» Home » Mental Health » Psychology »
Freudian Psychoanalysis is not a set of theories developed by a psychology professor in some Oxford or Harvard University library. Freud was a medical doctor and neurologist who sought to relieve neurotic patients of their obsessions, anxieties and depression. In other words, he developed his ideas based on his experiences with patients. And he left behind some remarkable descriptions of these encounters, known as his 'case studies'. Freud was a gifted writer and these studies, far from dry and clinical, often seem more like bizarre, macabre short stories.
The Case Studies
Of course, Freud is not the only person to have published such case studies. In 1941, for example, the American psychiatrist Hervey Cleckley published his classic Mask of Sanity, a dramatic and novelistic description of the psychopathic individuals he met in an institution for the criminally insane. The British psychiatrist R.D. Laing also published a collection of case studies under the title Sanity, Madness and the Family. Laing interviewed the parents of young schizophrenics, mostly in and around London, to show how mental illness can be triggered by life in a dysfunctional family.
When reading Freud's studies, the reader is immediately struck by the astonishing complexity of a neurotic illness. And this complexity may explain why Freud wrote up so few case histories. Over the whole of his career, he only published five of real depth and significance, and all were written before the First World War.
Anna O is often described as Freud's first case study. In fact, she was not really his patient at all but that of a colleague, Josef Breuer, with whom Freud wrote Studies on Hysteria, a collaborative work in which her case is presented. Anna was a pseudonym for Bertha Pappenheim, a 21-year-old Jewish girl who first visited Breuer in 1880. Her symptoms included a severe cough, hallucinations, disturbed vision and hearing, and paralysis of the right side of the body. Anna had been brought up in a very strict household and was sexually ignorant and immature. She had nursed her father through a terminal illness and, after his death, her symptoms grew worse.
During the day, she experienced hallucinations and at night fell into a trance and mumbled to herself. Breuer found that by encouraging her to describe these hallucinations and say aloud the words she normally mumbled, he could bring her some relief. Later, she developed a fear of water and was unable to drink for days at a time. During one of her trances, she recalled watching an English tourist allow her dog to drink water from a glass. After she had described this sight and released the emotion connected to it (in this case disgust), she was able to drink once more. Again and again Breuer found that by tracing a symptom back to its source it could be removed. For example, Anna had wanted to cry while sitting by her father, but she thought her tears would disturb him. And when she wanted to check the time, she had to squint. This had led to her impaired vision. The paralysis was traced once again to her father's bedside. One night she had seen a black snake. Obviously, she couldn't scream because it would have upset and frightened her father. She was so afraid that the right side of her body seemed to go numb, and she found that she couldn't move her right arm.
Dora, whose real name was Ida Bauer, was 18 when her father first brought her to see Freud. Like Anna O, she was diagnosed as hysteric. In Dora's case, however, she seems to have suffered with hysterical symptoms since childhood.
Like Anna, Dora suffered from multiple symptoms, including migraines, depression, breathing difficulties, nervous cough, and inexplicable voice loss. Her parents were unhappily married and her father had begun an affair with the wife of a close friend (whom Freud names Mrs K). The husband (Mr K) had made sexual suggestions to Dora, who suspected her father of secretly offering her to Mr K in return for his wife (something Freud did not believe).
Freud concluded that her symptoms derived from jealousy. In other words, it was a classic Oedipal (or rather Electra) conflict: Dora was jealous of Mrs K and wished to replace her. Freud also suspected a great deal of ambivalence towards Mr K and a possible lesbian attraction to Mrs K.
Of all the case studies, this was perhaps the simplest and most successful. Hans was a 5-year-old boy who had developed such an intense fear of horses that he refused to leave the house in case one bit him. The phobia began after the birth of his little sister, when Hans was around three and a half. He was an intelligent, inquisitive child and her birth started him on a train of thoughts about where babies came from and the differences between male and female anatomy. Hans then became more and more interested in his penis and frightened that he would be castrated.
Again, this was an Oedipal conflict. Hans desired his mother and feared that his father would castrate him in revenge. Horses had come to symbolize his father. The fear of being bitten was in fact a fear of being castrated. In other words, he had displaced the fear of his father on to a fear of horses.
Freud later argued that children undergo a latency period in which the psychosexual stages of development, which take place between around 3 months and 5-years-old and culminate in the Oedipus conflict, are forgotten. Fourteen years later, Hans paid a visit to Freud. He could remember nothing of his phobia or his treatment.
