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Dora::An Analysis of a Case of Hysteria[Paperback,1997]
An Analysis of a Case of Hysteria{Paperback,1997}
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September 14, 2025
THE CASE HISTORY OF ONE OF FREUD’S MOST FAMOUS (IF UNSUCCESSFUL) CASES
Sigmund Freud (1856-1939) wrote in the first chapter of this 1905 book (which also includes a 1908 and 1909 essay on female bisexuality and Hysteria), “In 1895 and 1896 I put forward certain views upon the pathogenesis of hysterical symptoms and upon the mental processes occurring in hysteria. Since that time several years have passed. In now proposing, therefore, to substantiate these views by giving a detailed report of the history of a case and its treatment, I cannot avoid making a few introductory remarks, for the purpose partly of justifying from various points of view the step I am taking, and partly of diminishing the expectations to which it will give rise.
“Certainly it was awkward that I was obliged to publish the results of my inquiries without there being any possibility of other specialists testing and checking them, particularly as those results were of a surprising and by no means gratifying character. But it will be scarcely less awkward now that I am beginning to bring forward some of the material upon which my conclusions were based and make it accessible to the judgment of the world. I shall not escape blame by this means. Only, whereas before I was accused of giving no information about my patients, now I shall be accused of giving information
about my patients which ought not to be given. I can only hope that in both cases the critics will be the same, and that they will merely have shifted the pretext for their reproaches; if so, I can resign in advance any possibility of ever removing their objections.” (Pg. 21)
He asserts, “It is true that the causes of hysterical disorders are to be found in the intimacies of the patents’ psycho-sexual life, and the hysterical symptoms are the expression of their most secret and repressed wishes, then the complete exposition of a case of hysteria is bound to involve the revelation of those intimacies and the betrayal of those secrets.” (Pg. 22)
He argues, “Now in this case history… sexual questions will be discussed with all possible frankness , the organs and functions of sexual life will be called by their proper names, and the pure-minded reader can convince himself from my description that I have not hesitated to converse upon such subjects in such language even with a young woman. Am I, then, to defend myself upon this score as well? I will simply claim for myself the rights of the gynecologist…” (Pg. 23)
He cautions, “It is not fair to expect from a single case more than it can offer. Any anyone who has hitherto been unwilling to believe that a psycho-sexual aetiology holds good generally and without exception for hysteria is scarcely likely to be convinced of the fact by taking stock of a single case history. He would do better to suspend his judgment until his own work has earned him the right to be convinced.” (Pg. 28)
Dora’s father told Freud, “She keeps pressing me to break off relations with Herr K. and more particularly with Frau K., whom she used positively to worship formerly. But that I cannot do. For, to begin with, I myself believe that Dora’s tale of the man’s immoral suggestions is a phantasy that has forced its way into her mind; and besides, I am bound to Frau K. by ties of honorable friendship and I do not wish to cause her pain. The poor woman is most unhappy with her husband, of whom, by the way, I have no very high opinion.” (Pg. 41)
Freud notes, “I remembered that long ago, while I was working at Charcot’s clinic, I had seen and heard how in cases of hysterical mutism writing operated vicariously in the place of speech. Some patients are able to write more fluently, quicker, and better than others did or they themselves had done previously. The same thing had happened with Dora. In the first days of her attacks of aphonia ‘writing had always come specially easy for her.’” (Pg. 56)
He explains, “I will… add a few general remarks upon the part played in hysteria by the MOTIVES OF ILLNESS. A motive for being ill is sharply to be distinguished as a concept from a LIABILITY to being ill---from the material out of which symptoms are formed. The motives have no share in the formation of symptoms, and indeed are not present at the beginning of the illness. They only appear secondarily to it; but it is not until they have appeared that the disease is fully constituted.” (Pg. 59)
He argues, “I have certainly heard of some persons---doctors and laymen---who are scandalized by a therapeutic method in which conversations of this sort occur, and who appear to envy either me or my patients the titillation which, according to their notions, such a method must afford. But I am too well acquainted with the respectability of these gentry I excite myself over them… [But] often, after I have for some time treated a patient who had not at first found it easy to be open about sexual matters, I have had the satisfaction of hearing her exclaim: ‘Why, after all, your treatment is far more respectable than Mr. X’s conversation!’” (Pg. 66)
He recounts, “Dora herself had a clear picture of a scene from her early childhood in which she was sitting on the floor… sucking her left thumb… No one will be inclined to dispute, that the mucus membrane of the lips and mouth is to be regarded as a primary erotogenic zone… An intense activity of this erotogenic zone at an early age thus determines the subsequent presence of a somatic compliance on the part of the tractus mucus membrane… It then needs very little creative power to substitute the sexual object of the moment (the penis) for the original object (the nipple)…” (Pg. 69)
