Lecture Notes on Hysteria and Dream Analysis

Presentation

• 6-8 minute presentation, at least two members should speak
• Option A: Causes of Hysteria
• Option B: Roleplay - Reenact a scene from Breuer’s case with Anna O.
• Q&A session after presentation

Hysteria

• Characterized by symptoms such as:
  • Paralyses
  • Contractions
  • Odd movements
  • Disturbances of vision, hearing, and smell
  • Pains
  • Anaesthesias
  • Seizures (fits)
  • Many more
• Known to the ancient Greeks – originally linked with the uterus
• Often confused with other conditions or dismissed as malingering (꾀병)
• Now known as "conversion disorder" or "functional neurological disorder"

Origins of the Psychoanalytic Method

• Jean-Martin Charcot at Salpetriere in Paris establishes hysteria as a genuine illness
• He used hypnosis to bring about hysteria-like symptoms and observes that hysterical symptoms are based on concepts rather than physical abnormalities
• Freud studies with Charcot 1885-86 and begins using hypnosis in his practice soon after

Origins of the Psychoanalytic Method

• Freud hears of an interesting case from his mentor Josef Breuer.
• Anna O. (real name Bertha Pappenheim), 1880-1882
• "Talking cure" aka "chimney sweeping"
• Breuer cures her hysterical symptoms through the "cathartic method"
• Development of technique: hypnosis -> "lie down and close your eyes" -> pressure technique -> free association

Freud-Breuer Theory of Hysteria

• For many hysterical symptoms:
  • (a) An unconscious memory is a cause of the symptom, and
  • (b) This memory is unconscious due to an ongoing repression.
• Evidence:
  • Disappearance of symptom on recall of memory and expression of affect
  • Thematic affinity between traumatic memory and symptom
  • Symptom "joins in conversation"
  • Resistance (patients would resist bringing up that memory)

Elizabeth von R. (Ilona Weiss)

• Freud tries Breuer’s cathartic cure
• Elizabeth resistant to hypnosis
• Freud tries the "pressure technique" and free association
• Some progress: her symptoms "join in the conversation"
• She shows resistance to recovering key memories (her "secret")
• Eventually Freud discovers the "secret": she was in love with her brother-in-law

Conversion

• The unconscious memory is associated with strong emotions that has not been approximately expressed, hence remains "energetic."

• A symptom is brought about by conversion: emotional energy finds expression as a symptom

• This occurs by means of an unconscious association of ideas that establishes a connection between the memory and the symptom.

• One of Freud’s most famous cases involving conversion was that of Anna O. (real name Bertha Pappenheim), a patient of Freud's colleague Josef Breuer. Anna O. suffered from a variety of physical symptoms, including paralysis, hallucinations, and speech disturbances, which had no clear medical cause. Through Breuer's and later Freud’s analysis, it was found that these symptoms were connected to emotional trauma and unresolved grief, particularly regarding her father’s illness and death. Her symptoms were an example of conversion hysteria, where psychological distress was expressed as physical symptoms.

• In another famous case, Freud worked with Elisabeth von R., who suffered from severe leg pain. Freud discovered that her pain was linked to emotional conflicts and guilt over her father’s death and her repressed feelings regarding her own romantic desires. In this case, the leg pain was a physical manifestation of her emotional turmoil, symbolizing her inability to move forward with her life due to unresolved guilt and grief.

Underlying Theory (Metapsychology)

• "Psychical energy" – what causes mental work
• Principle of constancy: the mind tries to keep the amount of energy constant by “disposing associatively of every sensible accretion of excitation or by discharging it by an appropriate motor reaction."
• Energy can pass from idea to idea, until it brings about action, whereby it diminishes

Later Development in Freud’s Theory of Hysteria

• Patients’ association led beyond recent trauma, beyond puberty, to passive sexual experiences in childhood.
• The seduction theory
• Freud, recognizing the role of phantasy, abandons the seduction theory
• Infantile sexuality - even infants can express their sexuality (different from adult sexuality) (oral stage-anal stage-phallic stage-latency period -genital phase)
• Fixation during each stages - ex) smoking (oral fixation) excessive eating (oral fixation) control (anal fixation)
• Conflict between sexuality and internalized prohibitions against sexuality are what lie at the basis of hysteria

