, she lay on a divan with distorted
features in an incessant state of restlessness of her whole body, her
hands always pressed to the forehead, calling longingly and despair-
ingly the word, “Emmy,” which was her own as well as her daugh-
ter’s name. In the hypnosis she recounted that this state represented
a repetition of so many attacks of despair which seized her during
the treatment of her daughter, after she had reflected in vain for
hours how the bad results of the treatment could be corrected. When
she then felt that her thoughts were becoming confused, she got into
the habit of calling loudly the name of her daughter in order to wake
herself by it back into clearness. For, at that time, when the state of
her daughter imposed new duties upon her and she felt that her
nervousness was again gaining power over her, she resolved that
whatever concerned this child must be kept away from the confusion,
no matter what other confusions might revolve in her head.

After a few weeks, these reminiscences, too, were mastered, and
Mrs. Emmy, though in perfect health, remained for some time longer
under my care. Just at the end of her sojourn something happened,
which I wish to relate in detail because this episode throws the
clearest light on the character of the patient as well as on the mode
of origin of her states.

I visited her once during her luncheon and surprised her as she
was throwing something into the garden wrapped in a paper, which
was caught by the janitor’s children. To my question, she admitted
that it was her (dry) dessert, which was wont to follow the same
path every day. This gave me the opportunity to look at the rem-
nants of the other courses, and I found that there was more left on
the plates than she could have consumed. When questioned as to
why she ate so little, she answered that she was not in the habit of
eating more, that more food would do her harm, and that she had
the same nature as her blessed father, who had also been a light eater.
As to fluids, she stated that she could only digest thick fluids like
milk, coffee, cocoa, etc., and that as often as she drank water or
mineral water, she spoiled her stomach. This showed the unmistak-
able sign of a nervous selection. I took along a specimen of her
urine, and I found that it was very concentrated, overloaded with
salts.

I then considered it appropriate to advise her to take more fluids

57

and also decided to increase her food. She was in no way strikingly
thin, but it seemed to me that a little more nourishment would be
worth while. When I prescribed during my next visit mineral water
and forbade her from disposing of her desserts, she became somewhat
excited. “I will do it because you desire it, but I can tell you before-
hand that it will turn out badly because it goes against my nature;
my father was also that way.” To the question put in hypnosis, as
to why she did not eat more and consume a full meal, and why she
did not drink water, she answered sulkily: “I do not know.” The
next day the nurse informed me that Mrs. Emmy had managed to
consume the whole meal and also drank a glass of mineral water.
But I found her lying in bed, very moody, and in a very ungracious
mood, and complaining of severe pains in the stomach. “But, I
warned you, now all the success for which we have so long tor-
mented ourselves is gone. I have spoiled my stomach as is always
the case when I eat more or drink water, and I will have to starve
myself for eight days or more until I can again tolerate anything.”
I assured her that she would not have to starve, and that it is quite
impossible to spoil one’s stomach in this way, that her pains were due
to the anxiety with which she ate and drank. I did not seem to make
the slightest impression upon her with this explanation, for when I
tried shortly thereafter to put her to sleep, the hypnosis failed for
the first time, and from the most raging look hurled at me, I recog-
nized that she was in the midst of a perfect rage and that the situation
was quite serious. I gave up the hypnosis and informed her that I
was giving her twenty-four hours for reflection in order to accept
my view that her stomach aches came only from her fear, and that
after this period I would ask her whether she still thought that one
can spoil one’s stomach for eight days from a glass of mineral water,
and a moderate meal, and if she answered in the affirmative, I would
ask her to leave for home. This little scene was a marked contrast
to our otherwise friendly relationship.

After twenty-four hours I found her very humble and mellow.
To the question what she thought about the origin of her stomach
aches, she answered: “I believe that they came from my fear, but
only because you say so.” I then put her in hypnosis and asked her
again, “Why can’t you eat more?”

The answer followed promptly, and again consisted of the fol-
lowing chronologically ordered series of motives from memory:
“When I was a child, it often happened that because of my naughti-
 

58

ness I did not wish to eat my meat at the table. My mother was
then always very strict and I was forced by severe punishment to
eat everything from the same plate two hours later. The meat was
then quite cold and the fat was so tough (disgust) . . . and I still
see the fork before me, one of the prongs slightly bent. Now when
I go to the table, I always see before me the plates with the cold
meat and the fat. And then many years later I lived with my
brother, who was an officer and who had a most foul disease. I
knew that it was contagious and hence I was in mortal dread lest I
make a mistake and use his set of dishes or his knife and fork
(horror), yet I did eat with him in order that no one should notice
that he was sick. Soon thereafter I nursed my other brother, who
was tubercular, and we ate at his bedside and his spittoon always
stood on the table, and quite open (horror) . . . and he had the
nasty habit of spitting across the plate into the cup. I always felt
such disgust, and yet I could not show it for fear of insulting him.
And this spittoon always stands on the table when I eat and I always
experience this same disgust when I eat.” With this I cleaned away
thoroughly the disgust. I then asked why she could not drink water.
When she was seventeen years old, her family spent a few months
in Munich, and almost all the members of her family contracted a
catarrh of the stomach because of the bad drinking water. The
others soon recovered through medical aid, but she never did. Nor
did the mineral water, which was recommended, improve her con-
dition. As the physician prescribed it, she immediately thought that
that, too, would not help. Since then, the intolerance for plain and
mineral water has repeated itself numerous times.

The therapeutic result of this hypnotic investigation was imme-
diate and permanent. She did not starve for eight days, but ate and
drank on the second day without the slightest complaint. Two
months later, she said in a letter: “I eat very well and I have gained
a lot. I have already consumed forty bottles of the water. Do you
think I should continue it?”