He recalls a session with Dora, where he told her, “‘you are afraid of Herr K., but … you are still more afraid of yourself, and of the temptation you feel to yield to him. In short, these efforts prove once more how deeply you loved him.’ Naturally Dora would not follow me in this part of the interpretation. I myself, however, had been able to arrive at a further step in the interpretation, which seemed to be indispensable both for the anamnesis of the case and for the theory of dreams. I promised to communicate this to Dora at the next sitting.” (Pg. 88)
He reports, “I came to the conclusion that the idea had probably occurred to her one day during a sitting that she would like to have a kiss from me. This would have been the exciting cause which led her to repeat the warning dream and to form her resolution of stopping the treatment. Everything fits together very satisfactorily upon this view; but owning to the characteristics of ‘transference’ its validity is not susceptible of definite proof.” (Pg. 92)
He states, “I have been able to trace back the symptoms of dyspnoea or nervous asthma to the same exciting cause---to the patient’s having overheard sexual intercourse taking place between adults. The sympathetic excitement which may be supposed to have occurred to Dora on such an occasion may easily have made the child’s sexuality veer round and have replaced her inclination to masturbation by an inclination to morbid anxiety.” (Pg. 98)
He notes, “It is only because the analysis was prematurely broken off that we have been obliged in Dora’s case to resort to framing conjectures and filling in deficiencies. What I have brought forward for filling up the gaps is invariably supported by other cases which have been more thoroughly analyzed.” (Pg. 104)
He asserts, “Dora’s father was never entirely straightforward. He had given his consent to the treatment so long as he could hope that I should ‘talk’ Dora out of her belief that there was something more than a friendship between him and Frau K. His interest faded when he observed that it was not my intention to bring about that result. I knew Dora would not come back again. Her breaking off so unexpectedly, just when my hopes of a successful termination of the treatment were at their highest, and her thus bringing those hopes to nothing---this was an unmistakable act of vengeance on her part. Her purpose of self-injury also profited by this action… Might I perhaps had kept the girl under my treatment if I myself had acted a part, if I had exaggerated the importance to me of her staying on, and had shown a warm personal interest in her---a course which… would have been tantamount to providing her with a substitute for the affection she longed for? I do not know…” (Pg. 131)
This book provides some insights into how Freud actually conducted his ‘sittings’ with his patients.
Sigmund Freud (1856-1939) wrote in the first chapter of this 1905 book (which also includes a 1908 and 1909 essay on female bisexuality and Hysteria), “In 1895 and 1896 I put forward certain views upon the pathogenesis of hysterical symptoms and upon the mental processes occurring in hysteria. Since that time several years have passed. In now proposing, therefore, to substantiate these views by giving a detailed report of the history of a case and its treatment, I cannot avoid making a few introductory remarks, for the purpose partly of justifying from various points of view the step I am taking, and partly of diminishing the expectations to which it will give rise.
“Certainly it was awkward that I was obliged to publish the results of my inquiries without there being any possibility of other specialists testing and checking them, particularly as those results were of a surprising and by no means gratifying character. But it will be scarcely less awkward now that I am beginning to bring forward some of the material upon which my conclusions were based and make it accessible to the judgment of the world. I shall not escape blame by this means. Only, whereas before I was accused of giving no information about my patients, now I shall be accused of giving information
about my patients which ought not to be given. I can only hope that in both cases the critics will be the same, and that they will merely have shifted the pretext for their reproaches; if so, I can resign in advance any possibility of ever removing their objections.” (Pg. 21)
He asserts, “It is true that the causes of hysterical disorders are to be found in the intimacies of the patents’ psycho-sexual life, and the hysterical symptoms are the expression of their most secret and repressed wishes, then the complete exposition of a case of hysteria is bound to involve the revelation of those intimacies and the betrayal of those secrets.” (Pg. 22)
He argues, “Now in this case history… sexual questions will be discussed with all possible frankness , the organs and functions of sexual life will be called by their proper names, and the pure-minded reader can convince himself from my description that I have not hesitated to converse upon such subjects in such language even with a young woman. Am I, then, to defend myself upon this score as well? I will simply claim for myself the rights of the gynecologist…” (Pg. 23)
He cautions, “It is not fair to expect from a single case more than it can offer. Any anyone who has hitherto been unwilling to believe that a psycho-sexual aetiology holds good generally and without exception for hysteria is scarcely likely to be convinced of the fact by taking stock of a single case history. He would do better to suspend his judgment until his own work has earned him the right to be convinced.” (Pg. 28)
