Bogousslavsky J (ed): Hysteria: The Rise of an Enigma. Front Neurol Neurosci.

Basel, Karger, 2014, vol 35, pp 109–125

DOI: 10.1159/000360244

Sigmund Freud and Hysteria: The Etiology

of Psychoanalysis?
Julien Bogousslavsky a · Sebastian Dieguez b
a Centerfor Brain and Nervous System Diseases, GSMN Neurocenter, Clinique Valmont, Glion/Montreux,
and b Laboratory for Cognitive and Neurological Sciences, Unité de Neurologie, Département de Médecine,
Université de Fribourg, Fribourg, Switzerland

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Abstract adapted his theories to the evolution of his own beliefs
Sigmund Freud developed a specific interest in hysteria on psychological conditions, selectively emphasizing the
after his stay with Professor Jean-Martin Charcot during aspects of his ‘therapies’ with patients which supported
the winter of 1885–1886, although his previous activity his emerging ideas, with often abrupt changes in theo-
mainly consisted of neuropathology and general medi- retical interpretations. While it remains difficult to get a
cal practice. Most of his initial studies on hysteria (hyste- clear, synthetic vision of what was Freud’s definite theo-
ria in men, influence of subconscious ideas, role of trau- ry of hysteria, it is obvious that hysteria really was the
mas, and psychological and sexual factors) were indeed origin of what would become Freud’s psychoanalytical
‘borrowed’ from Charcot and his immediate followers, theory. Indeed, psychoanalysis appears to have been ini-
such as Pierre Janet and Paul Richer. Subsequently, Freud tially developed by him largely in order to absorb and
developed with Breuer a theory of hysteria which encom- explain his many changes in the interpretation of hys-
passed a mixture of Janet’s ‘fixed subconscious ideas’ terical manifestations. © 2014 S. Karger AG, Basel
with the ‘pathological secret’ concept of Moriz Benedikt.
After their book Studies on Hysteria (1895), Freud inter-
rupted his collaboration with Breuer and developed the
concept of conversion of psychological problems into so- While psychoanalysis has endured continuous at-
matic manifestations, with a strong ‘sexualization’ of hys- tacks ever since the ‘talking cure’ began to be de-
teria. Firstly, he believed that actual abuses had occurred veloped by Sigmund Freud (1856–1939; fig. 1)
in these patients (the ‘seduction’ theory), but then and Joseph Breuer, it has recently witnessed a re-
blamed them for having deceived him on that issue, so emerging interest, including an unlikely fascina-
that he subsequently launched a ‘fantasy’ theory to ex- tion by prestigious nonclinician neuroscientists
plain the development of hysterical symptoms without [1, 2]. At about the same time, hysteria and hyp-
the necessity of actual abuses. Like many of his contem- nosis made a noticeable comeback in brain sci-
poraries, and contrary to his claims, Freud did not follow ences, thus addressing in new terms the very ori-
a scientific process of verified experiments, but rather gins of psychoanalysis [3, 4].
 was famous internationally. His stay there was
rather short (he met Charcot on October 20, 1885
and left on February 23, 1886), but was critical for
his career. Indeed, it is striking that a look at
Freud’s library shows that before coming to Paris,
he had virtually no books on hysteria, hypnosis,
or other psychological topics, while the stay with
Charcot was the trigger of a tremendous series of
acquisitions of works in these fields [5].
For Freud, hysteria really became the entry
door to neuropsychiatry. On the other hand, par-
adoxically, it is striking that there is no simple
way to find out what Freud’s views of hysteria
were. Imagine a curious reader completely unac-
quainted with the subtleties of psychoanalytic te-
Fig. 1. Rare photographic portrait of Freud. Philippe He- nets and history, who nevertheless would like to
laers library, with kind permission.
find out what the famous man exactly said on the
matter. This reader might think that Studies on
Hysteria [6], published in 1895 with Breuer,
Hysteria can be considered as the first signifi- would be an appropriate start. However, he might
cant clinical topic studied by Freud, and it really be surprised then to find almost no hint of sexual-
introduced him into the field of psychology. In- ity in that book. Or this reader might read Freud’s
deed, before his 1885–1886 stay with Jean-Martin later writings aimed at the general public, then
Charcot at La Salpêtrière, Freud was mainly a learning about the tripartite structure of the men-
neuropathologist with scarce clinical experience. tal apparatus, hidden and opposing forces fight-
Freud had started his medical studies in Vienna ing back in a dark corner of our minds, about an
in 1873 and obtained his diploma in 1881. During analytical technique that cures apparently incur-
the last part of these usually long studies, he able ailments, and about the discovery of deep
worked with Carl Claus in anatomy and then with and universal laws of human sexual and mental
Ernst Brücke in physiology and histology, where development, yet he would only get the most cur-
he also met Josef Breuer, who was also involved sory information about the hysterical symptoms
with clinical practice. It is possible that this en- which Freud examined several decades earlier in
counter stimulated Freud to leave a purely basic a handful of patients. Again, in most books on the
science career, and he indeed started work with history of psychoanalysis, the reader might also
Hermann Nothnagel in surgery, before going in learn that hysteria was first explained by repressed
1883 to the service of Theodor Meynert, who was shameful or harmful experiences, subsequently
mainly involved in neuroanatomy, along with uncovered by a therapeutic cathartic process in-
clinical activity with patients with nervous system volving hypnosis, pressure on the forehead, or the
disorders. He did some work on cocaine and also free association of words; then by actual early ex-
spent some time in the medical service of Scholtz, periences of sexual abuse, and then not, after all,
before he obtained his ‘Privat-Dozent’ title and a by actual abuses, but by a process of fantasy in-
travel grant with the support of Brücke and volving the imagining of seduction scenes as an
Meynert. This is when he decided to go to Paris to attempt to solve a universal conflicting experi-
study with Professor Jean-Martin Charcot, who ence through which all normal infants have to go.