I saw Mrs. Emmy von N. again in the spring of the next year on
her estate near D. Her older daughter, whose name she used to call
out during “the storm in the head” entered at this time into a phase
of abnormal development. She showed an excessive ambition, which
was disproportionate to her meager endowment. She became insub-
ordinate and even violent towards her mother. I still had the confi-
dence of the latter, and was requested to come there in order to give

59

CASE HISTORIES

an opinion about this young girl’s condition. I gained an unfavorable
impression of the psychic change which took place in the child, and
in giving the prognosis had to take into consideration that some half
siblings of the patient (children of Mr. von N. by his first marriage)
went to pieces from paranoia. Nor was there any lack of hereditary
burdening on the mother’s side of the family, although no members
of her immediate family lapsed into a final psychosis. Mrs. von N.,
to whom I gave the required information without any reservation,
took it quietly and understandingly. She looked stronger, and had
a blooming appearance. The eight months since the ending of the
last treatment had been passed in relatively excellent health; she was
only slightly disturbed by the cramp in the neck and other insignifi-
cant complaints. The large extent of her duties, accomplishments
and psychic interests I really learned during this many days’ visit
at her home. I also met the family physician, who did not have much
to complain of about the lady. Thus, she was more or less reconciled
to the “profession.”

The patient was very much improved in health and functioned
more capably, but the fundamentals of her character have changed
little despite all instructive suggestions. She did not seem to have
grasped the category of the “indifferent things,” her tendency to
self-torture was hardly less than during the period of treatment.
Nor was the hysterical disposition quiescent during this good period;
for example, she complained of an inability to take long railroad
trips, which she had had to do during the last months. A pressing,
hasty attempt to solve this hindrance yielded only a number of small
disagreeable impressions, which she experienced on the last journey
to D., as well as in the neighborhood. But in the hypnosis she seemed
reluctant to give information, and it occurred to me even then that
she was in the process of again withdrawing from my influence, and
that the secret intention of the railroad inhibition lay in her desire
to hinder another journey to Vienna.

During these days she also complained about gaps in her memory,
“precisely in the most important events,” from which I concluded
that my work of two years ago had impressed itself sufficiently and
lastingly.—When she conducted me one day through an alley, which
led from her house to a bay, I ventured the question whether this
alley was frequently covered with toads. As an answer, she met me
with a punishing look, which was not, however, accompanied by any
signs of fear, but which she supplemented with the following remark:

60

“But, here you find real toads.” During the hypnosis in which I
undertook to remove the railroad inhibition, she, herself, seemed to
be dissatisfied with her answers, and expressed the fear that now she
would not obey the hypnosis as much as she did before. I decided
to convince her of the opposite. I wrote a few words on a piece of
paper which I handed to her and said: “This noon you will again
pour for me a glass of red wine as you did yesterday. As I will take
the glass to my mouth, you will say: ‘Oh, please pour also a glassful
for me.’ And as I reach for the bottle, you will call out: ‘No thank
you, I’d rather not!’ Thereupon, you will put your hand in your
pocket and draw out the note upon which these words are written.”
That was done in the forenoon. A few hours later the little scene
was enacted precisely as I suggested it, and with such a natural
process that none of the numerous guests noticed anything. She
seemed visibly to struggle with herself when she asked me for the
wine—for she never drank any—and after she put away the drink
with apparent alleviation she felt in her pocket and drew out the note
upon which one could read the last spoken word. She shook her
head and looked at me with astonishment.
Since this visit of 1890, my information concerning Mrs. von N.
became more scant. In a roundabout way I found out that the dis-
agreeable state of her daughter, which caused her the most manifold
painful emotions, finally undermined her health. In the summer of
1893 I received a short note from her in which she asked my permis-
sion to go to another physician for hypnosis, as she was again ailing
and could not come to Vienna. At first I did not understand why
my permission was needed until I recalled that in 1890 I protected
her at her own request from being hypnotized by a stranger, and
that she now wished to obviate the danger of becoming subjected to
the painful compulsion of an unsympathetic physician. I, therefore,
renounced in writing my exclusive prerogative.

Epicrisis

Without any previous deeper understanding of the value and
significance of names, it is really not easy to decide whether a case
belongs to hysteria or to the other (not purely neurasthenic) neuroses.
In the realms of the commonly occurring mixed neuroses one still
waits for the directing hand to set the landmarks and to render
prominent the essential features characteristic of the disease. If we
are still accustomed to diagnosing hysteria in the narrow sense fol-
 

61

CASE HISTORIES

lowing the similarity to the familiar typical cases, the designation of
hysteria for the case of Mrs. Emmy von N. can hardly be disputed.
The ease with which the deliria and the hallucinations came into being
in an otherwise intact psychic activity, the alteration of personality
and memory in artificial somnambulism, the anesthesia in the painful
extremities, certain data of the anamnesis, the ovaritis, and similar
symptoms, all leave no doubt concerning the hysterical nature of the
disease, or at least of the patient. That the question should at all be
raised is due to a definite character of the case, which may also offer
occasion for an observation of general value. As was shown in our
“preliminary communication” we have considered the hysterical
symptoms as effects and remnants of excitements which have influ-
enced the nervous system as traumas. Such remnants do not remain
if the original excitement is discharged through abreaction and mental
elaboration. We can no longer reject here the consideration of
quantities (even if not measurable), and to conceive the process of
hysteria, as if a sum of excitement had entered into the nervous
system, and was transformed into a lasting symptom in so far as it
has not been utilized proportionately for action in the outside world.
We are now in the habit of finding in hysteria that a considerable
portion of the “sum of excitement” of the trauma changes into a
purely physical symptom. It is that very feature of hysteria which
stood in the way for so long a time of conceiving it as a psychic
affection.