The Rat Man
This was a case of obsessional neurosis, beginning in October 1907. The patient was a 29-year-old lawyer who had been drafted into the army. Freud saw him over an 11 month period and regarded the case as largely successful. The patient was later killed in the First World War.
The nickname 'rat man' came from the man's obsession with a punishment used in Asia. An officer had described to him the way criminals were tortured by having rats burrow into their anus. The patient became obsessed by this and began to fear that such a punishment may befall his girlfriend and father. To prevent it, he developed a series of defences. For example, he saw a stone on the road down which his girlfriend was due to travel. He feared the carriage might run over the stone and crash, so he removed it, changed his mind, and then became obsessed with replacing it in the exact same spot.
Freud delved into his childhood and discovered the usual sexual explorations and fears of being punished for them by his father. There was also the common ambivalence towards the father figure: even after his father had died, the rat man would study until late then, at 1 a.m., the time his father often returned, he would go and look at his penis in the mirror, thus seeking both to please his father (by studying) and to defy him (by exposing himself). His obsessional neurosis was traced back to a fixation at the anal stage of psychosexual development. This would make sense since it is the stage overseen by the parents and characterized by sadistic urges (hence the obsession with the rat torture).
The rat man's behavior made no sense because he was acting in response to the past. And this is key. As Freud famously put it, the neurotic repeats something from the past instead of remembering it. The punishment he claimed to fear for others was punishment he really feared for himself. He also revealed that as a child he had believed his parents could read his thoughts.
Of course, the Freudian case studies are vastly more complex than is suggested here. Reading them, you cannot help but be struck by the depth and complexity of the unconscious mind or the web in which the mentally ill are often caught.
The Wolf Man
Perhaps the most famous, and certainly the best, of Freud's case studies is that of the so-called 'Wolf Man'. The wolf man was in fact a wealthy, 23-year-old Russian. In many respects he was the most severely affected of all the cases, a man so neurotically ill he could barely dress himself. Treatment took place over a five year period, beginning in 1909, and was successful.
Related Articles And Other Topics
For the Italian comic book character, see Rat-Man. For the Stephen King character, see The Stand.
"Rat Man" was the nickname given by Sigmund Freud to a patient whose "case history" was published as Bemerkungen über einen Fall von Zwangsneurose ['Notes Upon A Case of Obsessional Neurosis'] (1909). This was the second of six case histories that Freud published, and the first in which he claimed that the patient had been cured by psychoanalysis.
The nickname derives from the fact that among the patient's many compulsions was an obsession with nightmarish fantasies about rats.
To protect the anonymity of patients, psychoanalytic case-studies would usually withhold or disguise the names of the individuals concerned ("Anna O"; "Little Hans"; "Wolf Man", etc.). Recent researchers have decided that the "Rat Man" was in fact a clever lawyer named Ernst Lanzer (1878–1914)—though many other sources maintain that the man's name was Paul Lorenz.
History of the analysis
Lanzer first came to Freud in October 1907 complaining of obsessive fears and compulsive impulses. Freud treated his patient for a little over three months on a regular daily basis. The treatment was irregular for the next three months and sporadic, at best, after that.
Lanzer's principal fear was that something terrible was going to happen to his father and a lady friend (who later became his wife). His fear had grown out of an account he heard from a fellow army officer concerning a Chinese torture method, in which a large pot, containing a live rat, was strapped to the buttocks of the victim, and the rat encouraged by a red-hot poker to gnaw his way out through the victim's anus.
Lanzer claimed that he fantasized about murder and suicide, and developed a number of compulsive irrational behavior patterns. For example, he mentioned his habit of opening the door to his flat between 12 midnight and 1:00 A.M., apparently so that his father's ghost could enter. Lanzer would then stare at his penis, some times using a mirror.
Freud encouraged Lanzer to discuss details of his sex life (such as his first efforts at masturbation at age 20) and focused on a number of verbal associations with the word 'Ratten' ('rats'). According to Freud's analysis, Lanzer unconsciously identified himself with rats. Lanzer was unconsciously fantasizing that he - a rat and a biter - was having anal intercourse with his father and with his lady friend.
Lanzer was verbally clever and himself introduced Freud to Nietzsche's phrase (which Freud would later cite) "'I did this,' says my Memory. 'I cannot have done this,' says my Pride, and remains inexorable. In the end – Memory yields". Freud would retell the saying more than once, and it would be taken up by later therapists such as Fritz Perls.
