Lecture Notes, Part 2 (© Robert DiSalle 2001)

1. Hypnosis and the origins of Freud's theory

Mesmerism: Supposed cure of physical and emotional ailments, and production of altered states of consciousness and hysterical symptoms, by the transfer of "animal magnetism" from Mesmer (or one of his assistants, or his "magnetizing" machine) to the patient.

The scientific judgement of this "therapy" was that it operated entirely by suggestion: if people think they are being magnetized, then they experience the symptoms whether the magnetizing apparatus is turned on or not. If they think they are not being magnetized, then they experience no symptoms whether the apparatus is turned on or not.

Does this mean that the symptoms are fake or simulated?

Tests of muscular tension, sensitivity, etc. show a clear difference between actions or postures produced intentionally, and those produced in the "mesmerized" state.

Therefore Mesmerism corresponds to some real phenomenon, but what is it?

In fact, what the experiments show is the power of suggestion to produce genuine symptoms, including hysterical symptoms.

Example: Hysterical paralysis. If it had a physiological basis, one could expect the affected region of the body to correspond to the appropriate physiological structure. If a nerve is responsible, then the paralyzed region should be the region controlled by that nerve. But in hysterical paralysis, the affected region always corresponds not to a physiologically defined region, but to the popular conception of the body part-the arm, leg, or whatever. I.e. the idea of the body part determines the location of the paralysis.

The lesson for Freud: Ideas that are not consciously known can influence conscious thought and behaviour, and can be responsible for hysterical symptoms.

1885: Freud visits La Salpetriere, a mental hospital in France, to study hysteria, hypnosis, and the relations between them, under the influence of Charcot.

The debate between Charcot and Bernheim:

According to Charcot, hysterical phenomena have a physiological basis in the nervous system.

According to Bernheim, these phenomena arise from suggestion on the part of the physician.

Freud: Only Charcot's position can explain why hypnotic phenomena would always follow certain deterministic laws. If everything were the result of suggestion by the physician, there would be much more randomness in the phenomena, which on the contrary are quite regular.

2. Breuer and Freud's Studies in Hysteria

Anna O: A patient of Breuer's in the 1880, suffering from a variety of physical and mental disturbances.

First phase: Hallucinations and "absences", which amounted to a "second state of consciousness"

Second phase: Seriously debilitating headaches, disturbances of vision, paralysis and anaesthesia, or unexplained contractions of the limbs.

"Two selves": her normal self and an "evil" one that forced her to misbehave.

Speech impairment, often complete loss of speech, cured temporarily by Breuer's forcing her to speak about her father.

Storytelling: Often fairy-tale like stories told in the evening would relieve the physical symptoms. Cues for stories came from words Anna would mention in the daytime, during absences.

Third phase: After her father's death in 1881, prolonged stupors, inability to speak German or to recognize other people.

Talking about her hallucinations would restore her to a normal state.

"Caprices": odd behaviors or aversions (e.g. not wearing stockings, not drinking water.) Talking about the origins of the caprices made them go away- the "talking cure".

Fourth phase: Gradual removal of symptoms by talking through remembered events from the year before.

Katharina:

"Anxiety attacks with hysterical aura", or "hysterical attack whose content is anxiety"

Shortness of breath, choking, fear, hallucination of an angry face

Attacks begin at when Katharina is upset by witnessing a sexual act, and are followed by attack of vomiting.

Freud's question: what is there about the scene witnessed that could possibly evoke these feelings?

They must be evoked by unconscious memories of an earlier, more directly disturbing sexual scene.

Breuer's understanding of the Anna O. case:

The fundamental lesson is the aetiological significance of affective ideas.

Such ideas can remain within the psychic system of the person, operating permanently like "foreign bodies" or antigens.

In this way they produce hysterical symptoms whose origin is unknown to the patient's conscious mind.

The cure for the symptoms is catharsis, or the release of previously pent-up emotion

The key to catharsis is abreaction, or the expression of the emotions felt at the time of the original events, but not then expressed.

The key to abreaction is to identify the event by analytic therapy.