There was no obvious neuropathic heredity in Fräulein Katharina’s family, though she seemed to know little about her mother’s English relations beyond her maternal grandmother, a healthy old woman who had occasionally travelled from her home in London to visit them. Though German was her first language, Katharina spoke fluent English, with no accent, so far as I could judge; she also demonstrated competence in French when I asked her to speak in that language. The reason for my doing so was that she had complained of complete aphonia on two occasions in the last two years, the first time when she was visiting her brother in Paris, and I was interested in establishing whether her temporary loss of speech might have had some connection with a lack of confidence in a foreign language.
The most intriguing aspect of Fräulein Katharina was the contrast between, on the one hand, the range of symptoms she presented and the very real distress that they occasioned her and, on the other, a kind of rational detachment. It was becoming clear to me that the initial impression that this evidently thoughtful young woman gave to the world concealed an extremely troubled interior life, and I was inclined to attribute the stoical air with which she bore her considerable troubles to what Charcot called the belle indifférence of the hysteric.
The clinical picture was further complicated by what one might term superficial anxiety states, expressed in a chronic insomnia, a tendency to low spirits, and a somewhat morbid fear of animals1. It was, at our first consultation, impossible for me to investigate fully these symptoms or to assign them their proper places in the hierarchy of her illness. My initial reaction was to see these relatively common and not particularly severe symptoms as – with one exception – a kind of diversion or displacement of more serious concerns and not in themselves particularly significant; and I am happy to say that my subsequent investigations were to prove me right.
Having arranged for Fräulein Katharina’s admission to the sanatorium, I concluded our first consultation by assuring her I was confident we should shortly get to the root of her troubles. Privately, I was inclining to a mixed diagnosis, in which it was possible that while some organic disorder might originally have been present, it was hysteria that was now, as it were, conducting the orchestra.2 I told her that we would begin with some massage and electrotherapy and that her diet and exercise regimen would be closely supervised by the staff between her consultations with me.
She appeared happy to think that positive steps were being taken and made no resistance when I told her that, in addition to these measures, I might wish to enquire into her personal history in considerably more depth in the course of the following days. To tell the truth, I was somewhat daunted by the thought of how the techniques of psychophysical resolution might be applied to such a wide variety of symptoms in the case of a patient with an apparently well developed self-understanding. It was difficult, on the other hand, not to feel sympathy for the evident suffering of a transparently affectionate and well-meaning young woman, so the prospect of resolution also held out considerable therapeutic allure.
April 19 [morning]
Fräulein Katharina said she had passed a very disturbed night. She was at pains to stress that the fault did not lie with her accommodation, which evidently pleased her and which she was quick to praise, but with the acute discomfort from her joints.
I examined her again and applied the faradic brush to a part of her arm she reported as having lost sensation; I then massaged her back and shoulders and told her she could expect a consequent relief in the pains of the joints. She appeared to enjoy the experience and was happy for me to stroke the parts of the lower abdomen that had most troubled her, though I applied only a limited pressure. I said I would arrange for twice-daily massage to become part of her régime, but she seemed alarmed that it might not be I who administered it on each occasion, so I agreed to postpone any firm decision.
By now I had decided to try to hypnotise the patient to see if somnambulism could provide a route into her unconscious, there being in my view a degree of urgency about the case. She readily agreed to the procedure and, when she was fully dressed again, lay down on the couch. After several attempts to put her into a hypnotic sleep, I had to confess that she was an extremely resistant subject; for all that I have studied Bernheim’s methods at close quarters, I have concluded that his own skill with hypnosis is as much responsible for his remarkable results as the innate suggestibility of his patients. With Fräulein Katharina, I had to be content with a state of co-operative relaxation, from which, I told her, she would be able to remember more at key moments suggested by the pressure of my hand on her forehead.
Using this technique, I was soon able to establish the moment at which she had first been aware of her abdominal troubles.
Her father had first fallen ill when Katharina – or Kitty, as she was known to her family – was twenty-one years old. They had enjoyed a relationship of unusual closeness throughout her life; he treated her more as a sister than a daughter and appeared to rely on her for a level-headedness and equanimity sometimes absent in the mother. He used to take Katharina to the theatre and discussed his work with her in detail, sometimes joking with her that he wished he could take her into the gentlemen’s clubs he frequented for supper, since she was ‘as good as any man’. He was a generous and loyal father; he enjoyed buying her dresses and small pieces of jewellery. On many occasions he told her how much he loved her and that she was a ‘blessing sent to him as a sign of love from God’.
By her own account, Katharina had been a tomboy, who much enjoyed playing with the local youths on a farm near Hanover where they had passed the summers of her early childhood. In the course of these she had become acquainted with the rudiments of animal reproduction; she had watched a bull being put to the cows and one spring had helped with lambing. Her mother appeared to have been an indolent and rather foolish woman who, while remaining undoubtedly good-looking and possessed of considerable charm, had not made the most of her gifts.
