A Case of Hysteria

Jeffrey Moussaieff Masson is, or perhaps rather was, a psychoanalyst—at present he is not, one gathers, a member of any psychoanalytical organization, does not see patients, and does not teach psychoanalysis anywhere. His book is a contribution to the early history of psychoanalysis, or rather would have been if he had not elected to present it in the form of a polemical attack on Freud, and on Freud’s literary executors, notably Anna Freud, Ernest Jones, and K.R. Eissler. Its title is, indeed, in a most peculiar way a misnomer, since Masson attacks Freud not for assaulting truth but for retreating from it, and the assault described is Masson’s on Freud, whom he accuses of cowardice, on his literary executors, whom he accuses of suppressio veri, and on contemporary analysts, whom he accuses of ignoring the real violence inflicted on children.

As has been widely publicized, Dr. Masson was for a short while projects director of the Sigmund Freud Archives and as such had access to letters and documents that are still inaccessible to the general public. He was dismissed from this post after delivering a lecture in which he argued that Freud’s abandonment of the theory that all his patients had been seduced as children had led to the “present-day sterility of psychoanalysis throughout the world.” Details of Masson’s career, of his relations with Anna Freud and Kurt Eissler, director of the Sigmund Freud Archives, and of his reaction to his dismissal, can be found in Janet Malcolm’s articles, “Annals of Scholarship: Trouble in the Archives,” in The New Yorker.^*

For those unfamiliar with its early history, it must be explained that psychoanalysis began with the investigation of hysteria, a disorder common in the nineteenth century but now apparently rare. Freud originally maintained that the paralyses, faints, spells, deliriums, etc., suffered by hysterics were not, as previous neurologists had insisted, caused by exhaustion or degeneration of the nervous system, but were reactions to traumatic experiences, to disturbing events which the patient-victim had been unable to respond to and assimilate at the time. And he claimed, furthermore, that it was possible to cure hysteria by discovering what these traumatic experiences had been and helping the patient to remember them and to discharge the emotions appropriate to them.

Now this idea that hysterical, and by extension other neurotic, symptoms were reactions to traumata obviously raised the question of what kind of experiences could be traumatizing. By 1896 Freud had come to the conclusion that they were invariably sexual. In April of that year, he presented to the Society for Psychiatry and Neurology, Vienna, a paper, “The Aetiology of Hysteria,” in which he asserted that “without exception” “at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood but which can be reproduced through the work of psychoanalysis in spite of the intervening decades.”

He went on to say that these premature sexual experiences had all occurred to children before the age of eight and that the eighteen cases (twelve female, six male) on which he based his paper could be divided into three groups, “according to the origin of the sexual stimulation”: those who had been assaulted by a stranger, those who had been seduced by “some adult looking after the child—a nursery maid or governess, or tutor, or, unhappily all too often, a close relative,” and those who had had a sexual relationship with another child, usually a brother, sister, or cousin. Throughout this paper Freud assumes without question that he and his audience are agreed on what they mean by the diagnostic label hysteria—an assumption that no contemporary lecturer on hysteria could make—and he explicitly states that all his eighteen cases had severe illnesses “which threatened to make life impossible.” The implication is that they were much more disturbed than the kind of patient who consults a psychoanalyst today.

This paper, which is reprinted in full by Masson, met apparently with an icy reception, and Richard von Krafft-Ebing, who was in the chair, remarked that it sounded like a scientific fairy tale. And Freud himself soon began privately to have second thoughts on the matter. In a letter written on September 21, 1897, to his friend Wilhelm Fliess, the otorhinolaryngologist (or ear, nose, and throat surgeon), Freud informed him that he no longer believed that all his hysterical patients had been seduced in childhood. One of the reasons for his disbelief was the fact that, if he continued to believe what his patients were telling him, “in all cases, the father, not excluding my own, had to be accused of being perverse.” This statement suggests, first, that Freud had been less than outspoken when he read his paper, which refers not to fathers but to strangers, governesses, tutors, and “unhappily all too often, a close relative,” and, secondly, that he must have arrived at the seduction theory of hysteria as much by self-analysis as by listening to his patients.