110 Bogousslavsky · Dieguez

So What Is the Place of Hysteria in Freud’s of thinking and adopted another’. It is not that
Work and Theory? Freud gave up scientific practice and discourse to
create psychoanalysis, but rather that psycho-
When one reads Freud’s work in chronological analysis was the direct result of the evolution of
order, one sees that like in many of his contempo- his concepts, where patients were at least as much
raries, there are no actual ‘studies’ with an exper- used as confirmation as ‘origin’ of these concepts.
imental paradigm, which could then be submit- Put simply, it may seem that Freud’s case histo-
ted to confirmation or disproval, as in what we ries were never really meant to adduce evidence
now consider as scientific activity. Rather, Freud for his methods and ideas. Indeed, they were most-
reported cases from his (or Breuer’s, initially) ly ‘fragments’ or ‘notes’ mixed with theoretical
practice, where his ‘findings’ seemed to coincide speculations, incomplete or unsuccessful analyses,
with the evolution of his own concepts, so that it becoming increasingly contradictory as years went
is indeed difficult to guess what was first: the con- by, along with the changes in Freud’s concepts. In
cepts or the observations? Freud has always re- parallel, we are now unable to retrieve information
mained elusive on his ‘method’, never really ex- on the exact method that was being used. Also, be-
plaining how he actually went about making his cause Freud commonly acknowledged his previ-
discoveries on ‘curing’ people [7]. It is particu- ous ‘mistakes’ along the evolution of his concepts,
larly telling that his 1908 project to publish Gen- he acquired a flavor of modesty associated with a
eral Methodology of Psychoanalysis never saw concern for truth, which fitted well with the pro-
completion. Indeed, it appears that there never gressive nature of a scientific endeavor.
was such a ‘method’, with details and technical
specifics, which one could for instance publish in
a scientific methodology section. Contemporary Freud’s Beginnings in Hysteria: A Charcot
reviews of Freud’s works clearly pointed to the Sequela
vague nature of Freud’s assertions and the impos-
sibility to replicate his results. Even his former Freud’s conception of hysteria is inseparable from
colleague and friend, the otorhinolaryngologist his larger intellectual legacy. The very idea of the
Wilhelm Fliess (whom he had met in 1887), fa- (Freudian) unconscious was derived from the ob-
mously accused him of ‘reading his own thoughts servation of some obstacles in the treatment of a
into the minds of his patients’. While the absence handful of hysterical patients.
of a clear method, the evolving character of One knows the famous words of Freud [6, p.
Freud’s attitude towards therapy and theory, the 42]: ‘Our hysterical patients suffer from reminis-
retrospective revisions of these views, and the in- cences. Their symptoms are the remnants and the
herently subjective, intuitive, and private nature memory symbols of certain (traumatic) experi-
of the practical aspects of his ‘technique’ may now ences.’ While Freud had heard of the case of Anna
look controversial and underline what we can O. through Breuer already in November 1882, it
now call an exploratory, nonscientific, approach, is obvious that his interest for hysteria was built
at the time they effectively made him immune to around his stay with Jean-Martin Charcot during
criticism and created a legendary aura of secre- the winter of 1885–1886. At that time, the great
tiveness. This would contribute to the institution- French neurologist was developing his studies on
al diffusion of psychoanalysis, while at the same hysterics at La Salpêtrière, initially upon the stim-
time building up his own legend of the isolated ulation from his former ‘interne’ Désiré Bournev-
avant-garde scientist. In fact, as Wittgenstein put ille, and subsequently with other collaborators,
it quite plainly, he merely had ‘given up one way such as Paul Richer, then followed by Joseph

Sigmund Freud and Hysteria 111

Babinski and Georges Gilles de la Tourette. Freud a case he had seen at La Salpêtrière, which was
met all of them during his short stay in Paris, and part of the lectures he translated into German, a
even reported to his fiancée Martha Bernays the bricklayer named ‘Pin’. The presentation was
‘décolleté’ of Madame Richer and the rivalry he coldly received: the audience saw it as unoriginal
had with Babinski. Freud’s Parisian correspon- (ideas on hysteria and male hysteria were already
dence shows his ambition to become important widely discussed in Vienna, and Freud may sim-
in a field opened by Charcot, and as we already ply not have been aware of the large amount of
mentioned, he acquired a conspicuous amount of previous and ongoing works on the matter) or
books devoted to hysteria and hypnosis [5]. simply wrong to link a physical trauma to hys-
At the time, Charcot devised the concept of terical symptoms. Perhaps a certain chauvinism
‘dynamic lesions’ and recognized the role of trau- was at play, where the Austrian medical audience
matic events, physical or psychological, in the was unhappy with Charcot’s ideas, that seemed to
triggering of hysteria. However, he also main- contradict the widely held organic view of hyste-
tained a strong emphasis on the role of heredity, ria. In addition, ‘Pin’ turned out to present only
and confided these traumatic events to that of mild symptoms and certainly was not an example
mere ‘agents provocateurs’ (triggering factors). of ‘grande hystérie’.
Yet the focus on heredity, which in due time The second lecture was held on November 26,
Freud would strongly oppose, would lead Char- 1886 [10]: Indeed, in the month following the first
cot and his colleagues to collect extraordinarily lecture, Freud was able to find a new case of male
careful and detailed personal and familial case hysteria. Interestingly, this case of hysterical hemi-
histories, an investigation not much different anesthesia in a male did not seem to be directly
from the information Freud would subsequently associated to a physical trauma. Rather, the trau-
strive to gain in psychoanalytical sessions. Com- ma involved a violent and frightful dispute with
bined with the practice of hypnosis, in order to the patient’s brother, who threatened the patient
demonstrate the suggestible nature of the symp- with a knife. This was followed by a ‘ringing’ in the
toms presented by these patients, the grounds for head and an episode of violent spasms involving
psychotherapy were indeed well laid down during loss of consciousness. The fear itself, rather than
those early years at La Salpêtrière. the specific event leading to the fear, was the key
The influence of Charcot on Freud has led to etiological feature of the ‘trauma’, which fitted
endless discussions. That the young neuropatholo- well with Charcot’s theory and would subsequent-
gist was greatly impressed by the Parisian master is ly also adapt to Freud’s further elaborations on the
undeniable, although in the first place, he counted etiology of hysteria. However, at age 8, the patient
on his visit to advance his career. Shortly thereaf- was involved in an accident, in which he was run
ter, he translated a volume of Charcot’s work into over in the street. At this point, Freud did not con-
German and even named his first son Jean-Martin. sider the possible link between both events, i.e. the
In 1886, upon his return from Paris, Freud old accident and the more recent dispute with the
made two presentations on hysteria [8, 9, pp. brother. The paper also contained clinical data
458–464]. The first one was never published, but predating Freud’s subsequent elaborations on the
its content could be fairly well reconstructed from distinction between organic and hysterical paraly-
several reports on the event. The second one con- sis, thereby foreshadowing the notion of ‘conver-
cerned a case report of male hysteria [10]. The sion hysteria’. Most notably, the clinical findings
first lecture took place on October 15, 1886: Freud did not follow the laws of anatomy, a point which
presented Charcot’s views on male hysteria and he would develop in his ‘Hysteria’ entry in the Vil-
its traumatic (physical) etiology, and introduced laret medical encyclopedia in 1888 (Handwörter-