If for the sake of brevity, we choose to designate the term “-
version,” as the transformation of psychic excitement into chronic
physical symptoms, which characterizes hysteria, we can say that in the
case of Mrs. Emmy von N. there was a small amount of conversion.
But as the original psychic excitement remained mostly in the psychic
spheres, it was easy to see why it resembled other non-hysterical
neuroses. There are cases of hysteria in which the conversion
embraces the sum total of the excitement, so that the physical symp-
toms of hysteria seem to fuse with perfectly normal consciousness;
more usually, however, there is an incomplete transformation, so that
at least a part of the affect accompanying the trauma remains in
consciousness as a component of the disposition.

The psychic symptoms of our case, which show a slight conversion
hysteria, can be grouped as a change of disposition (anxiety, melan-
cholic depression), phobias, and abulias (inhibitions of will). The
two latter kinds of psychic disturbances which are conceived, how-

62

ever, by the French school of psychiatrists as stigmata of nervous
degeneration, prove to be in our case prolifically determined by
traumatic experiences, they are mostly traumatic phobias and abulias,
as I shall show in detail.

As to the phobias, some surely correspond to the primary phobias
of man, particularly of the neurotic; this is especially true of the fear
of animals (snakes, toads, besides all vermin, as the master of which
Mephistopheles boasted), the fear of storms, and others. But even
these phobias were reinforced by traumatic experiences; thus, the fear
of toads by the impressions from early youth when her brother threw
a dead toad at her, to which she reacted with an attack of hysterical
convulsions; the fear of storms, came from that fright which gave
cause to the origin of the smacking, and the fear of fog from that
walk in Rügen. At all events, the primary, so to speak, instinctive
fear, which is taken as a psychic stigma, plays the main rôle in this
group.

The other and more special phobias were also justified through
particular experiences. The fear of an unexpected sudden fright
was determined by the sudden experience of that most horrible
impression in her life, when she saw her husband, apparently in the
best of health, die suddenly of a heart attack. Fear of strange people,
or fear of men in general, turned out to be a remnant of that period
when she was subjected to persecutions by her family and was wont
to see in every stranger an agent of her relatives, or it was determined
by the thought that strangers knew about the things which were
spread about her orally and in writing. The fear of the insane
asylum and its inhabitants went back to a whole series of sad experi-
ences in her family, and to descriptions which were imparted to the
child by a stupid servant girl. Moreover, this phobia was also sup-
ported on the one hand by the primary instinctive fear of insanity
entertained by healthy persons, and on the other hand, as in every
nervous person, by the worry that she, herself, might become insane.
Such special anxiety, as the one that someone stood behind her, was
motivated by many frightful impressions of her childhood, and of
later periods. Since the one special painful experience in the hotel,
painful because it was connected with eroticism, the anxiety that a
strange person might sneak in was particularly prominent. Finally,
one of the phobias frequently seen in neurotics, namely, that she
might be buried alive, can be fully explained by the belief that her
husband was not dead when his body was carried away, a belief

63

which manifests itself so touchingly in an inability to feel one’s self
suddenly cut off from all relationship with a beloved being. At all
events, I believe that all those psychic factors can only explain the
selection, but not the continuation of the phobias. The latter must
be explained by the neurotic factors—that is, by the circumstance
that the patient lived for so many years in sexual abstinence, which
furnishes the most frequent causes for tendencies to anxiety.

The abulias (the incapacities and inhibitions of will) which
existed in our patient, justify even less than the phobias the assump-
tion of psychic stigmata as a result of a generally restricted, functional
capacity. On the contrary, the hypnotic analysis of the case demon-
strates that the abulias were here conditioned by a double psychic
mechanism, which basically is again only one. The abulia is either
simply the effect of a phobia, to wit, in all the cases in which the
phobia is connected with a particular act, instead of with an expec-
tation (to go out to visit people—the other case, that someone might
sneak in, etc.), or the cause of the abulia, is the anxiety connected
with the effect of the act. It would be incorrect to describe as a
special symptom this form of abulia with its corresponding phobias,
though one must admit that such a phobia can exist, if it is not of too
high a grade, without leading to an abulia. The other form of abulia
depends upon the existence of emotionally accentuated and unsolved
associations, which resist connection to new associations, and espe-
cially to such as are unbearable. The most splendid example of such
an abulia is offered by the anorexia of our patient. She ate so little
only because it did not appeal to her, and she could not get any taste
from the food because the act of eating was associated from her early
age with memories of disgust, the affective sum of which had not yet
become diminished. But it is impossible to eat simultaneously with
both disgust and pleasure. The diminution of the disgust, which
was connected with the meals from the first, did not take place
because she had to suppress the disgust each time, instead of freeing
herself from it through a reaction. As a child, she was forced to eat
the cold meal through fear of punishment, and in more mature years
she was prevented from expressing her emotions because of her
regard for her brothers, with whom she had to take her meals.

I may here perhaps recall a small work, in which I attempted to
give a psychological explanation of hysterical paralyses. There I
came to the conclusion that the reason for these paralyses lies in the
inadequacy of the ideation sphere, perhaps in an extremity for new

64

associations. But the associative inadequacy, as such, is due to the
fact that the idea of the paralyzed limb is involved in the traumatic
memory with an unsettled affect. From examples of everyday life, I
concluded that such an investment of an idea with undischarged affect
always carries with it a certain amount of associative inadequacy or
an incompatibility with new emotional investments ²⁴⁾ (cathexis).

Until this day I have not been able to demonstrate my former
theories through hypnotic analysis of a case of motor paralysis, but
I can refer to the anorexia of Mrs. von N. as proof that this mecha-
nism concurs with some cases of abulias, and abulias are really
nothing but expressions for very specialized, or “systematized”
(following a French expression) psychic paralyses.