Masson, incidentally or perhaps not incidentally, does not mention the fact that Freud’s father died in October 1896, that is, after Freud presented the seduction theory paper and before he wrote the disclaiming letter to Fliess. Freud, as is well known, believed that his father’s death had been a turning point in his life: “the most important event, the most poignant loss.” Masson also does not take full account of Jones’s paraphrase of Freud’s letter to Fliess, which reads, “It was the awful truth that most—not all—of the seductions in childhood which his patients had revealed and about which he had built his whole theory of hysteria, had never occurred.” This implies that Freud continued to believe that some of his hysterical patients had been seduced in childhood.

For Jones, and indeed for most people, Freud’s abandonment of the seduction theory was a victory for common sense and the beginning of a new era, one in which it became possible to elucidate the way in which fantasies can distort memory and in which infantile sexual wishes and parental attitudes combine to generate what we now call the Oedipus complex. As Anna Freud put it in a letter to Masson:

Keeping up the seduction theory would mean to abandon the Oedipus complex, and with it the whole importance of phantasy life, conscious or unconscious phantasy. In fact, I think there would have been no psychoanalysis afterwards.

But for Masson Freud’s abandonment of the seduction theory was a disaster, a betrayal, and a failure of courage. To quote from the lecture that precipitated Masson’s dismissal from his post with the Sigmund Freud Archives:

By shifting the emphasis from a real world of sadness, misery and cruelty to an internal stage on which actors performed invented dramas for an invisible audience of their own creation, Freud began a trend away from the real world that, it seems to me, has come to a dead halt in the present-day sterility of psychoanalysis throughout the world.

Despite Freud’s letter to Fliess, which Freud can have had no reason to suppose would ever be published, and which in fact was not published until the 1950s, Masson seems to believe that Freud did not really and truly abandon the theory as erroneous, but put it out of his mind because he could not bear the professional isolation into which it was putting him. Hence Masson’s subtitle, “The Suppression of the Seduction Theory,” which implies both that Freud suppressed his own insight into the importance and frequency of child abuse and seduction, and that the editors of Freud’s letters to Fliess, Anna Freud, Marie Bonaparte, and Ernst Kris, suppressed all references suggesting that Freud had continued to believe in the seduction theory after the date at which he was supposed to have abandoned it.

However, the evidence adduced by Masson is not very convincing. In fact he seems to have unearthed only one document which could be construed to mean that Freud continued to believe that all his hysterical patients had been seduced by their fathers after the September 1897 letter abandoning the idea. But one obscure, rather gnomic letter does not make or break a theory; at the most it indicates that Freud was capable of wavering temporarily between two incompatible ideas. And this one letter was written only ten weeks after the one in which he had announced his disillusionment in the seduction theory.

However, in his search for evidence that Freud continued to believe in the seduction theory and that it deserves to be treated more seriously than it has been by most of Freud’s followers, Masson, who combines the nose of a trufflehound with an incapacity to distinguish between facts, inferences, and speculations, has unearthed some curious information which will, I think, permanently dent Freud’s image.

First, he has found evidence suggesting that Freud was more familiar with the forensic literature on child abuse, both sexual and what we now call child battering, than anyone reading his collected works would suppose, and that he had almost certainly, when in Paris, attended autopsies on children who had died of nonaccidental injuries. So he must have appreciated that assaults on children really do happen and have known what their physical consequences could be. His eventual incredulity about the stories his hysterical patients had told him cannot have derived from the sentimental idea that such things just don’t happen.

Surprisingly, Masson makes no reference whatever to the modern forensic literature on child abuse, child battering, pedophilia, and incest. He might have used this literature to support the idea that contemporary analysts should consider the possibility that their patients’ fantasies may be grounded in truth more often than, in his opinion, they do. Although Masson says that he is “inclined to accept” the view that the incidence of sexual violence in the early lives of children may be as high as one in three in the general population and is “undoubtedly higher among women who seek psychotherapy,” he gives no evidence or references to support his inclination. His slide from being “inclined to accept” to “undoubtedly” is typical of his way of thinking.