112 Bogousslavsky · Dieguez

buch der gesamten Medizin) [■■] and in a paper scious ego. The concept of the arm would not be
commissioned by Charcot which was published destroyed or damaged, but merely be inaccessi-
only in 1893 (after Charcot’s death). ble. The reason why an idea may become inacces-
At the time, and still in the encyclopedia entry, sible and separated from other ideas is that it is
Freud defended rather forcefully the hereditary affectively overcharged and the patient currently
views of Charcot, which he would subsequently is unable to deal with the emotion associated with
criticize [■■]: a certain body part. In other words, the represen-
The etiology of the status hystericus is to be looked tation of an organ becomes linked to a traumatic
for entirely in heredity: hysterics are always disposed to memory, and both end up buried deep under and
disturbances of nervous activity, and epileptics, psychi- apart from the rest of conscious bodily represen-
cal patients, tabetics, etc., are found among their rela- tations. It is striking that this theory is more or
tives. Direct hereditary transmission of hysteria, too, is less identical with the one delineated by Charcot
observed, and is the basis, for instance, of the appear- in newly discovered archives material [11].
ance of hysteria in boys (from their mother). Compared Also striking is that within a single month sepa-
with the factor of heredity, all other factors take a sec- rating both 1886 lectures, Freud moved from the
ond place and play the part of incidental causes, the im-
older Charcot-Oppenheim view of male hysteria as
portance of which is as a rule overrated in practice.
being prominently linked to physical trauma (Her-
But in his Charcot obituary (1893) [■■], mann Oppenheim was famous for his physical
Freud took some distance from the master’s ideas: trauma theory, which he developed in the context
‘As for the etiological theories which Charcot de- of train accidents), to a picture closer to the simul-
fended in his doctrine of the ‘‘famille név- taneously developing views of Charcot, in which
ropathique’’ and made the cornerstone of his hysteria depended foremost on the psychological
whole conception of nervous disease, they too consequences, especially the unconscious ones, of
will probably soon need to be probed into and a psychical trauma. Physical and psychical trau-
corrected’. Freud’s footnotes in his translation of matic events could then have the same pathologi-
Charcot’s lessons also make clear that he did not cal effects. From an epistemological point of view,
fully subscribe to the hereditary approach. it is fascinating that this turn in Freud’s views could
That the hysterical symptoms did not respect very well be entirely due to the urgent need to find
anatomical constraints was suggestive of a non- a new case of male hysteria, and thus perhaps of
physiological mechanism at work. Indeed, in the stumbling on an unsatisfying one (provided so to
Villaret entry [■■], Freud made the argument speak at the last minute by laryngologist Dr. von
that there cannot be an organic lesion at work in Bergszászy, as Freud was denied access to the wid-
hysteria precisely because its symptoms do not er population of the general hospital), while at the
match the laws of anatomy. What is, then, this same time retaining some ambiguity since the case
nonphysiological, functional, dynamical princi- still could be interpreted as linked to an early phys-
ple at work? Not mere malingering, but some- ical trauma perhaps revived by the newer one. Sex-
thing like the ‘idea’ of a disease stored in the mind uality, by the way, played no role at all at this stage.
and engaged unconsciously in the production of
symptoms. The concept was very close to Pierre
Janet’s ideas on dissociation, which Freud indeed The Invention of Freud’s Hysteria
acknowledged. During hysterical paralysis of an
arm, for instance, what happens would be that the Back in Vienna from Paris, Freud heard again of
concept, the idea of the arm, cannot be integrated Josef Breuer’s work on hysteria and the two set
with the rest of the ideas constituting the con- out to work on a paper advancing new concep-

Sigmund Freud and Hysteria 113

tions of the condition [12]. With the adjunction tion is indeed a landmark because it is a concen-
of a series of case reports and theoretical and clin- trate of the psychological mechanisms that Freud
ical developments, the paper later became a full would develop at large during the following years,
book, Studies on Hysteria [6]. and which can grossly be summarized into the as-
Indeed, Freud followed-up on his interest for sociation of the concept of the pathological secret
Breuer’s cathartic method during his ‘analyses’ of of Moriz Benedikt with that of the ‘idées subcon-
the patients provided by him. Progressively, thus, scientes fixes’ (fixed subconscious ideas) of Pierre
hysterical symptoms became associated neither Janet. Benedikt, who by the way had supported
with a hereditary predisposition nor with the Freud’s 1885 trip to Paris with a letter to Charcot,
emotional impact per se of a physical or even psy- had developed the concept of private secrets in-
chical trauma, but with the affect connected to an vading the life and behavior of patients at the ori-
unpleasant idea or memory and effectively aim- gin of their mental dysfunction. On the other
ing at its suppression from conscious thought. hand, Pierre Janet already had a significant expe-
Charcot’s concept of an ‘agent provocateur’, in rience with the management of hysterical patients
his mind a physical trauma activating the idea of before he joined Charcot’s service in 1889, and his
a physical impairment and ultimately leading, first reports of cathartic cures allowing subcon-
through self-directed suggestion, to hysterical pa- scious ideas to emerge into consciousness dated
ralysis, was thus expanded to include purely psy- back to 1886 in Le Havre. Thus, while the pre-
chical events that could directly lead to similar ef- liminary communication was a brilliant synthe-
fects. The trend seemed to follow-up on Charcot’s sis, none of its individual concepts could be qual-
progressive turn from neurology to psychology to ified as new.
explain hysteria. A few months later in 1893, Freud published
In 1892, Freud and Breuer published their first an article in French in the Archives de Neurologie,
paper on ‘traumatic hysteria’, in which a hypnoid an earlier assignment from Charcot, where he
state was emphasized, along with a dissociation of showed the differences in organic versus hysteri-
consciousness. The latter concept, again, was very cal paralyses [13, 14]. Here, he quoted Janet about
close to the ideas of Pierre Janet, who was prepar- the lack of respect of anatomical rules in hysteri-
ing his medical doctorate under the supervision cal paralysis. One year later, Freud introduced the
of Charcot. In his published thesis (1893), Janet term ‘Abwehr’ (defense), which he had borrowed
indeed quoted the present work, although he mis- from his Austrian mentor Theodor Meynert, in
spelled Breuer’s name into ‘Brener’. Freud and order to focus on psychological mechanisms de-
Breuer underscored the symbolic role of emo- signed by patients to protect their own function-
tional trauma, with two rules: the strength of the ing. And then came the important 1895 book
trauma, and its close link with the symptoms. Studies on Hysteria, which included several case
The psychologization of hysteria is the topic of presentations, some of which would become fa-
the celebrated ‘preliminary communication’ by mous, such as Anna O. or Emmy von N. These
Freud and Breuer, ‘On the psychical mechanism case descriptions have been discussed at length,
of hysterical phenomena’ [12], in which, as in the along with criticisms on the authenticity of cer-
subsequent book Studies on Hysteria, heredity is tain features [9], such as the cure of Anna O. by
almost altogether absent. He and Breuer still held Breuer. Indeed, Freud himself declared years later
to the notion that hysterical patients had a certain that the cathartic cure of Anna O. (Bertha Pap-
‘proclivity’ to express the disorder, although such penheim, 1856–1936) never happened, although
‘proclivity’ and its features were said to remain it was reported to have taken place in 1882 (but
mysterious. The short preliminary communica- published 13 years later). This case was particu-

