Freud determined that hysterical symptoms were not “mentally determined or removable by analysis,” but instead they were “direct toxic consequences of disturbed sexual chemical processes” (Veith, 266). Therefore, he had to find the root of the sexual trauma before he could treat the symptoms. Freud was initially receptive to Charcot’s treatment methods, particularly hypnosis. However, he held a growing belief in “the possibility of exploring the patient’s unconscious and repressed memories without altering his mental state by inducing hypnosis” (Veith, 268). Freud, therefore, morphed hypnosis into the practice of psychoanalysis, in which he delved into the patient’s unconsciousness through free association and questioning techniques.
Freud’s most famous case study on hysteria focused on a patient he called Dora. Dora suffered from what he called petit hysterie, which including symptoms such as dyspnea, migraines, depression, unsociability, and a recurring cough (Freud, 17). As a girl, Dora was particularly close to her father, and together they spent a lot of time with his friend Herr K. She entered therapy after her parents found a suicide note on her desk (Freud, 16). Freud determined that the primary cause of her hysteria was her experiences with Herr K., which included him flirting with her and trying to kiss her. Freud also believed that Dora’s hysterical symptoms occurred because she had repressed homosexual feelings for her father’s mistress and Herr K’s wife, Frau K. He therefore sought to uncover how this singular traumatic experience was causing her wide variety of hysterical symptoms.
He began Dora’s treatment by determining how her hysterical symptoms had stemmed from the original traumatic experience with Herr K. Freud’s main method to determine this was dream interpretation. He believed that he could use dreams to uncover the gaps in Dora’s memory that were representing repressed experiences. For example, Dora related this dream to Freud:
A house was on fire. My father was standing beside my bed and woke me up. I dressed myself quickly. Mother wanted to stop and save her jewel-case; but father said: “I refuse to let myself and my two children be burnt for the sake of your jewel case.” We hurried downstairs, and as soon as I was outside I woke up (Freud, 56).
She had first had the dream right after Herr K propositioned her, so Freud linked the dream with her experience. Freud explained that the term “jewel-case” was a euphemism for the female genitalia (Freud, 61). Therefore, her father’s refusal to accept her mother’s request meant that her father was no longer sexually attracted to her mother. Freud then determined that this dream had begun just after her encounter with Herr K because she was inherently sexually attracted to her father and wanted to assure herself that her father was not satisfied by her mother.
Freud then worked with Dora to find the underlying cause for each of her hysterical symptoms. For example, Dora had experienced asthmatic attacks throughout her life. Freud believed that the cause of her asthmas was “the patient’s having overheard sexual intercourse taking place between adults” (Freud, 72). He believed that because of her attraction to her father, these sounds sexually excited her. Therefore, “a little while later, when her father was away and the child, devotedly in love with him, was wishing him back, she must have reproduced in the form of an attack of asthmas the impression she had received” (Freud, 72). Freud also explained Dora’s recurrent cough by her relationship with her father. He argued that Dora heard of performing oral sex, and she believed that her father’s mistress, Frau K, was pleasuring her father in this way. Freud, therefore, believed that she was putting herself in Frau K’s place and therefore had developed an unconscious phantasy and was expressing it through “an irritation in her throat and by coughing” (Freud, 44). These are just two examples of how Freud believed that hysterical symptoms signified “the representation – the realization – of a phantasy with a sexual content” (Freud, 39).
Freud developed psychoanalysis as an attempt to avoid the suggestibility of hypnosis while still probing his patients’ consciousness. Although he specifically used a hands-off method to ensure that no psychic links were made between him and the patient, his own questions and interjections “could constitute the fantasy of seduction, or even of rape, and thus further contribute to the symptoms of the hysteric” (Kahane, 18). Freud’s leading questions could be as suggestive as hypnosis. Psychoanalysis was also criticized because it separated “the personal history and the psychic characteristics of the mentally ill from the world of normal mental development, thereby blocking the way to a more general and unified conception of mental activity” (McGrath, 194). For example, Freud’s analysis of Dora’s case could not provide a generalized definition or treatment for hysteria; it was too personalized. However, psychoanalysis formed a foundation for later psychotherapeutic methods.