The author of a biographical novel treads through a historical minefield. Get a fact wrong and the historians are up in arms; the validity of the entire work is compromised. Yet there is always more than one side to a story and in the past it has usually been the male side that has been able to make itself heard. This is particularly true of the medical case history. Here it is the doctor's voice which has always been to the fore, and again, until fairly recently, this has been a male voice. Medical historian Roy Porter draws attention to what he calls the 'patient-shaped' gap in medical history, pointing out that histories of epilepsy and hysteria exist, but none by epileptics and hysterics.
When I set out to write a novel about Bertha Pappenheim, the young woman diagnosed as hysterical who later came to be considered the 'founding patient' of psychoanalysis, it was with the hope that I might contribute to the filling of this gap. Of course, I can't know exactly how Bertha felt or thought; we are separated by a wide gulf of time and culture. But I could research the case to the best of my ability and put forward a reasonable hypothesis, which is no less, after all, than her own doctor was doing, not to mention the many therapists since then who have written about her.
My feeling from the beginning was that Bertha's condition was due to a multiplicity of factors, the principal one being neurological. One of the advantages I have had over earlier writers, including Bertha's own doctor, Josef Breuer, is that much more is now known about neurological disorders. In the 1880s, the time of her illness, there was still a general ignorance about this subject, even among the medical fraternity. In the case of Bertha, it now seems likely that a number of her symptoms could be attributed to a form of temporal lobe epilepsy, as suggested by Alison Orr-Andrawes.To get an idea of what it could be like to be experiencing such symptoms I researched personal accounts of present-day sufferers. This not only helped me in fleshing out the lived experience of Bertha, it also strengthened my suspicion that she did indeed have this form of illness.
It is likely that Bertha also had psychological problems as she was an intelligent young woman deprived of educational and career opportunities. With the greater understanding we now have of women's frustrations in this respect is not difficult to imagine how this could have impacted on her emotional state. She was also undoubtedly affected by the large amounts of chloral hydrate and morphine which she was taking, something which Breuer admitted but did not discuss in relation to her symptomatology. Finally, there was very probably a iatrogenic element. There is every indication that the 'talking treatment' generated a strong transference, with Bertha becoming extremely dependent on Breuer emotionally. Again, this is not something dealt with in the two published case histories.
The biographical novel can never claim to be as faithful to reality as an autobiography — though how many of those are true representations rather than accounts of how the author would like to be perceived? — but at least it can give a voice to the unvoiced, those who, for whatever reason, were unable to tell their stories themselves.