114 Bogousslavsky · Dieguez

larly strange, and to our knowledge a similar pa- presented his cases of anosognosia and the con-
tient has never been reported again. Among other cept of anosodiaphoria at the Société Neu-
peculiar symptoms, she displayed a time switch of rologique [17]. It was in Studies on Hysteria that
365 days between her present hallucinations and Freud and Breuer wrote their well-known apho-
what she had actually lived a year earlier, with im- rism, ‘hysterics suffer mainly from reminiscenc-
peccable memory of all the details of her life dur- es’, by which they sought to describe a ‘commem-
ing the corresponding time. The cure supposedly oration of events by symptoms’ [18].
occurred when the patient was able to revive ret- It is also interesting to mention that during
rospectively each day of the whole year. The pa- this period (the last decade of the 19th century),
tient herself coined the process a ‘talking cure’ Freud also pursued some works on classical neu-
and a ‘chimney sweeping’, obviously sarcastically, rological topics, such as aphasia and agnosia (he
in English (as one of her symptoms was being de- even coined the latter term), or infantile palsy and
prived of the use of her mother tongue, German). hemiplegia, fields which he would soon abandon.
On the other hand, Freud spoke of ‘cleansing of It seems as if Freud initially wanted to keep a
the soul’ to describe Breuer’s cure with Anna O. strong organic/neurological basis in his work, as
In any case, the fact that the cure report seemed was clearly evident in his ambitious 1895 uncom-
fraudulent, along with the fact that the actual pleted and unpublished Project for a Scientific
publication dated from 1895, clearly confirms Psychology [19], before he definitively and com-
that Pierre Janet was right in claiming priority of pletely switched to psychology, the unconscious,
the cathartic cures of hysterics. While Janet and and sexuality.
Freud had never met (when Freud went to Paris,
Janet was still in Le Havre), they remained life-
long rivals. In 1913 at the International Congress Conversion, Repression, and Abreaction as
of Psychiatry, Janet strongly criticized Freud, and Embodied Metaphors
when Janet went to Vienna two decades later,
Freud refused to receive him. In 1895, Freud and Breuer published Studies on
These reports with Breuer would make Freud Hysteria and an article on anxiety neurosis. With
pinpoint at an intrapsychic conflict of representa- reference to mechanisms of hysteria, three main
tions. In their work, they also emphasized the types were put forward by Freud and Breuer dur-
‘Nachträglichkeit’ or deferred action of the trau- ing the years 1894–1895. ‘Abwehrhysterie’ (de-
ma: an initial trauma becomes a symptom only at fense hysteria) corresponded to a protective reac-
a later stage of development, when a second trau- tion against unpleasant representations. ‘Reten-
ma reactivates the earlier one, which at the time tionshysterie’ (retention hysteria) corresponded
could not be reacted to adequately. It is also in to affects which were not ‘abreacted’, i.e. lacking
Studies on Hysteria that the term ‘la belle indif- the emotional discharge which would have freed
férence’ first appeared to describe a patient, Elisa- the subject from clinical manifestations. ‘Hyp-
beth von R., and was later attributed by Freud to noidhysterie’ (hypnoid hysteria) was associated
Charcot [15]. The exact meaning of this symptom with hypnoid states, which lead to unconscious
has been disputed, but it refers to an apparent se- representations developing during such states,
rene cheerfulness in the face of an underlying dis- usually in connection with fear. However, these
turbance, obvious to anyone but the patient. It is categories were subsequently abandoned by
noteworthy that Freud would mention ‘la belle Freud without much explanation, probably be-
indifférence’ again only in 1915, in his paper on cause they no longer fit with the new evolutions
repression [16], only a few months after Babinski of his thinking and theories.

Sigmund Freud and Hysteria 115

 The term ‘conversion’, which has had an in- While the term ‘conversion’ thus appeared
credible success in the 20th century, first ap- early in Freud’s work, it is striking that this was
peared in 1894 in Freud’s article on defense psy- not the case for ‘conversion hysteria’. Indeed,
choneuroses, and it was subsequently used in Freud first coined the term in a discussion on
Studies on Hysteria for the cases of Emmy von N. the ‘Little Hans’ case (published in 1905) in 1909,
and Cäcilia M. It implied a transposal of the intra- in order to distinguish it from ‘anxiety hysteria’
psychic conflict with a resolution attempt through presented by the patient. Anxiety (or fear) hyste-
somatic manifestations. ria (‘Angst Hysterie’) had been introduced by
The metaphorical origin of the symptoms of Wilhelm Stekel in 1908 to express a phobia, in
conversion has understandably raised some eye- which a substitute object focuses anxiety. This
brows, to say the least. Yet the notion, as ex- was different from Freud’s 1895 ‘anxiety/fear
plained by Freud while discussing the case of Cä- neurosis’ (‘Angst Neurosis’), where no substitute
cilia M. is most interesting in light of current de- object is present. In both conversion hysteria
velopments in embodied cognition research and anxiety hysteria, the term ‘hysteria’ was jus-
[20]. The patient, for instance, would suffer from tified in Freud’s view since in both instances re-
facial neuralgia traceable, according to Freud, to pression tends to dissociate representations from
an instance where her husband had made a re- their corresponding affect.
mark that felt ‘like a slap in the face’. Likewise,
through a process of ‘associative reverberations’
she would complain of a shooting pain in her The Sexualization of Hysteria
right heel, apparently due to the fact that at some
point, she did not ‘find herself on a right footing’ Studies on Hysteria almost completely lacked ex-
with some strangers. A penetrating pain in her plicit sexual issues and explanations. According to
forehead would be due to the ‘penetrating look’ Freud himself, this was so because of Breuer’s un-
of her grandmother, which she remembered ease with the sexual matter, but this a posteriori
‘had gone right into her brain’. And so forth. claim may more accurately reflect Freud’s own
Freud offered an evolutionary explanation, and evolution after his split from Breuer. In putting
alluded to Darwin’s The Expression of the Emo- together the second edition of the book in 1908,
tions [6, p. 223]: Freud indeed distanced himself from the initial
work with Breuer. The development of psycho-
All these sensations and innervations belong to
the field of ‘The Expression of the Emotions’, which, analysis was by then well under way, and Freud
as Darwin (1872) has taught us, consists of actions sought to introduce a wealth of new ideas into his
which originally had a meaning and served a purpose. views of hysteria. This restructuring already took
These may now for the most part have become so place in his study of the Dora case in 1905.
much weakened that the expression of them in words Therein, Freud’s belief of the sexual origins of
seems to us only to be a figurative picture of them, all hysterical symptoms was made explicit. And
whereas in all probability the description was once revisiting his early cases, Freud noted in the
meant literally; and hysteria is right in restoring the fourth chapter of Studies on Hysteria (‘The psy-
original meaning of the words in depicting its unusu-
chotherapy of hysteria’) that they all must have
ally strong innervations. Indeed, it is perhaps wrong
to say that hysteria creates these sensations by sym-
been marked by sexual traumas. He put forward
bolization. It may be that it does not take linguistic the thesis that at the bottom of every case of hys-
usage as its model at all, but that both hysteria and teria there are one or more occurrences of prema-
linguistic usage alike draw their material from a com- ture sexual experience, occurrences which belong
mon source. to the earliest years of childhood.