The psychic state of affairs of Mrs. von N. can essentially be
characterized, if we render prominent two things: (1) The painful
effects of traumatic experiences remained unsettled in her, the moodi-
ness, the pain (from the death of her husband), the anger (from the
persecution by relatives), the disgust (from the forced meals), the
anxiety (from so many frightful experiences), etc.; and (2) She
had a very vivid, active memory, which brought into actual conscious-
ness, now spontaneously, and now through awakened stimuli of the
present (e.g., the information of the revolution in Santo Domingo),
fragment by fragment, all the traumas with their accompanying
affects. My therapy followed the course of these memory activities,
and sought to unravel and to settle, day by day, what the particular
day brought to the surface, until the last stock of the disease-produc-
ing memories seemed exhausted.

To these psychic characteristics, which I consider as general find-
ings in hysterical paroxysms, could be added some important con-
siderations, which I shall postpone until I shall give some attention
to the mechanism of the physical symptoms.

It is impossible to give the same deductions for all of the patient’s
symptoms; on the contrary, one discovers from this in itself not very
prolific case that the physical symptoms of hysteria come about in
various ways. First of all I take the liberty of attributing the pains
to the physical symptoms. As far as I can see, some of the pains
were certainly organically determined by the slight (rheumatic)

²⁴⁾ Archives de Neurologie, Nr. 77, 1893. The author uses here for the first
time the word Besetzung (occupation) in the sense of occupying, investing, or
filling with a charge of energy a definite affective event. As this term was
frequently used by Freud in his later works and gave rise to considerable
ambiguity the word, cathexis, from the Greek, ‘to occupy,’ was coined about
thirty years later to designate a concentration of energy in a particular channel.

65

changes in the muscles, tendons, and fascias, which produce so much
more pain in the neurotic than in the healthy. Another part of the
pains were most probably memory pains, symbolic memories of
periods of excitement and sick nursing, which had taken up so much
time in the life of the patient. These pains, too, might originally
have been organically justified, but have since then become elab-
orated into neurotic aims. I base these statements concerning the
pains of Mrs. von N. on experiences gained elsewhere, which I shall
relate in a subsequent passage of this work; from the patient, herself,
there was little explanation to be gained, especially about this point.

A part of the striking motor manifestations evinced by Mrs.
von N. was simply an emotional expression, and easily recognized in
this significance; thus, the extension of the hand with the spread out
and curved fingers as an expression of fear, the same is also true
of the play of features and similar signs. To be sure, it was a more
vivid and more uninhibited expression of emotions than corresponded
to the patient’s former mimicry, to her education, and to her race.
When not in an hysterical state, she was reserved, almost rigid in
her emotional expressions. Another part of her motor symptoms
was, in accordance with her statement, directly connected with her
pain. She played restlessly with her fingers (1888), or rubbed her
hands together (1889) in order not to cry out. This motivation
vividly recalls Darwin’s principles of “discharge of excitement” by
which, for example, he explains the tail-wagging of dogs. To be
sure, all of us substitute it when painfully stimulated by crying or
some other motor innervation. Whoever resolves to keep his head
and mouth quiet in the dental chair and not to interfere with his
hands, at least drums with his feet.

Mrs. von N.’s tic-like movements form a more complicated man-
ner of conversion. We refer to the smacking of her tongue and
stuttering, the calling out of the name, “Emmy,” in attacks of con-
fusion, and to the compounded protective formula, “Keep quiet,
don’t speak, don’t touch me” (1888). Of these motor expressions
the stuttering and smacking can be explained by a mechanism which
I have designated in a short contribution on the objectivity of con-
trast ideas.²⁵ This process could be explained even from our own
example, in the following manner: The hysterical patient, exhausted
from worry and vigilance, sits at the bed of her sick child and

²⁵Zeitschrift für Hypnotismus, Band 1, 1893, “Objectivirung der
Contrastvorstellung.”

66

finally(!) falls asleep. She says to herself: “But now you must
remain perfectly quiet, so that the child shall not be disturbed.” This
resolution probably awakened a contrast idea, or the apprehension
that she might, nevertheless, make a noise, and that it would awaken
the little one from the long desired sleep. Such contrast ideas against
the resolution come into being in tangible degree also in us, when
we are not sure of putting through an important resolution.

The neurotic, in whose self-consciousness one can seldom miss a
trait of depression and anxious expectation, forms a larger amount
of such contrast ideas, or he perceives them more easily; they appear
to him also as more important. In the state of exhaustion in which
our patient happened to be, this very contrast idea, which is ordi-
narily pushed aside, proved to be the stronger of the two. It was
this idea which was objectivated, and to the horror of the patient,
she then actually produced the dreaded noise. In order to explain
the whole process, I also assume that the exhaustion was only partial;
it concerned, as one would say in terms of Janet and his pupils, only
the primary ego of the patient, but had not caused a weakening also
of the contrasting idea.

Furthermore, I assume that it was the horror of the noise pro-
duced by the counter-will which endowed the moment with traumatic
effectiveness, and fixed the noise itself as a physical memory symp-
tom of the whole scene. Indeed, I believe that in the character of
this very tic, consisting of many spasmodically emitted sounds sep-
arated from one another by pauses, and resembling mostly smackings,
one can recognize the traces of the processes to which it owes its
origins. It seems that there was a struggle between the resolution
and the contrast idea, that is, the “counter-will,” which furnished
the tic with the cast of character, and which restricted the contrast
idea to the unusual path of innervation of the speech muscles.

The spasmodic speech inhibition, or the peculiar stuttering, was
the remnant of an essentially similar cause, only that here it was not
the result of the final innervation, that is, the crying, but of the
process of innervation itself, that is, the attempt of a cramp-like
inhibition of the speech organs became raised in the memory to a
symbol of the event.

Both symptoms, the smacking and stuttering, closely related
through the history of their origin, remained henceforth associated,
and through a repetition on a similar occasion, developed into con-
stant symptoms. Later, however, they were adapted for further use.

67

CASE HISTORIES

Having originated under violent fright, they henceforth associated
themselves (following the mechanisms of mono-
symptomatic hysteria,
which I will show in Case V) with every fear, even if the latter could
not give cause for the objectivation of a contrast idea.