Secondly, Masson adds a few details to the unedifying story of how Freud and Fliess bungled the treatment of Emma Eckstein, a young woman who must have been one of the eighteen patients on whom Freud based his paper “The Aetiology of Hysteria.” In 1895 Fliess, with Freud’s blessing, operated on Emma Eckstein’s nose, hoping thereby to relieve her of various unspecified neurotic and gynecological symptoms. After the operation she had severe nasal bleeding, which persisted until another surgeon removed “at least half a meter of gauze” which Fliess had inadvertently left in her nose. Instead of being indignant at Fliess’s incompetence, Freud persuaded himself that Emma Eckstein’s postoperative bleeding had been hysterical in origin. According to Masson, Freud’s need to persuade himself that Fliess’s surgical assault on Emma Eckstein had not really happened and that her postoperative bleedings were products of her neurotic imagination contributed to his later belief that all tales of assault recounted by hysterical patients were fantasies.

Most of this story has already been told by Freud’s doctor, Max Schur, and, as far as facts go, Masson’s only additions are that Emma Eckstein remained permanently disfigured, that two to three years after the operation she was herself analyzing a patient under Freud’s supervision, and that she preserved and left to her nephew (who gave them to the Library of Congress) fourteen letters from Freud, dating from 1895 to 1910 and including a prescription for “boric acid for the vagina.” He also argues that Freud was preoccupied with her to the end of his days, as indeed he may well have been.

However, Masson’s technique of confusing facts with speculation does not inspire confidence. After mentioning that Emma Eckstein wrote a book on The Question of Sexuality in Child-Rearing, in which she used an invented letter from a mother to a son to express some of her ideas, Masson goes on:

It is not beyond the realm of possibility that Emma Eckstein had an illegitimate child, and that her letter is in fact based on reality. If the child was ten at the time this book was written in 1904, then she would have given birth in 1894, during her analysis. Being in analysis, she would have told Freud, and possibly nobody else. I must stress that none of the six people I spoke to who knew Emma Eckstein had ever heard any such rumor. Nor do I believe this is anything more than speculation. But it is one more piece of evidence that the mystery surrounding Emma Eckstein has by no means been resolved.

But a speculation cannot be a piece of evidence, and the passage has too many ifs and woulds and possibles in it to be taken seriously. It also contains an insinuation: an illegitimate child must have a father as well as a mother. Although Masson’s avowed aim in discussing the case of Emma Eckstein is to demonstrate that Freud had a powerful subjective motive for wishing to deny the real effects of assaults, it is hard to resist the temptation that Masson is also engaged in stirring dirt in the hope that some will stick.

Thirdly, Masson marshals evidence to suggest that Freud’s repudiation of his disciple Ferenczi and of his 1932 paper “Confusion of Tongues between Adults and the Child” was provoked by Ferenczi’s having rediscovered the truth of the seduction theory that he had suppressed thirty-five years previously. According to Ferenczi,

Even children of respected, highminded puritanical families fall victim to real rape much more frequently than one had dared to suspect. Either the parents themselves seek substitution for their lack of [sexual] satisfaction in this pathological manner, or else trusted persons such as relatives (uncles, aunts, grandparents), tutors, servants, abuse the ignorance and innocence of children.

This corresponds exactly to what Freud had said in his 1896 paper, but Ferenczi goes on to add something that Freud did not say: “The obvious objection that we are dealing with sexual fantasies of the child himself, that is, with hysterical lies, unfortunately is weakened by the multitude of confessions of this kind, on the part of patients in analysis, to assaults on children.” But, curiously, Ferenczi does not go on to cite any of the “multitude of confessions” made to him by patients in analysis but to make a much weaker claim:

Thus I was not surprised when a short time ago an educator known for his high-minded philanthropy came to see me in a state of veritable despair to tell me that thus far he had been unfortunate enough to discover five families of good society in which the governesses lived in a regular conjugal state with nine- to eleven-year-old boys.

Characteristically, Masson does not perceive that this passage from Ferenczi does not survive critical scrutiny and could, indeed, be used as a textbook example of sloppy, crooked thinking. First, Ferenczi has “children of respected, high-minded puritanical families” being raped “much more frequently than one had dared to suspect”—how frequently would that be?—and later in life telling their analyst about it. Then, to rebut the argument that these patients might have been telling “hysterical lies,” he refers to “the multitudes of confessions … to assaults on children” made to him by adult patients in analysis. He thereby leaves himself open to such questions as: “Did a multitude of patients make single confessions?”, “Did each of a few patients make a multitude of confessions?”, or “Did patients who had themselves been raped as children make a contribution to the multitude of confessions?” And then in support of the truth of the multitude of confessions made to him, Ferenczi cites the hearsay evidence of “an educator known for his high-minded philanthropy” that five nine- to eleven-year-old boys of good society were living “in a regular conjugal state” with their governesses. Now, it may or may not be a good thing for nine- to eleven-year-old boys to sleep with their governesses, but “living in a regular conjugal state” with a governess is certainly neither rape nor assault, though it does suggest that some seduction may have been going on.