116 Bogousslavsky · Dieguez

 Moreover, as Allison and Roberts [21, pp. tients would thoroughly deny (‘resist’) Freud’s
255–256] underscored, Freud would then gener- proposal that they must have been abused.
alize his sexual theory of hysteria to all cases of In 1895, these repressed ‘memories’ of child-
neurosis: hood abuse were nowhere to be found in Studies
In the early writings on hysteria, Freud had fo- on Hysteria. Yet in 1896, Freud now claimed evi-
cused on the importance of memory, trauma, and the dence for 16 cases (none of which, by the way,
therapeutic use of hypnosis, to help diagnose his pa- involved fathers as assailants; fathers would be-
tients. By the time of his major case studies, he was come involved first in a later letter to Fliess).
equipped with a remarkably well developed theoreti- These three papers of 1896, presented and pub-
cal apparatus. During the intervening years – preced- lished in Paris, Berlin, and Vienna [22–24], make
ing the celebrated Dora case – he had elaborated the no ambiguity about the fact that Freud believed
mechanics of the unconscious and repression, the dy-
these patients had been abused, but he was more
namics of the dream-work, the theory of infantile sex-
mysterious about the way he obtained that infor-
uality, the oedipal complex, etc. This would permit
him to engage in a far more complex analysis of what mation, not to mention just how far he verified it.
he examined early on in his professional career, name- In the ‘Aetiology’ paper [24], he wrote that ‘in a
ly, hysteria. In the Dora case, e.g., he would explicitly few instances the accumulation of sexual experi-
identify neurosis in general with a sexual etiology, and ences coming from different quarters was truly
hysteria in particular would be equated with the in- amazing’, including quite explicitly ‘all the abuses
ability to deal successfully with the erotic drives on a known to debauched and impotent persons,
conscious level. among whom the buccal cavity and the rectum
These papers, beyond the ‘seduction theory’ are misused for sexual purposes’. In the ‘Further
per se (see below), argued for a new nosological remarks’ paper, he noted that the cases were all ‘of
approach to the neuroses. Freud’s ambition was a severe kind’ involving ‘grave sexual injuries;
to find a specific etiology for each specific ail- some of them […] positively revolting’. In the pa-
ment (anxiety, hysteria, obsession, paranoia, per ‘Heredity and the aetiology of the neuroses’
etc.), whereby he could establish a proof of a spe- [22], where we can find the first mention of the
cial etiological relationship between the nature word ‘psychoanalysis’, he referred to these infan-
of the sexual influence and the pathological spe- tile scenes as ‘a brutal assault’.
cies of the neurosis. This is somewhat contradic- Again, none of that had ever seen light in Stud-
tory with the meticulous efforts made in Studies ies on Hysteria, despite the fact he had been using
on Hysteria to track back the very specific sym- more or less the same ‘technique’, supposed now
bolic elements derived from singular traumatic to uncover a universal and unmistakable truth
events that would each find their way in their about the origins of hysteria. However, as we will
own particular ‘innervation’ pathway to be ex- see, all of it would be forgotten and negated a year
pressed as symptoms. The new formula – re- later anyway.
pressed early abuse inevitably leading to hysteria
after having been reactivated by a similar event –
suddenly seems much more generic and vague, The ‘Seduction’ (Abuse) Theory
while at the same time ruling out countless pos-
sibilities merely because they do not involve a How did Freud argue for the reality of the early
sexual element. The patients would ‘reproduce’ sexual abuse while avoiding providing clinical ev-
in therapy, to the request of Freud, their early idence? He assured the reader that [see 25]:
abuse. Now, what Freud meant by ‘reproduce’ (1) the patients relived vividly and intensely
was not made exactly clear. In any case, the pa- those events (and they most vehemently