Hysteria to Dreams

• Hysterics often spoke about dreams as they free associated
• Freud began applying the psychoanalytic technique to dreams
• Method: free associate with individual elements of the dream, interpret

The Dream of Irma’s Injection (Background)

• Freud had various insecurities and anxieties.
• His income was irregular
• His family was growing – at the time of the dream his wife was pregnant with their sixth child.
• He faced antisemitic discrimination and hostility against his ideas about the relation between sexuality and neuroses
• Even Breuer was distancing himself from him
• Just a few months before, his patient Emma Eckstein had suffered a near-fatal hemorrhage due to the medical negligence of Freud’s closest friend, Wilhelm Fliess, to whom he had referred Emma

The Dream of Irma’s Injection (Background)

• Freud’s specimen dream (July 23-24 1895)
• Freud had been treating a young lady, Irma, about whose case he felt pressured due to his close acquaintance with her family
• He had partially cured her of her hysterical symptoms but was anxious because the cure was incomplete
• The day before his dream, a friend a fellow physician, Otto, who had seen Irma while she was on vacation, had responded to Freud’s inquiries about her by remarking that, while she was better, she was not yet well
• Freud thought this a reproof 책망 꾸짖음, which angered him
• It prompted him to spends much of the night writing a long letter of self- justification to Breuer(who is doctor M in the dream)

The Dream of Irma’s Injection (Analysis)

• "I was alarmed…"
• "A faint doubt crept into my mind… that my mind was not entirely genuine."
• -> He comes to realize that he actually wishes that the symptom has an organic cause, as this would relieve him of responsibility for not being able to cure Irma
• Irma
  • The presence of Irma by the window brings to Freud’s mind other people
  • One is Irma’s friend, a woman he admires. He had chanced upon her one evening while she was standing by the window just as Irma was in the dream. Also, he knows that she suffers from hysterical choking as Irma does in the dream.
  • Freud wanted her as his patient, but she was too reserved- too recalcitrant
  • The other lady, being wiser, would not have disputed his solution to her hysteria as Irma has done
  • Irma’s pale, puffy face and her pains in her abdomen reminded him of his wife whose birthday party is the event the dream is anticipating

The Dream of Irma’s Injection (Analysis)

• Dr. M
  • Dr. M of the dream also brings to mind another person
  • Freud’s older brother, who is similarly clean-shaven, has recently had a limp, and otherwise closely resembles Dr. M as he appears in the dream
  • There is in Freud’s mind one salient connection between these two older men: they both rejected a suggestion he had made
  • "It’s an infection, but no matter. Dysentry will supervene and the toxin will be eliminated."
  • Dysentry reminds Freud of a patient of his whose symptoms he had diagnosed as hysterical, but while he was away, an ignorant doctor diagnosed him as having dysentry
  • This reminds Freud of an anecdote that M told him: failing to recognize the seriousness of a patient’s symptoms
  • Freud concludes from this that he was mocking M for failing to realize that Irma’s symptoms were hysterical
  • He realizes he is wishing a loss of face on both M and brother for not accepting his theories

The Dream of Irma’s Injection (Analysis)

• Otto
  • In the dream, Leopold(relative of Otto), observes that there is "a dull area low down on the left"
  • This agrees "in every detail" with a case that he remembers in which Leopold impressed him with his thoroughness
  • This contrasts with Otto’s hasty judgement of Freud. Freud is thus comparing Otto unfavorably with his relative.
  • Later in the dream he reports that Irma was feeling unwell because "Otto had given her an injection" – blaming him directly for Irma’s illness
  • Otto is thus blamed and denigrated in several ways in this dream

The Dream of Irma’s Injection (Analysis)

• "Propyl,,, propyl,,, propionic acid"
  • That night his wife had opened a bottle of liquor that Otto had given them as a gift, but it gave off such a pungent smell that refused to drink
  • This smell led him to the list of chemicals in his dream
  • Freud infers that he is avenging himself on Otto in the dream for this as well as for his remarks about Irma
• Trimethylamin
  • Freud recalls a conversation he had with Willhelm Fliess about the latter’s theory that T was linked to sexual processes
  • At this time Freud was developing his idea that certain of the neuroses were caused by sexual frustration