Dora’s father told Freud, “She keeps pressing me to break off relations with Herr K. and more particularly with Frau K., whom she used positively to worship formerly. But that I cannot do. For, to begin with, I myself believe that Dora’s tale of the man’s immoral suggestions is a phantasy that has forced its way into her mind; and besides, I am bound to Frau K. by ties of honorable friendship and I do not wish to cause her pain. The poor woman is most unhappy with her husband, of whom, by the way, I have no very high opinion.” (Pg. 41)
Freud notes, “I remembered that long ago, while I was working at Charcot’s clinic, I had seen and heard how in cases of hysterical mutism writing operated vicariously in the place of speech. Some patients are able to write more fluently, quicker, and better than others did or they themselves had done previously. The same thing had happened with Dora. In the first days of her attacks of aphonia ‘writing had always come specially easy for her.’” (Pg. 56)
He explains, “I will… add a few general remarks upon the part played in hysteria by the MOTIVES OF ILLNESS. A motive for being ill is sharply to be distinguished as a concept from a LIABILITY to being ill---from the material out of which symptoms are formed. The motives have no share in the formation of symptoms, and indeed are not present at the beginning of the illness. They only appear secondarily to it; but it is not until they have appeared that the disease is fully constituted.” (Pg. 59)
He argues, “I have certainly heard of some persons---doctors and laymen---who are scandalized by a therapeutic method in which conversations of this sort occur, and who appear to envy either me or my patients the titillation which, according to their notions, such a method must afford. But I am too well acquainted with the respectability of these gentry I excite myself over them… [But] often, after I have for some time treated a patient who had not at first found it easy to be open about sexual matters, I have had the satisfaction of hearing her exclaim: ‘Why, after all, your treatment is far more respectable than Mr. X’s conversation!’” (Pg. 66)
He recounts, “Dora herself had a clear picture of a scene from her early childhood in which she was sitting on the floor… sucking her left thumb… No one will be inclined to dispute, that the mucus membrane of the lips and mouth is to be regarded as a primary erotogenic zone… An intense activity of this erotogenic zone at an early age thus determines the subsequent presence of a somatic compliance on the part of the tractus mucus membrane… It then needs very little creative power to substitute the sexual object of the moment (the penis) for the original object (the nipple)…” (Pg. 69)
He recalls a session with Dora, where he told her, “‘you are afraid of Herr K., but … you are still more afraid of yourself, and of the temptation you feel to yield to him. In short, these efforts prove once more how deeply you loved him.’ Naturally Dora would not follow me in this part of the interpretation. I myself, however, had been able to arrive at a further step in the interpretation, which seemed to be indispensable both for the anamnesis of the case and for the theory of dreams. I promised to communicate this to Dora at the next sitting.” (Pg. 88)
He reports, “I came to the conclusion that the idea had probably occurred to her one day during a sitting that she would like to have a kiss from me. This would have been the exciting cause which led her to repeat the warning dream and to form her resolution of stopping the treatment. Everything fits together very satisfactorily upon this view; but owning to the characteristics of ‘transference’ its validity is not susceptible of definite proof.” (Pg. 92)
He states, “I have been able to trace back the symptoms of dyspnoea or nervous asthma to the same exciting cause---to the patient’s having overheard sexual intercourse taking place between adults. The sympathetic excitement which may be supposed to have occurred to Dora on such an occasion may easily have made the child’s sexuality veer round and have replaced her inclination to masturbation by an inclination to morbid anxiety.” (Pg. 98)
He notes, “It is only because the analysis was prematurely broken off that we have been obliged in Dora’s case to resort to framing conjectures and filling in deficiencies. What I have brought forward for filling up the gaps is invariably supported by other cases which have been more thoroughly analyzed.” (Pg. 104)
He asserts, “Dora’s father was never entirely straightforward. He had given his consent to the treatment so long as he could hope that I should ‘talk’ Dora out of her belief that there was something more than a friendship between him and Frau K. His interest faded when he observed that it was not my intention to bring about that result. I knew Dora would not come back again. Her breaking off so unexpectedly, just when my hopes of a successful termination of the treatment were at their highest, and her thus bringing those hopes to nothing---this was an unmistakable act of vengeance on her part. Her purpose of self-injury also profited by this action… Might I perhaps had kept the girl under my treatment if I myself had acted a part, if I had exaggerated the importance to me of her staying on, and had shown a warm personal interest in her---a course which… would have been tantamount to providing her with a substitute for the affection she longed for? I do not know…” (Pg. 131)
This book provides some insights into how Freud actually conducted his ‘sittings’ with his patients.
Displaying 1 of 1 review