They were finally connected with so many traumas, and acquired
so much right to reproduce themselves in memory, that without any
further cause, following the manner of a senseless tic, they constantly
interrupted speech. But the hypnotic analysis could then show how
much meaning there was concealed behind this apparent tic, and
even if it was not possible to bring both symptoms to full disappear-
ance with one stroke by the Breuer method, this was due to the fact
that the catharsis was extended only to the three principal traumas,
and not to those of secondary association.²⁶

²⁶I could here give the impression that I put too much weight on the details
of the symptom, and that I am losing myself in superfluous astrology. How-
ever, I have learned that the determination of hysterical symptoms really
reaches back into the most delicate elaborations, and that one cannot easily
attribute to them too much meaning. I shall cite an example which will justify
my attitude. Months ago, I treated an eighteen year old girl from a family
burdened by heredity, whose complicated neurosis showed its good share of
hysteria. The first thing that I learned from her was a complaint of attacks
of despair that had a twofold content; in the one, she felt a pulling and prickling
on the lower part of the face, from the cheeks down towards the mouth, in the
other the toes of both feet were spasmodically extended and moved restlessly
to and fro. In the beginning, I, myself, was not inclined to attribute much
significance to these details and it was quite in harmony with the former views
of hysteria to see in these manifestations proof of an irritation in the cortical
center. Where the centers of such parasthesia were we surely did not know,
but it was known that such parasthesias initiated partial epilepsy, and con-
tributed to the sensory epilepsy of Charcot. However, the situation was
differently explained. When I became better acquainted with the girl, I once
asked her directly what thoughts came to her mind. I told her that she should
not be ashamed to tell, that there must be an explanation for these two mani-
festations. The patient became red in the face, and finally was led without
hypnosis to the following explanation, the reality of which was fully confirmed
by her companion, who happened to be present. Since the beginning of her
menstruation she suffered for years from adolescent headaches, which made
any continuous occupation impossible, and interrupted her education. Finally,
when she became freed from this impediment, the ambitious but somewhat
simple-minded child decided to work zealously in order to catch up with her
sisters and casual friends. In doing this, she exerted herself beyond measure,
and such an effort usually ended with an outbreak of despair over the fact that
she overestimated her strength. She naturally was also in the habit of com-
paring herself physically with other girls, and felt unhappy when she dis-
covered in herself a physical disadvantage. Her very prominent prognathism
began to worry her, and she conceived the idea of correcting it by practicing
for fifteen minutes at a time pulling down her upper lip over her protruding
teeth. The failure of this childish effort once led her to an outbreak of despair,
and from that time on, she gave as the content of one kind of her attacks a
pulling and prickling from the cheeks downward.—No less transparent was
the determination of the other attacks with the motor symptoms of extension
and motion of her toes. I was informed that the first of these attacks appeared

68

Calling out the name, “Emmy,” in attacks of confusion, which,
according to the rules of hysterical attacks, reproduced the frequent
states of helplessness during the treatment of her daughter, was con-
nected through a complicated trend of thought with the content of
the attack, and corresponded perhaps to a protective formula of the
patient against this attack. In a looser utilization of its meaning,
this call would probably have been adaptable as a tic. The compli-
cated protective formula, “Do not touch me, etc. . . . ,” had
already attained this application, but the hypnotic therapy held back
in both cases the further development of these symptoms. The call,
“Emmy,” which was quite newly developed, I still found in its
native soil; that is, it was restricted to the attack of confusion.

Whether all these motor symptoms: the smacking, through the
objectivation of a contrast idea, the stuttering, through a mere con-
version of psychic motor excitement, the call, “Emmy,” and the
longer formula as a protective measure, may have originated through
an intentional act of the patient in an hysterical paroxysm—all of
them have this one thing in common, to wit, that in origin or con-
tinuity they are in demonstrable association with the traumas, for
which they appear as symbols in the memory activity.

The patient’s other physical symptoms were not at all of an
hysterical nature. Thus, the neck cramps, which I conceived as a
modified migraine, do not, as such, really belong to the neurosis, but

after a mountain-climbing party in a mountain resort, and the relatives were
naturally inclined to attribute it to overexertion, but the girl gave the following
information: One of the standing themes of mutual teasing among her brothers
and sisters was to call attention to her undeniably large feet. Our patient,
having been unhappy for a long time over this lack of beauty, strove to force
her feet into the narrowest shoes, but her observant father would not allow
this, and took care that she wore only comfortable footwear. She was quite
dissatisfied with this arrangement, thought continuously of it, and got into the
habit of playing with her toes in her shoes, like one does when one wishes to
measure by how much the shoe is too big, and how much smaller a size one
can wear, etc. During the mountain-climbing party, which she did not in any
way find exerting, there was naturally another occasion to make remarks about
her shoes, which were visible on account of her short skirt. One of her sisters
said on the way, “But you are wearing particularly large shoes today.” She
then measured with her toes, and she thought so, too. The excitement over
the unfortunately big feet no longer left her, and when she came home, she had
the first attack in which her toes cramped and moved involuntarily as a memory
symbol for the whole depressive trend of thought. I observe that we deal here
with a symptom of attack and not with a permanent symptom. Moreover I
wish to add that after this confession the attacks of the first kind ceased,
whereas the second with the restless toes continued. There must surely have
been a fragment connected with it, which has not been confessed.
Postscript: I also discovered later that this simple-minded girl worked
overzealously to beautify herself because she wanted to please a young cousin.

69

must be put among the organic affections, though they regularly
become connected with hysterical symptoms. In Mrs. von N. the
neck cramps were utilized as hysterical attacks, whereas they exerted
no influence over the typical forms of manifestations of the hysterical
attacks.