Katharina had a brother called Gustav, two years younger than herself, and a sister called Anna, three years younger than Gustav. It naturally fell to Kitty to help nurse them, particularly when her mother was going out for the evening. These tasks she performed with good grace and devotion, dressing up dolls for Anna and allowing Gustav to share her room and even her bed when he was frightened of the dark. The ebullience of her temperament doubtless made such duties easy for her to perform, but at the same time she told me she was anxious that she was likely to be used both as a substitute mother for her siblings and to some extent as a surrogate wife by her father; she was clearly a high-spirited and determined girl who felt there was a possibility that she would be denied the time to develop her own talents, which her father had convinced her were the ‘equal of any boy’s’.
At the age of fifteen, Fräulein Katharina was sent to a girls’ boarding school near Wolfsburg and for a time felt extremely disconsolate about being parted from her family, particularly from her father and from little Gustav, with whom she had been accustomed to share her secrets. At school, her anxieties about being used by the needs of others, and thus somehow finding herself overlooked, began to take a sexual form. As I applied mild pressure to her forehead, she confessed that she craved attention and had enjoyed sapphic fantasies about the older girls at school and had occasionally masturbated at night in her bed. She further volunteered that when she was about twelve, she and her friend Maria had been playing in the woods when both found it necessary to hoist up their skirts to squat down and micturate; they discovered later that Gustav had been spying on them, and Kitty confessed that she had enjoyed being exposed to her brother’s gaze in this way and had wanted to touch Maria’s genitals while they were wet, ‘to lure something warm out of her’, as she put it. She had, at this time, an irrational fear that she would die virgo intacta and felt she could not rest easy until she had experienced the sexual act, though her modesty and upbringing of course made such a thing impossible.
When she retur
ned home for the holidays, she found that her father had hired a secretary, Frau E—, a commanding character who had to some extent taken over Kitty’s role in the house. A domestic war seemed to break out between this woman and Katharina, who not only resented the way that Frau E— had usurped her place but found, to her alarm, that she felt physically fascinated by her. Things came to a head about a year later when Katharina was seventeen, when, after they had drunk some of her father’s wine, the secretary seduced her and apparently showed her how to masturbate to orgasm, something Katharina had never achieved before.
The important events of the next few years can be briefly summarised: on leaving school, Katharina resumed her position as her father’s principal helpmeet and secretary; Frau E— parted from the family on good terms, and wrote frequently to Kitty, whom she called‘my little weasel’. Their secret was not discovered by either parent and the incident itself was apparently not repeated.
Soon afterwards, Katharina’s father fell seriously ill with a heart complaint and was obliged to retire from work; the task of nursing him fell to Kitty, since her mother declared herself too distraught and was not in good health herself. During this time, the house inVienna was frequently visited by Herr P, a lawyer of about thirty-five who was a junior partner in Herr von A’s company and his confidant in business matters. Kitty would be obliged to leave the sick room when Herr P came to visit so that the men could conduct their business in private. On such occasions, she would either repair to the kitchen to instruct the maid to make some refreshment for the visitor or would go to her own bedroom until such time as her father should need her again. She would also, quite naturally, follow the same course of action when the doctor came to see her father. On one such occasion the regular doctor could not come but sent some sort of locum tenens in his place, a young man less well-mannered than the regular physician, who, after his consultation with Herr von A came into Katharina’s room without knocking to tell her he was leaving. She had felt irrationally furious and embarrassed by this intrusion, she said; she felt powerless, ‘as though my hands were tied’, and she thought it typical of this young man’s presumptuous yet stealthy manner in her father’s house.
For almost two years Fräulein Katharina nursed her dying father, with little help from her mother, who was suffering from chronic anaemia, and none at all from her younger brother and sister, who were respectively at university in Heidelberg and at Kitty’s old school near Wolfsburg. She was doubtless lonely and vulnerable at this time, though was still able to leave the house occasionally and to see friends of her own age, and usually of her own sex. She said that she ‘fell in love easily’ with young men, but distrusted her emotions and had never had any sort of sexual relations with a man; her mother told her she was ‘too affectionate’ and she was inclined to agree. During all the time of her father’s illness, Herr P was the most regular visitor, though various family friends called for half an hour or so in the evening and Frau E— remained a regular correspondent.
One day at lunchtime, Kitty left her father with the doctor and went down to the kitchen where she made a tray for herself and took it back to her room so she could be near at hand if he should call. While she was drinking some courgette soup and eating a bread roll, the door swung open after a single knock, and the doctor came in to tell her that the worst had happened: her father was dead. Kitty, overcome by grief at the loss of this most loving and gentle of fathers and distraught that after a vigil of almost two years she should not be present at his bedside when it happened, was violently sick, vomiting her lunch back over the tray.
After persistent questioning on my part, she confirmed that she had no recollection of abdominal pain before this moment, but that it had been intermittently with her ever since.