Sigmund Freud and Hysteria 117

 denied any remembrance of the event, unlike theory when all his interpretations fitted the ‘in-
other types of recovered forgotten nervation’ approach to the traumatic theory of
memories); conversion. In A Short Account of Psychoanalysis
(2) all the patients reacted independently in the (1924), Freud candidly reported that his patients,
same fashion; at the time, ‘did not bring up what had actually
(3) the memories fitted nicely with the rest of the been forgotten’, but ‘with the help of a certain
clinical history, and amount of supplementing and interpreting, the
(4) the symptoms disappeared thanks to the doctor was able to guess (or reconstruct) the forgot-
unveiling of the early memory. ten material from it [italics added]’ [26, p. 196].
The possibility that he may have suggested or In a way, it seems that whatever ‘evidence’
forced the memories appeared ‘untenable’ to him Freud needed at any developing stage of his views,
because, as he claimed, he generally failed to in- he managed to obtain it. When he no longer
duce or force such memories when he tried so. needed it, he simply forgot about it and obtained
Moreover, Freud claimed (in the Vienna paper new confirmatory facts for his newer views. Freud
[24]) to have obtained corroborating evidence of evolved as a ‘thinker’, or even a philosopher,
sexual abuse for 3 patients (one brother confirm- whose aims were to develop new ideas and theo-
ing that a patient was abused; and 2 patients ac- ries, rather than the scientist he claimed to be.
cusing a common abuser). Nevertheless, the One should of course remember that at the time,
‘pressure technique’, ‘insistence’, and suggestion this attitude was not uncommon among many of
may look like a very effective way of getting pa- his colleagues completely outside the field of psy-
tients to say what the therapist wanted to hear, choanalysis, when facts were often retained main-
whether or not these patients believed what they ly if they corroborated beliefs.
were saying. Were the memories of abuse really ‘recovered’,
In any case, in a mere 4 months after having were they ‘unconscious’? In describing his ‘tech-
first stated the seduction theory [26], Freud nique’ in Studies on Hysteria, Freud admitted that
claimed, in two articles, to have found 16 patients this was not always the case. It seems that the ar-
in which he could trace back their symptoms (13 duous process of uncovering repressed thoughts
hysterics and 3 ‘pure obsessionals’) to infantile sometimes merely corresponded to a confession
sexual abuse experiences. Such experiences, using of something that was accessible to conscious
a similar clinical method, had never appeared awareness all along, but which the patient was re-
even shortly before, and thus, Freud’s patients luctant to share [6, p. 324]:
could not have been selected on the basis of hav- The patient then adds: ‘I could have told you that
ing been abused. So, assuming that the patients the first time.’ ‘Why didn’t you say it?’ [Freud asks]. ‘I
were truly victims of early sexual abuse, either his couldn’t believe it could be that. It was only when it
new theory was correct and he had somehow came back every time that I made up my mind to say
failed to find memories of sexual abuse in his pri- it.’ Or else ‘I hoped it wouldn’t be that of all things. I
or patients despite considerable efforts at tracing could well do without saying that. It was only when it
back symptoms to their causes, or the theory was refused to be repressed that I saw I shouldn’t be let
wrong and by sheer coincidence all his subse- off...’. Thus, after the event the patient betrays the mo-
tives for a resistance which he refused to admit to begin
quent patients turned out to have been abused.
with.
Obviously, it makes more sense to consider the
possibility that these ‘memories’ were simply new While it is commonly said the ‘discovery’ of
interpretations by Freud, conveniently fitting his infantile abuse came to Freud as a ‘surprise’, in
new theory, just as he did prior to the seduction Studies on Hysteria it was made clear by Freud

118 Bogousslavsky · Dieguez

himself that his habit was to indicate to patients later contributed to the Freudian legend, being
what he expected them to produce. In any case, it mainly fostered by Ernest Jones and Ernst Kris
seems obvious that the ‘theory’ came to him be- [27].
fore the ‘discovery’. By 1906, almost 10 years after his private aban-
donment of the seduction theory, Freud started
providing retrospective accounts of this episode,
‘I No Longer Believe in My Neurotica’, essentially blaming his patients in order to ex-
September 21, 1897 plain his ‘mistake’ [28]. They were the ones who
produced the false ‘memories’ after all! The meth-
In this famous letter to his friend and colleague, od by which the private information was ‘ob-
Wilhelm Fliess, Freud confessed that he did not tained’, the fact that this information remained
believe anymore in the fact that his patients had unconscious and that patients often disagreed
actually been sexually abused. From that point with the ‘finding’, were now firmly buried in the
on, he built a new theory based on ‘phantasmatic’ past. As Esterton [28] reports:
seduction and ‘abuse’ to replace his previous hy- ...perhaps because he had recently reread the se-
potheses. Among the reasons stated to give up his duction theory papers, Freud’s 1925 account is par-
‘seduction theory’, Freud pointed out that a high ticularly revealing. He wrote that he was obliged to
incidence of sexual abuse would be required in recognize that the ‘scenes of seduction’ were ‘only
order to account for the high incidence of hyste- phantasies which my patients had made up or which I
ria, whereas such a distribution of perversion had perhaps forced on them’ (emphasis added). He
against children seemed very unlikely to Freud. went on to say: ‘I do not believe even now that I forced
Also, Freud acknowledged that in the uncon- the seduction phantasies on my patients, that I ‘‘sug-
gested’’ them’, but remarkably, given the ‘overwhelm-
scious there is no necessary sign allowing phan-
ing importance’ he accorded his discovery of the sup-
tasms to be distinguished from actual reality, so posed infantile phantasies, he gave no reason why he
that one cannot differentiate between the truth rejected this possibility.
and a fiction invested with feelings. And Freud,
who looked rather distressed, ended his letter to For several authors this corresponded to a
Fliess [■■]: ‘same-method-same-errors’ problem, as Cioffi
summarized: ‘Freud could not bring himself to
… in the deepest psychoses the unconscious mem-
ory does not force its way through, so that the secret of recognize the reasoning by which he had per-
experiences of childhood would also not reveal itself in suaded himself of the authenticity of the seduc-
the most confused delirium. When one sees that the tions because it was the same sort of reasoning
unconscious never overcomes the resistance of the which, for the rest of his career, he was to employ
conscious, then the expectation that in treatment the in his reconstruction of infantile fantasy life and
opposite has to happen, to the point of the complete of the content of the unconscious in general’
taming of the unconscious by the conscious, also sinks. [quoted in 29].
I was so struck by this that I was ready to give up two Now, of course, to make matters even more
things: complete resolution of a neurosis and the cer-
complicated, it should be noted that the element
tain knowledge of its etiology in childhood. Now I have
no idea where I stand… .
of fantasy was not altogether absent from the se-
duction theory. To the contrary, Freud held that
Thus, after much fanfare about his revolution- fantasies were invented precisely to disguise or re-
ary theory, Freud shortly thereafter silently aban- place the traumatic events [see 30, fn 25].
doned it. The idea that there was a smooth shift The fact remains that once Freud privately
from the abuse theory to the fantasy theory only abandoned the theory that actual infantile abuse