I will now complete the characteristics of Mrs. von N.’s psychic
state by taking up the demonstrable morbid changes of her conscious-
ness. Just as through the neck cramps, she also lapsed into a
delirium through painful impressions of the present,²⁷ or through
forceful allusions to one of her traumas (judging by only few
observations I cannot say anything different).—Such a delirium was
swayed by a restriction of consciousness and by an associative force
similar to that in the dream, in which hallucinations and illusions
develop most easily, and in which weak and even contradictory conclu-
sions are drawn. This state, comparable to a psychic alienation, prob-
ably took the place of her attack, something like an acute psychosis
as an equivalent for the attack, which we would classify as an “hal-
lucinatory confusion.” Another similarity to the typical hysterical
attack also lies in the fact that in most of them a fragment of the
old traumatic memory could be demonstrated as the foundation of
the delirium. The transition from the normal state into this delirium
frequently proceeded quite imperceptibly. Thus, as she was speaking
quite normally about more or less affective things and the conversa-
tion drifted to painful ideas, I suddenly noticed by her accelerated
gestures, by the appearance of her speech formula, and similar signs,
that she was in a state of delirium. In the beginning of the treat-
ment the delirium continued throughout the whole day so that it was
difficult to tell with certainty from individual symptoms, such as
gestures, whether they belonged to the psychic state, as a symptom of
the attack, or whether like the smacking and stuttering, they had
developed into real permanent symptoms. It was often only possible
to distinguish subsequently what occurred in the delirium, and what
occurred in the normal state. The two states were actually separated
by the memory, and she was then most surprised to hear what things
had pieced together the delirium and the normally conducted con-
versation. How the two states permeated each other without one
taking notice of the other was shown in the most remarkable way in
my first conversation with her. Only once during this psychic see-
sawing could one observe any impinging upon the normal conscious-
ness.

27 Cf. the last delirium in the garden.

70

ness of the present, and that happened when she gave me an answer
which originated in her delirium when she said that she was a woman
of the last century.

The main reason for the superficiality of the analysis of this
delirium was due to the fact that her condition improved so quickly
that the deliria were soon sharply distinguished from her normal
life, and confined themselves to the periods of her neck cramps. In
contrast to this, I have gathered so much more experience concerning
the behavior of the patient in the third psychic state, that is, in the
artificial somnambulism. While she did not know in her normal
state what psychic experiences she went through in her delirium and
what in her somnambulism, she had full command over her memory
in her somnambulism of all three states; here she was really most
normal. If I disregard the fact that in a somnambulic state she was
less reserved towards me than in the best hours of her ordinary life,
as shown by the fact that she gave me information about her family
and similar intimacies, whereas ordinarily she treated me as if I were
a stranger, and when I also disregard the fact that she showed the
full suggestibility of somnambulism, I must really say that in her
somnambulism she was in a perfectly normal state. It was interest-
ing to observe that this somnambulism showed no supernormal fea-
tures, that it evinced all the psychic shortcomings which one expects
in the normal state of consciousness. The behavior of the som-
nambulic memory may explain the following tests: While conversing
with me, she once expressed her enthusiasm over a beautiful flower
pot which decorated the vestibule of the sanitarium. “But what is
the name of it, Doctor?” “Don’t you know?” I knew both the
German and the Latin names, but I have forgotten both.” She was
an excellent connoisseur of plants, whereas I admitted my botanical
ignorance on such occasions. A few minutes later I asked her in
hypnosis: “Do you know now the name of the plant in the vesti-
bule?” The answer came without the slightest hesitation: “The
German name is turk lily, and the Latin name I really have for-
gotten.” On another occasion she told me during a period of well
being about her visit to the catacombs of Rome, and could not recall
two terms in the description, in which I could not assist her. I
immediately thereafter found out in the hypnosis what words she
meant. She did not know them even in the hypnosis. I, thereupon,
said to her: “Don’t think of it now, tomorrow between five and

71

CASE HISTORIES

six in the afternoon in the garden, perhaps a little nearer to six, the
names will suddenly come to you.”

The next morning during a conversation which was quite foreign
to the catacombs, she suddenly burst out: “Doctor, crypt and
columbarium.” “Oh, these are the words which you could not recall
yesterday. When did they flash through your mind?” “This
afternoon in the garden shortly before I came up.” I noticed that
in this way she wished to show me that she was punctual to the exact
time, for she was in the habit of leaving the garden at about six
o’clock. Thus, even in her somnambulism she did not have at her
disposal the whole bulk of her knowledge; here, too, there existed
an actual and a potential consciousness. Often enough it happened
that to my question in hypnosis, “Whence did this or that manifes-
tation originate?” she wrinkled her forehead, and after a pause
answered quietly, “That I do not know.” I was in the habit of
saying, “Just think and you will soon find out,” and after a little
while she could give me the desired information. But it also hap-
pened that nothing came to her mind and I had to leave her the task
of recalling it the next day. This was invariably the case. This
woman, who in everyday life avoided painfully every untruth, did not
lie in the hypnosis either; but it often happened that she gave imper-
fect information and held back a fragment of the report until I forced
her to complete it the next time. As mentioned above,²⁸⁾ this was
mainly due to a revulsion which the particular theme evoked, and
which shut her mouth even in somnambulism. Despite these restrict-
ing features, the impression gained from her psychic behavior in
somnambulism was one of uninhibited unfolding of her mental force
and of a perfect mastery of her whole memory.

Her undeniably marked suggestibility in somnambulism was,
nevertheless, very far from a morbid lack of resistance. On the
whole, I must say that I really made no more impression upon her
than I might have expected from such an investigation of the psychic
mechanism of any person who would have listened to me with great
confidence and with full mental clearness, except that Mrs. von N.
could not offer me such a favorable psychic attitude when she was
in her so-called normal state. Whenever, as in the case of the animal
phobia, I was unsuccessful in showing her the causes of the convic-
tion, or whenever I did not enter into the history of the psychic
origin of the symptoms, but wished to produce results by means of

²⁸⁾P. 66.