I have dwelt on this passage and dissected it in some detail because it is a good example not only of how Ferenczi thought but also of how Masson thinks—the translation from the original German is, incidentally, by Masson himself. The thesis that neuroses are the result of childhood sexual traumatic experiences is sustained in each case by the tendentious use of language, by the refusal to distinguish between such concepts as rape, assault, and seduction, and even by failure to distinguish between “some,” “many,” and “all”; the fact that some children are indeed raped, assaulted, and seduced is inflated into a theory that all neurosis is caused by assaults.

Masson’s account of Freud’s repudiation of Ferenczi is also marred by dirt stirring. Freud is presented as not only a hypocrite and a prig but also as thinking that all patients are riffraff (Gesindel)—the evidence is one remark of Freud’s recorded in Ferenczi’s diary—while Ferenczi is inadvertently (I think) made to sound pathetic and silly. Even before he became an analyst he had a tendency to “sexual playing about with patients”; he saw one of his analytical patients, a beautiful American dancer whose portrait is the best thing in the book, for four or five sessions a day. He sat another on his lap, gave yet another a doll to comfort her, fell in love with a patient but married her mother, and went through life longing for the parental love he had never received as a child. He was “a middle child among eleven or thirteen others.” As in his account of Freud’s relationship with Emma Eckstein, Masson cites details from unpublished letters and diaries without giving enough of their personal and social contexts for the reader to be able to know how to evaluate them.

Masson’s reasons for wishing to resurrect the seduction theory do not emerge in this book. Since he is a Sanskrit scholar, not a doctor of medicine, and can have treated only a few patients himself, it cannot be that clinical or professional experience has driven him to return to Freud’s original hypothesis. He tells us that even as a student it had never seemed right to him that Freud would not believe his patients. “I did not agree that the seduction scenes represented as memories were only fantasies, or memories of fantasies.” He seems, indeed, to make use of a naive, literal-minded antithesis between memories that are real and fantasies that are imaginary. In his view, if a patient recounts a “memory” of a sexual assault or seduction, the analyst is lacking in respect for the patient and accusing him of lying if he questions its literal truth. It does not seem to occur to him that there can be a dialectical relationship between experience and fantasy, each affecting the other, or that apparent memories may express metaphorical truths and fantasies contain both literal and metaphorical truths. As a result he has to believe that all patients have been literally assaulted or seduced, and he lacks the conceptual approach with which to explore the ways in which psychological and emotional violations and manipulations may be expressed in sexual imagery. Many patients must have been buggered up by their parents, but only a few, I think, have been literally buggered by them.

Rather surprisingly, Masson does not refer to the fact that many child-rearing and surgical procedures involve literal violations of bodily integrity and must inevitably be experienced by small children as assaults, regardless of the conscious or unconscious motives of the parents and surgeons who inflict such traumas on their children. This is a curious omission, since it would be possible to resurrect the traumatic theory of neurosis on the basis of the mishandling of small children. In England, D. W. Winnicott went a long way in this direction.

Lastly, it must be said, I think, that there is a persecutory slant in Masson’s thinking. The idea that neuroses are due to violations inflicted on children by sexually perverse and dissatisfied adults attributes blame to the offending adults, who are cast in the role of villains. But in fact, of course, many patients are the victims not of malice or cruelty or perversion but of tragedy. Parents may die, or themselves be grieving for the deaths of their own parents, or they may have to leave home for reasons of work or war, thereby producing anxious, insecure, depressive patients, whose illnesses are nobody’s fault. If Masson had really wanted to reintroduce a traumatic theory of neurosis, he would have done better to base it on John Bowlby’s work on separation and loss, instead of attempting to resuscitate Freud’s seduction theory. As it is, he has produced a book that is distasteful, misguided, and at times silly.