Sigmund Freud and Hysteria 119

leads to the delayed appearance of hysterical its most iconic origin. Epistemologically, it
symptoms, he had a problem. Either he had data marked a revolutionary turn from reality-based
to substantiate his earlier theory, or he simply did life to a parallel, self-sustaining, and extremely
not. In the first case, if he was misled by his pa- intrusive universe of fantasies, hidden mecha-
tients, he could have reported evidence of the nisms, and deep secrets in symbolic disguise. In
forged nature of these accounts of abuse, for ex- fact, none of it would have been possible without
ample by further investigation of the files or ac- the early revelatory missteps.
tual interrogation of the involved parties, in ad- Jeffrey Masson is among the few but influen-
dition to the explicit admission of such accounts tial scholars claiming that Freud was wrong to
by his patients (as opposed to merely inferring recant, as his patients really had been abused and
that the patients had made up the accounts). his change of views thus was a betrayal to them
However, if the accounts were true, in addition to [see also 25]. According to Masson, Freud’s ‘cov-
the aforementioned explicit admission and fac- er-up’ of the seduction ‘findings’ could be asso-
tual documentation of the abuses, he would have ciated with an attempt to escape the subversive
had to report that his theory was based on the and isolating consequences, among his male col-
coincidental finding that his patients somehow leagues, of this theory of widespread incest and
all had in common the unfortunate, but irrele- pedophilia (the ‘loss of courage’ hypothesis).
vant, experience of having been abused. Now However, the fact is, sexual perversions were
what if he simply had no evidence whatsoever for nothing new in Freud’s intellectual environ-
the ‘actual abuse theory’? In this case, of course, ment, and accusations of incest could hardly
he would have to admit that his theory was a shock scholars. Furthermore, that Freud’s ‘dis-
product of his imagination, that he recanted it, covery’ of the fictional content of his patient’s
and in fact that his previous scientific and medi- ‘claims’ was nothing new either is clear from the
cal publications on the matter were mainly hy- writing of his ‘colleagues’ in the field of sexual
potheses. And what about the new theory, that of medicine. Krafft-Ebing, as Freud himself report-
‘seduction fantasies’ which in fact never hap- ed, saw the seduction theory story as a ‘scientific
pened other than in his patients’ imagination? fairy tale’, and Löwenfeld, wrote in 1899 [quoted
Did he actually have newly found evidence? in 30, p. 24]:
Freud realized that he could no longer sustain the By chance, one of the patients on whom Freud
abuse theory when the theory ‘broke down under used the analytic method came under my observation.
the weight of its own improbability’, as he put it The patient told me with certainty that the infantile
himself in 1914 (History of the Psycho-Analytic sexual scene which analysis had apparently uncovered
Movement). But why was it improbable in the was pure fantasy and had never really happened to
first place? Freud never explained. In a way, he him.
had to come up with something else, but he did As we have seen, it would take many years for
not give specific evidence leading to the change, Freud to publicly admit the very same thing. The
except that he simply did not believe his previous fact is Freud’s 1896 claims were received coldly
concepts anymore. In a way, leaving the older not because of their sexual contents, but because
theory was a good move since the new ‘discov- of their background theory and method. Unsur-
ery’, in fact, covered exactly the realization that prisingly, authors hinging on the constitutional
the previous findings were untrue. That the the- (hereditary, endowment) theory of hysteria were
ory of actual abuse was unfounded indeed be- unconvinced by Freud’s new etiology. But mostly,
came a major discovery – if not the most seminal critics were dismayed by the way Freud obtained
event in the history of psychoanalysis, certainly his material, namely by suggestion [31].

120 Bogousslavsky · Dieguez

 The ‘overestimation’ hypothesis, in essence mained silent on this point [32, p. 179]. Was
stating that it just so happened by coincidence Freud ‘blind’ in believing the stories his patients
that cases of actual abuse were overrepresented in told him? In his Autobiographical Study (1925) he
Freud’s early sample population, implies that far stated that ‘this was at a time when I was inten-
from being wrong, dishonest, or misled by his pa- tionally keeping my critical faculty in abeyance so
tients, Freud was correct about the recovered as to preserve an unprejudiced and receptive at-
memories of ‘seduction’ being real. This is stated titude towards the many novelties which were
explicitly in his first published detailed account coming to my notice every day’ [■■].
acknowledging his mistake, in ‘My views on the Retrospectively, several questions remain, but
part played by sexuality in the etiology of the neu- it appears that Freud’s change of views was more
roses’ (1906) [■■]: associated with the private evolution of his own
At that time my material was still scanty, and it hap- theories than with experimental facts or repro-
pened by chance [Zufall] to include a disproportionate- ducible observations. According to Triplett [27],
ly large number of cases in which sexual seduction the seduction theory anyway was a ‘misnomer’
[Verführung] by an adult or by older children played the and a ‘historical distortion’. Indeed, the seduc-
chief part in the history of the patient’s childhood. I thus tion theory would have been more appropriately
over estimated the frequency of such events (though in referred to as the ‘infant genital trauma theory’
other respects they were not open to doubt) [dieser in the first place. Besides, in his retrospective ac-
(sonst nicht anzuzweifelnden) Vorkommnisse]. counts of his abandonment of the seduction the-
Yet he immediately attempts to have it both ory, Freud would focus specifically on the role of
ways, admitting the following: ‘Moreover, I was at fathers. This is remarkable insofar as fathers were
that period unable to distinguish with certainty not mentioned in the seduction papers of 1896.
between falsifications made by hysterics in their It makes little sense to claim that Freud chose to
memories of childhood [die Erinnerungs-täusc- disguise fathers as other adults in 1896. Rather, it
hungen der Hysterischen über ihre Kindheit] and seems that Freud, in light of his new Oedipal the-
traces of real events’. He continued [■■]: ory, would distort his earlier theory to make the
Since then I have learned to explain a number of continuity smoother. Freud blamed fathers, but
phantasies of seduction as attempts at fending off no fathers or repressed memories, instances of
memories of the subject’s own sexual activity (infantile actual ‘seduction’, or even any success with the
masturbation). When this point had been clarified, the cathartic method for that matter were presented
‘traumatic’ element in the sexual experiences of child- in his writings. His correspondence with Fliess,
hood lost its importance and what was left was the re- on the other hand, indicated in many instances
alization that infantile sexual activity (whether sponta- that Freud, in fact, was short of cases and did not
neous or provoked) prescribes the direction that will ‘complete’ any at this time. It appears that he had
be taken by later sexual life after maturity.
a theory without data, a fact on which he spent a
Did he overestimate the importance of abuses great deal of his career trying to somehow
in infancy and mistakenly consider them as nec- accommodate.
essary for hysteria? Or could it be that he simply
had no means to distinguish real from fantasized
(or forcibly extracted, or plainly suggested) abus- ‘Dora’ and Further Developments
es? Note also that in 1906, Freud seemed to imply
that while then (in 1896) he was unable to distin- ‘Dora’, the first psychoanalytic case study was
guish with certainty between falsifications and written in 1901 and published in 1905 (fig. 2).
real events, he could now. But how? Freud re- It included the application of Freud’s new ideas