Lanzer broke off his analysis with Freud after a relatively brief period and well before his transference had been fully resolved. Just after Freud had completed the written version of the case history in October 1909, he confessed to Jung that his patient was still having ongoing problems. Lanzer was killed in the first World War and therefore later researchers were unable to interview him.
Freud's write-up: 'Notes Upon A Case of Obsessional Neurosis'
Freud was led to publish the Rat Man case history because he was feeling pressured to show the world that psychoanalysis could achieve successful therapeutic results. Since the Rat Man had previously consulted Julius von Wagner-Jauregg, Freud's eminent psychiatric colleague at the University of Vienna, the case was a particularly critical test of Freud's therapeutic abilities. Before October 1908, when he communicated this case history at the First International Psychoanalytic Congress in Salzburg, Freud had yet to publish the results of a successful psychoanalysis.
The case study was published in 1909 in Germany. Freud saw the Rat Man patient for some six months, despite later claiming the treatment lasted about a year. He considered the treatment a success.
The patient presented with obsessional thoughts and with behaviors that he felt compelled to carry out, which had been precipitated by the loss/replacement of his pince-nez, and the problem of paying for them, combined with the impact of a story he heard from a fellow officer about a torture wherein rats would eat their way into the anal cavity of the victim. The patient then felt a compulsion to imagine that this fate was befalling two people dear to him, specifically his father and his fiancée. The irrational nature of this obsession is revealed by the fact that the man had the greatest regard for his fiancée and that his revered father had actually been dead for some years. Freud theorized that these obsessive ideas and similar thoughts were produced by conflicts consisting of the combination of loving and aggressive impulses relating to the people concerned – what Eugen Bleuler would later term ambivalence.
The Rat Man also often defended himself against his own thoughts. He had had a secret thought that he wished his father would die so he could inherit all of his money, and become rich enough to marry, before shaming himself by fantasizing that his father would die and leave him nothing. The patient even goes so far as to fantasize about marrying Freud's daughter, believing (Freud writes) that "the only reason I was so kind and incredibly patient with him was that I wanted to have him for a son-in-law" – a matter linked in the transference to his conflicts between his mother's wish for him to marry rich like his father, and his fiancée's poverty.
In addition, the symptoms were believed to keep the patient from needing to make difficult decisions in his current life, and to ward off the anxiety that would be involved in experiencing the angry and aggressive impulses directly. The patient's older sister and father had died, and these losses were considered, along with his suicidal thoughts and his tendency, to form part of the tissue of phantasies, verbal associations and symbolic meanings in which he was trapped. Freud believed that they had their origin in the Rat Man's sexual experiences of infancy, in particular harsh punishment for childhood masturbation, and the vicissitudes of sexual curiosity.
In the theoretical second part of the case study, Freud elaborates on such defence mechanisms as rationalization, doubt, undoing and displacement.
In a later footnote, Freud laments that although "the patient's mental health was restored to him by the analysis...like so many young men of value and promise, he perished in the Great War".
A number of significant discrepancies between the published case history and Freud's process notes, which were discovered among his papers after his death, have been pointed out by Patrick Mahony. According to Mahony, who is himself an analyst and sympathetic to the general goals of psychoanalysis, Freud's published case history is "muddled" and "inconsistent" on various matters of fact and also exhibits "glaring" omissions of information. In particular, there is an overemphasis on the father to the exclusion of the mother. As Mahony sums up, "Freud mixed momentous insights with exaggerated claims," some of which "were made in his zeal to protect and promote a new discipline."
Jacques Lacan built his early structuralist theory around the Rat Man case, in particular the polarity of father-rich wife/son-poor wife as an intergenerational force creating the individual neurosis.
Freud's late note upon the Rat Man's acute sense of smell would later be developed into his theory of the process of civilisation and organic repression.
Criticism of Freud
The only known case in which Freud's notes survive is that of Ernst Lanzer, the Rat-Man, where they exist for the first third of the treatment. Freud treated him for obsessions, particularly the dread that something terrible would happen to his father and his fiancée. His fear of rats, Freud showed through elaborate interpretations, was based on disguised anal erotic fantasies. Mr. Stadlen tracked down relatives of Mr. Lanzer who said the account handed down by the family was that Freud had helped him overcome shyness so that he could marry.
Peter Gay concluded in Freud: A Life for Our Time (1988) that "apart from a handful of interesting deviations, the case history Freud published generally followed the process notes he made every night". Patrick Mahony, a psychoanalyst and professor of English at the University of Montreal, has highlighted such discrepancies in his detailed study, Freud and the Rat Man, published in 1986 by the Yale University Press.