72

authoritative suggestion, I have always observed the tense, unsatis-
fied expression in her features. And when I asked at the end, “Well,
will you be afraid of these animals?”, the answer was “No, because
you desire it.” Such promising, which could have been based only
on her yieldingness to me, produced no better results than the many
general precepts which I imparted to her, instead of which I might
just as lief have given her such a suggestion as, “Be in good health.”

This same person who held on so stubbornly to her morbid
symptoms in the face of suggestions, and only dropped them when
confronted with psychic analysis or through conviction, was on the
other hand, as passive as the best hospital medium when it concerned
indifferent suggestions, things which had no reference to her disease.
I have reported examples of such post-hypnotic obedience in the case
history. I find no contradiction in this behavior. The right of the
stronger idea had to assert itself even here. If one investigates the
mechanisms of the pathological “fixed idea,” one finds that it is
founded on and supported by so many intensively effective experi-
ences that one cannot be surprised that it can offer successful resist-
ance to a suggested counter-idea, which again possesses only a certain
force. If it would really be possible to blow away such justified
experiences of intensive psychic processes through suggestion, we
would surely deal with a very pathological brain.²⁹

²⁹In other cases I have gained a deep insight into these interesting contrasts
between the most far-reaching somnambulistic obedience and the most stubborn
persistence of the morbid symptoms because the latter were deeply founded and
inaccessible to analysis. I treated unsuccessfully for over five months a young,
active, and talented girl, who was afflicted with a severe disturbance of her gait.
This patient showed analgesias and painful spots in both legs, a rapid tremor of
the hands, she walked with heavy, short steps, her body bent forward swaying
like in a cerebellar affliction, so that now and then she fell to the floor. Her
state of mind, however, was strikingly cheerful. Because of this symptom-
complex, one of our erstwhile Viennese authorities was led to make the diag-
nosis of multiple sclerosis. Another specialist recognized it as hysteria, which
was favored by the complicated structure of the morbid picture at the onset
of the disease (pains, faintings, amaurosis), and referred the patient to me
for treatment. I made an attempt to improve her gait by means of hypnotic
suggestions and treated also her legs by hypnosis, etc., but without success,
although she was an excellent subject for somnambulism. One day as she
again entered the office, swaying, supporting one arm on her father and the
other on an umbrella, the tip of which was markedly worn off, I became
impatient and screamed at her in the hypnosis, “You have carried on long
enough, before noon tomorrow the umbrella you are holding in your hand will
break and you will have to go home without an umbrella.” I do not know
how I came to the stupidity of directing any suggestion to an umbrella. Later,
I was ashamed of it, but had no inkling that my smart patient would take it
upon herself to save my reputation from her father who was a physician and
witnessed this procedure. The next day, the father reported the following:
“Do you know what she did yesterday? We were walking in the Ringstrasse.

73

When I studied the somnambulic state of Mrs. von N., weighty
doubts arose in me for the first time about the correctness of Bern-
heim’s statement: Tout est dans la suggestion—and about the thought
of my keen-minded friend, Delboeuf: Comme quoi il n’y a pas
d’hypnotisme. Nor can I understand today how my extended finger
and the single repetition of “Sleep” could have created this special
psychic state of the patient. I might have evoked this state, but I
have surely not created it by my suggestions, for its characteristics,
which were surely firmly established, surprised me very much.

How the somnambulic therapy was practised in this case can be
readily seen from the case history. As is customary in hypnotic
psychotherapy, I combated the existing morbid ideas through assur-
ances, prohibitions, and the introduction of all kinds of counter ideas,
but I was not satisfied with just that. I traced, therefore, the history
of the origin of the individual symptoms in order to be able to
combat the assumptions upon which the morbid ideas were con-
structed. During these analyses it regularly happened that the
patient spoke under the stress of excitement about things the affects
of which had hitherto gained discharge only through expressions
of emotional feelings. How much of each therapeutic result could be
attributed to this suggesting away in statu nascendi, and how much
to the loosening of the affect through abreaction I cannot state,
because I have allowed the two therapeutic factors to work together.
Accordingly, this case could not be used as a strong proof that the
cathartic method contains therapeutic efficacy. Nevertheless, I must
say that only those morbid symptoms which were subjected to a
psychic analysis were really removed permanently.

On the whole, the therapeutic result was considerable, but not

Suddenly, she became exaggeratingly cheerful and began to sing in the street:
“We lead a free life . . .” and accompanied herself by beating time with the
umbrella, and striking it against the sidewalk until it broke.” She naturally
had no idea that through her own good sense she transformed a foolish sugges-
tion into a very successful one. When her condition had shown no improve-
ment after assurance, command, and treatment in the hypnosis, I turned to
psychic analysis and wanted to know what emotional state preceded the out-
break of her ailment. She then related in the hypnosis, but without any
emotionalism, that shortly before her illness a young relative died, whose
betrothed she had considered herself for many years. This information, how-
ever, changed nothing in her condition; accordingly, I said to her in the next
hypnosis that I was quite convinced that the death of her cousin had nothing to
do with her condition, that something else must have happened, which she did
not mention. She then permitted herself to be drawn into one single allusion,
but hardly had she uttered one word when she became mute and her elderly
father, sitting behind her, began to sob bitterly. I naturally did not press the
patient any further, nor have I ever seen her again.