The Dream of Irma’s Injection (Conclusion)

• Short dream, long analysis
• Free associates with numerous elements of the dream
• Interprets these as a series of excuses for why Irma’s symptoms couldn’t be cured:
  • Her symptoms had a physiological rather than psychological cause
  • She failed to accept his solution
  • Her symptoms had been caused by Otto’s carelessness
  • Her symptoms are due to her widowhood
• Meaning of the dream: the wish that he was not responsible for the persistence of Irma’s pains

The Dream of Irma’s Injection (Conclusion)

• Freud’s method: free association, followed by interpretation
• The meaning of the dream:
  • Makes sense of the dream-content
  • Is the cause of the dream
• Manifest vs Latent Content (dream-content vs dream-thoughts)
  • Dream content: what you actually experience in the dream.
    • Manifest content: surface level of the dream
    • Latent content: the actual meaning of the dream
  • Dream thoughts: raw, unprocessed, unconscious thoughts, desires, or emotions that give rise to the dream. Ex: repressed wishes or fears

Freud’s Dream Theory

• D1. All dreams are interpretable
• D2. Dream distortion is the product of censorship and disguise
• D3. All dreams are wish-fulfillments
• D4. Ultimately, all dreams are the wish-fulfillments of infantile wishes
• D5. The function of dreams is to preserve sleep (to let us sleep longer)

D1. Dreams Are Interpretable

• Undistorted dreams (clear dreams): young children’s dreams, adult dreams of convenience (ex: dreaming of waking up)
• Distorted dreams: meaning uncovered by Freud’s method
• Do all dreams have meaning? -> Freud claims (almost) all dreams he analyzed (>1000) had a meaning
• Those he initially failed to interpret, were interpreted later when therapy had cleared up obstacles
• Young children’s dreams are always straightforwardly interpretable: it would be strange if children’s dream always had meaning but adult dreams didn’t

D2. Censorship Disguise

• Explains dream distortion

• Two-agency theory: our minds split and conflict with each other-> the result of this conflict is censorship disguise

• This is a metaphor

• Evidence:

  • Individual dreams show evidence of disguise (e.g., yellow beard)
  • Dreamer shows resistance, both in recall (failure in recall) and analysis

• Distorted dreams always involve (in their interpretation) repressed thoughts, and such thoughts are always expressed in the dream only in obscure form

• "A dream is a (possibly disguised) fulfillment of a (possibly suppressed or repressed) wish"

• For any dream,

  • (a) The motive of the dream is a wish
  • (b) The content of the dream is the (possibly disguised) fulfillment of that wish

Wish-Fulfillment

Evidence (Why Does He Think This?)

• Induction:
  • i) Undistorted dreams
  • ii) Distorted dreams (he thinks most dreams are like this)
  • iii) Counter-wish (e.g., supper-party)
• This evidence is not sufficient, as Freud admitted. His main rationale is based on theoretical reason (we’ll see this later)

The Dream- Work

• The process of going from latent content to manifest content
  1. Condensation
  2. Displacement
  3. Considerations of representability
  4. Symbolization

Condensation

• The operation by which numerous dream-thoughts are reduced to a smaller number of elements of the dream-content, through omission and fusion
• Fusion example: yellow beard dream.

Displacement 1

• The operation by which a dream thought is transformed into another thought on the basis of some similarity between them
• e.g., dream of Irma’s injection / amyls -> displaced by propyls in the dream

Displacement 2

• The operation by which the psychical intensity of a dream thought is displaced to other thoughts
• What is of intense interest in the dream thoughts is often peripheral in the dream and vice versa
• E.g., in the dream of the yellow beard: central theme of dream thoughts is professorship, but of dream content yellow beard

Considerations of Representability

• Also called visualization or dramatization
• The operation by which abstract thoughts are turned into visual images or dramatic scenes
• E.g. hypnagogic hallucinations:
  • Silberer: “I thought of having to revise an uneven passage in an essay. … I saw myself planing a piece of wood."

Symbolization

• The operation by which a dream thought is replaced by a symbol for it
• A symbol is a concrete concept that has come to represent another concept
• "Sometimes, a cigar is just a cigar" -> to interpret correctly you need to understand the dream fully

Freudian Symbols