Dr. Mahony said Freud seems to have consistently implied that the case lasted longer than it actually did. He also said Freud claimed in a lecture to be able to guess the name of the Rat Man's girlfriend, Gisela, from an anagram, Glejisamen, which the patient had invented. Actually, the notes show Freud had learned her name first, and then used it to deduce the meaning of the anagram, although in the actual case-study Freud merely states that "when he told it to me, I could not help noticing that the word was in fact an anagram of the name of his lady".
Critics have also objected to Freud's downplaying of the role of the Rat Man's mother, and for several deviations on his part from what would later become standard psychoanalytic practice.
Efficacy of the treatment
Mahoney accepted that Freud obtained a degree of success in restoring his patient to functional life, though he considered Freud exaggerated the extent of this in his case-study. Others have suggested that by concentrating on building rapport with his patient, at the expense of analyzing the negative transference, Freud merely achieved a temporary transference cure. Lacan for his part concluded that although he did not "regard the Rat Man as a case that Freud cured", in it "Freud made the fundamental discoveries, which we are still living off, concerning the dynamics and structure of obsessional neurosis".
In a letter Freud himself wrote to Jung, shortly after publication of the case study, he claimed of the Rat Man that "he is facing life with courage and ability. The one point that still gives him trouble (father-complex and transference) has shown up clearly in my conversations with this intelligent and grateful man" – a not insignificant reservation. But while Freud in the case-history had certainly claimed that "the patient's rat delirium had disappeared", he had also pointed out the limited time and depth of the analysis: "The patient recovered, and his ordinary life began to assert its claims...which were incompatible with a continuation of the treatment".
As the average length of time expected of an analysis increased from months to years over the 20th century, so too the success of the Rat Man's case has perhaps come to resemble rather the symptomatic relief of brief psychotherapy or focal psychotherapy, more than the achievement of a full psychoanalysis.
- ^Sigmund Freud, Case Histories II (PFL 9) p. 93
- ^Katz, Maya Balakirsky (2011). "A Rabbi, A Priest, and a Psychoanalyst: Religion in the Early Psychoanalytic Case History". Contemporary Jewry 31 (1): 3–24. doi:10.1007/s12397-010-9059-y
- ^Frederick J. Wertz (22 March 2003). "Freud's case of the Rat Man revisited: an existential-phenomenological and socio-historical analysis". Journal of Phenomenological Psychology.
- ^Steele, Robert S. (1982). Freud and Jung. Conflicts of Interpretation. Law Book Co of Australasia. ISBN 0-7100-9067-6.
- ^Quoted in L. Appignanesi/J, Forrester, Freud's Women (2004) p. 113
- ^F. Perls, Gestalt Therapy Verbatim (1972) p. 45
- ^Mahony: Freud and the Rat Man, page 69. Yale University Press, 1986
- ^Freud, p. 39
- ^Elisabeth Roudinesco, Jacques Lacan (2005) p. 214-5
- ^Freud, p. 48
- ^Freud, p. 119
- ^Freud, p. 80
- ^Roudinesco, p. 214-5
- ^Freud, p. 88n
- ^Freud, 122-8
- ^Freud, p. 128
- ^Mahony, Freud and the Rat Man, pp. 32, 34, 216.
- ^Roudinesco, p. 213-6
- ^Angela Richards ed., Civilisation, Society and Religion (PFL 12) p. 247
- ^Angela Richards, in Freud, p. 34
- ^Peter Gay, Freud: A Life for our Time (1989) p. 266
- ^Gay, p. 262
- ^Patrick Mahoney, 'Rat Man'
- ^DANIEL GOLEMAN (6 March 1990). "As a Therapist, Freud Fell Short, Scholars Find". New York Times. Retrieved 8 August 2008.
- ^Freud, p. 105
- ^Gay, p. 263 and p. 266-7
- ^Michael Thompson, The Truth about Freud's Technique (1995) p. 239
- ^J. Lacan, Écrits: A Selection (1997) p. 237-8
- ^McGuire, W: The Freud/Jung Letters, page 255. Princeton University Press, 1974.
- ^Freud, p. 100
- ^Freud, p. 88n
- ^Janet Malcolm, Psychoanalysis (1989) p. 151
- ^Gay, p. 245
Mark Kanzer/Jules Glenn, Freud and His Patients (1980)