74

permanent. However, the patient’s tendency to become sick in the
same manner from new traumatic occurrences was not removed. He
who wishes to bring about a permanent cure of such hysteria must
obtain a more detailed account of the causal relations of the phe-
nomena than I had attempted at that time. Mrs. von N. was certainly
a neuropathic person, burdened by heredity; without such a dispo-
sition no hysteria could have probably developed. Yet, a disposition
alone does not make a hysteria, it requires other causes, and to be
sure, as stated, adequate causes, that is, an etiology of a definite
nature. I have mentioned before that in Mrs. von N. the affects of
so many traumatic experiences seemed to have been retained, and
that a vivid memory activity then brought to the surface now this,
and now that, trauma. I will now venture to give the cause for this
retention of the affects in Mrs. von N. In the first place, it probably
depended on her hereditary predisposition. Her feelings were on the
one hand very intensive; she was of a violent nature, capable of the
greatest discharge of passions, and on the other hand, since her
husband’s death she lived in a state of complete psychic isolation,
she was suspicious of her friends because of persecution by her rela-
tives; and she watched jealously lest someone should gain too much
influence over her. The sphere of her duties was large and the
psychic work which was imposed upon her she attended personally
without the aid of a friend or a confidant. She was almost isolated
from her family, and labored under difficulties imposed upon her by
her conscientiousness, her tendency to self-torture, and often also by
her natural helplessness as a woman. In fine, the mechanism of the
retention of large sums of excitement, as such, cannot be ignored
here. It was based in part on the circumstances of her life, and in
part of her own natural make-up. Thus, her shyness to tell any-
thing about herself was so great that none of her daily frequenters,
as I learned with surprise during my visit in 1891, knew that she
was a patient and I her physician.

Have I exhausted with these remarks the etiology of this case
of hysteria? I do not think so, for at the time of these two periods
of treatment, I had not yet put to myself the question which could
be answered only by an exhaustive explanation. I now think that
something else must have developed in the hitherto unchanged
etiological relations to provoke an outbreak of the disease precisely
in these last years. I was also struck by the fact that of all the
intimate information imparted by the patient, the sexual element,

75

which is more responsible for traumas than anything else, was
entirely lacking. Stimulations from these spheres hardly could have
vanished without leaving any traumatic trace. What she allowed me
to hear was probably an editio in usum delphini of her life’s history.
In her behavior the patient always displayed the most unartificial
decency without any prudery. But when I think of the reverse with
which she related in the hypnosis the little adventure about the hotel
chambermaid, I suspect that this impetuous woman, capable of such
strong feelings, must have mastered her sexual needs with no little
struggle, and that her effort to suppress all these very strong impulses
must have entailed much psychic exhaustion. She once confessed to
me that she did not marry again because with her large fortune she
could not trust herself to the unselfishness of her suitors, and that
had she married, she would have reproached herself with harming
the interests of her two children.

One more observation before I close the history of Mrs. von N.
Both Breuer and myself knew her quite well and for quite a long
time. We used to smile when we compared her character with the
portrait of the hysterical psyche as found from the time of antiquity
in books and as drawn by physicians. Just as our observation of
Mrs. Cecilia M. had taught us that the severest form of hysteria is
compatible with the richest and most original endowment—a fact
which one gathers almost to the point of evidence from biographies
of famous women in history and literature—so in Mrs. Emmy von N.
we had a good example for the fact that the development of an
irreproachable character and a well directed course of life is not
incompatible with hysteria. She was a remarkable woman, whom
we have learned to know, whose moral earnestness in the concept of
her duties, whose very masculine intelligence and energy, whose high
education and love for truth impressed both of us, while her kindly
care of her dependents, her inner modesty, and the refinement of her
company, stamped her as a most esteemed lady. To call such a
woman “degenerate” is to distort this word beyond recognition.
One does well to distinguish sharply those who are “predisposed”
from those who are “degenerate”; otherwise, one will be forced to
admit that mankind owes a great deal of its great accomplishments
to the efforts of “degenerate” individuals.

I also admit that I could find nothing in the history of Mrs. von N.
that would point to that “psychic inferiority” upon which P. Janet
bases the origin of hysteria. According to Janet, the hysterical

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disposition consists in an abnormal narrowing of the field of con-
sciousness (in consequence of hereditary degeneration), which leads
to the neglect of whole series of perceptions, and in serious courses
of this development, to the destruction of the ego, and to an organi-
zation of secondary personalities. Accordingly, after the subtraction
of the hysterically organized psychic groups, the rest of the ego
would also be less functionally capable than the normal ego. And
as a matter of fact, Janet actually maintains that this ego, which
is burdened in all hysterics by psychic stigmata, is condemned to
monoideism, and is incapable of the ordinary volitional activity of
life. It is my opinion that Janet has here unjustly raised the end-
results of the hysterical change of consciousness to the rank of
primary conditions of hysteria. This theme is worthy of a more
thorough discussion in another place; but such functional inferiority
was not observed in Mrs. von N. During the period of her most
severe illness she was, and remained, capable of participating in the
management of a large industrial undertaking, she never lost sight of
the education of her children, and kept up a correspondence with
mentally superior persons. In brief, she attended to all her duties
so. well that no one had any inkling of her illness. I would think,
however, that such behavior would result in a palpable amount of
psychic overexertion, and could not perhaps be maintained for a long
time, and in our case had to lead to an exhaustion or to a secondary
“misère psychologique.” It is probable that such disturbances of her
functional capacity began to make themselves already noticeable
when I first saw her, but at all events, there existed a severe hysteria
for many years before these symptoms of exhaustion manifested
themselves.

OBSERVATION III. MISS LUCIE R. (FREUD)

Towards the end of 1892 a friendly colleague recommended to me
a young lady whom he had been treating for chronic recurrent purulent
rhinitis. It was later found that the obstinacy of her trouble was caused
by a caries of the ethmoid. She finally complained of new symptoms
which this experienced physician could no longer refer to local affec-
tions. She had lost all perception of smell and was almost constantly
bothered by one or two subjective sensations of smell. This she found
very irksome. In addition to this she was depressed in spirits, weak,
and complained of a heavy head, loss of appetite, and an incapacity
for work.

This young lady visited me from time to time during my office hours—
she was a governess in the family of a factory superintendent living