Fräulein Katharina had been extremely co-operative during the preceding ninety minutes; she had evinced some surprise at the intimacy of some of the inquiries, but had done her best to respond, even when evidently embarrassed by the memories that I had unearthed. I judged it prudent to terminate the consultation at this point.
April 20 [evening]
Katharina was in much better spirits this evening. She had had a bran bath in the morning and ate well at lunchtime; she had had some galvanic treatment on her shoulders and arms and then a warm bath before coming to see me. Her menstrual period had started today after an interval of only two and a half weeks; although she seemed pleased by this, I promised her that if she were fully hypnotised, I could reset the interval, using suggestion, at twenty-eight days.
We began by bringing the story of her life up to date, and this was easily accomplished. Her mother had recovered her health quite quickly after her father’s death and within the year was engaged to be married again – to Herr P, her father’s young colleague whose visits to the house had been a regular but, she claimed, to Katharina a less than welcome feature of life during her father’s illness. The newly married couple would move to a house in the outskirts of Vienna and the family home would be sold; Katharina expected to set up house in an apartment in town with her younger sister Anna, since her brother Gustav was now working in Paris. In the time immediately preceding our first appointment, she had been searching for a suitable place and helping to pack up her parents’ old house.
I had spent many hours reflecting on what Fräulein Katharina had told me in the course of our previous meeting. I felt that a fairly clear picture of the trauma that had precipitated her hysteria was now available to me (and must by now also be taking shape in the mind of anyone to whom the outline of the case has been related), yet I was puzzled by the fact that the patient had found access to the relevant memories without being in a state of hypnosis, since it is a principle of resolution that pathogenic memories are not present in the conscious mind, or at least only in summary form. I continued my questioning, therefore, on the assumption that a part of what Fräulein Katharina had told me was the result of what I shall call a ‘delegate’ or ‘proxy’ memory – that is to say a recollection which, while not in itself mendacious or incomplete, is of interest to us chiefly for what it tells us of something more important which is absent or withheld.
With this thought in mind, I decided to see if I could find a more direct road into her unconscious by asking her about her dreams. She affected to find this amusing at first, assuring me that her dreams were commonplace and lacking significance, but I emphasised that, on the contrary, as Maury had explained so well, the commonplace is the one thing that is never present in our dreams.
Eventually, she was able to tell me of a dream that she could clearly remember after some months, aspects of which still troubled her. She was in a large street in Vienna, probably the Kärntnerstrasse, and running up the stairs to a set of rooms in an office building where her mother lay dead. She was in a panic because she had to make the arrangements for the burial as soon as possible, yet she felt that someone very important was missing. ‘I felt it was imperative that I take matters into my own hands,’ she said, ‘yet I felt paralysed from doing so.’ It was this haunting or double sense of absence, not only of her mother but of someone else, that made the dream so memorable. She was also worried about her clothes, which had become mud-spattered as she ran down the Kärntnerstrasse; there was a more suitable dress in a wardrobe in the corner of the room where her mother’s body lay, but she feared to open it because there was a mouse hole in the adjacent wainscoting and she had seen a single eye glinting out at her from inside.
April 25 [evening]
I had seen Fräulein Katharina on a number of occasions since she revealed to me the content of her troubling dream, though without feeling that she had subsequently disclosed anything of a great significance so far as the resolution was concerned.
I felt that the preconditions for the onset of her hysteria were now established beyond doubt: namely that a traumatic incident had been deliberately suppressed by her conscious mind because she found the implications of it intolerable. This sum of psychological excitat
ion, being denied proper release, had converted itself easily through the pathways of somatic innervation into the distressing symptoms – the abdominal discomfort, the joint pains in arms and fingers – from which she now suffered. The basis of her decision to suppress the memory of the incident could quite easily be seen to spring from an unendurable conflict between the thoughts and desires it gave rise to on the one hand and, on the other, the entity of her social personality, composed of the duties and affections that had been expected of her. The last laugh, as it were, had remained with the suppressed ideas, however, which had turned pathogenic.
I was now ready to reveal to the patient my understanding of the pathological process that had taken place – and indeed I was eager to do so, since it must be remembered that it was distressing to see the anguish of a young woman of such principled and gentle character.
Before proceeding, I asked her to recall the occasions on which she had suffered her aphonia and found that the first instance had followed swiftly on the incident in which the young doctor so suddenly interrupted her reverie in her bedroom. She could not place the second incidence with any degree of certainty.
I began my resolution of Fräulein Katharina’s difficulties by asking her to re-examine the dream she had described to me. Who was it that she believed to be bafflingly absent from the scene? ‘Why, my father of course!’ she responded in a light-hearted way. I explained to her that the interpretation of dreams depended on their being understood essentially as the fulfilment of a frustrated wish – a longing which the censor who watched her thoughts by day had compelled her to displace. The release of such a wish in her dream, albeit disguised and clothed in paradox, was the parallel process to that of resolution with which we had been engaged: her dream offered a semaphore version of a displacement that we should more surely establish in waking hours; we might pore over it, I suggested, as over a pictographic script.