Sigmund Freud and Hysteria 121

Fig. 2. First page of the original
report of ‘Dora’, the first
psychoanalytic case, published in
1905 by Karger Publishers. Philippe
Helaers Library.

on dreams and the unconscious to a hysteric However, the interpretation of that case was
patient. It is somewhat ironic that Freud would also criticized. For example, Huopainen [33, pp.
be confronted by a patient that was, unques- 100–101] stated about the Dora case:
tionably, actually ‘seduced’ at a time when he
In his thought, Freud was unable to integrate con-
had not yet repudiated publicly his ‘seduction temporary traumas explaining Dora’s hysteria, such
theory’, but about 3 years after he did privately. as a child’s naturally felt horror and repulsion to-
This was Freud’s first effort to relate the Oedi- wards pedophilic sexuality and her background of
pus complex to an individual patient. traumatic interaction experiences in childhood, and

122 Bogousslavsky · Dieguez

was thus unable to understand the frailty of Dora’s lenses, for instance analyzing the meaning of
ego. Freud’s bypassing of his patients’ real emotional Freud’s dreams of that period and pointing to
difficulties prevented not only Dora’s integration but the emotional and professional turmoil he en-
also the resolution of her libidinal conflicts and the
dured at that time, shortly following his father’s
continuation of her treatment, and together these fac-
death, even by postulating a ‘creative illness’ [9].
tors most likely served to further aggravate Dora’s dif-
ficulties.’ As we have seen, such accounts still do not ac-
count for how exactly he came up with the se-
On the other hand, it could be argued that duction theory in the first place, what became of
Freud was well aware of these facts, but was sim- his early ‘data’, what changed in his ‘method’ af-
ply paid to silence a turbulent young girl that was terwards, and so forth. The chronological devel-
getting in the way of her family’s libertine where- opments as well as the nature of the changes in
abouts. Indeed, it can be questioned whether Freud’s theory may in fact suffice to state that
Dora was ‘ill’ at all, let alone ‘hysteric’ [34]. Freud in fact found the answers he was looking
for ‘in himself ’.
Freud used hysteria to build a reputation and
From Hysteria to Psychoanalysis develop his new psychological theory. In the
process, hysteria per se was in fact hardly ad-
Critics of psychoanalysis often point out the nu- dressed, much less explained, solved, or cured.
merous ‘Freudian lies’. In fact, psychoanalysis The very same processes that would in time ex-
was born precisely out of the attempt not to lie. plain ‘conversion symptoms’, which required
The ‘seduction theory’ put Freud in such an un- (as we have seen) revising, ignoring, and some-
comfortable situation that he had to resort to an what distorting previous explanations, would
unfalsifiable alternate reality positing the exis- end up as the all-purpose neuropsychoanalytic
tence of an invisible world of conflicts that would package still in use today. With intelligence and
secure the ‘progress’ of the theory while at the intuition, Freud would subsequently apply in all
same time immunizing it against all attacks, and matters of human existence his purportedly uni-
in the progress, actually indicting the very attacks versal discoveries about the human psyche. It is
as symptoms and ‘resistance’ [35]. Rhetorically, truly remarkable that his failure to document
the stroke of genius was, retrospectively and and test his early ideas about hysterical symp-
smoothly, to link the unfortunate episode of the toms would progressively transform, without
abuse theory to the ‘discovery’ of the Oedipus the benefit of any actual new scientific research,
complex. It was fathers all along! This is the place into a mechanism that could likewise explain ev-
that hysteria occupies in the history of the psy- erything from dreams, jokes, art, and culture,
choanalytic movement: an embarrassing condi- not to mention mental disorders.
tion, which Freud, however, managed to integrate That hysteria is intrinsically linked to the
in his developing theories of libido, finally to ob- emergence of psychoanalysis, to the extent that
tain an initially unexpected success. without this specific condition it would probably
Before the emergence of a scholarly Freudian never have seen light, is not a new idea:
critique, the retrospective accounts of Freud’s
Analysts today believe that psychoanalysis could
change of mind were typically interpreted as a
only have evolved out of work with hysterics because
sign of scientific guarantee, which of course hysterics formed strong, explicit transferences to
helped to propagate and solidify the legend. their doctors and thus provided examples of projec-
Others have tried to account for this period’s tion and sexual conflict. Kurt Eissler has hypothe-
events through psychoanalytic or psychological sized that ‘the discovery of psychoanalysis would

Sigmund Freud and Hysteria 123

have been greatly impeded, delayed, or even made ued struggling with the cathartic method, trying
impossible if in the second half of the nineteenth cen- to uncover the deepest strata of unconscious trau-
tury the prevailing neurosis had not been hysteria’ matic memories that led to the symptoms. There
[36, p. 44].
would have been no need to posit some universal
Likewise, du Preez stated that ‘one might, in and all-encompassing mechanism to rationalize
fact, argue that it was from the ‘‘wandering the errors and failure to cure the patients in the
wombs’’ identified in hysterical patients of the long term. As a clinician he would have simply
late nineteenth and early twentieth centuries that followed, like everybody else, the course of medi-
psychoanalysis and the discovery of the uncon- cal discomfort with conversion and dissociative
scious emerged’ [37, p. 47]. disorders (indeed, it is not as if these are well un-
But perhaps one could go a step further and derstood even today, not to mention easily cur-
submit that hysteria really was the cause, the etiol- able). Psychoanalysis seemed to have developed
ogy of psychoanalysis. Indeed, let’s imagine that within a context in which the patients always con-
Freud was right about the seduction theory, or firmed any pre-established theory. They may
that he had stumbled upon some causal mecha- have led to psychoanalysis as a mirror of their
nism that would resolve the mystery of hysteria suggestibility, malleability, and sheer mysterious-
once and for all. There would have been no sub- ness. The rest is history, of course, with the need
sequent need to develop psychoanalysis because for psychoanalysis to insulate itself further, not
there would be no error to justify retroactively. unlike a ‘secret society’, as Ernest Jones put it. Us-
Imagine, likewise, that Freud had never proposed ing Pierre Janet’s terms, psychoanalysis thus be-
the seduction theory in 1896, but instead contin- came the new clothes of hysteria.

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Prof. Julien Bogousslavsky

Center for Brain and Nervous System Diseases
GSMN Neurocenter, Clinique Valmont
CH–1823 Glion/Montreux (Switzerland)
E-Mail [email protected]

Sigmund Freud and Hysteria 125