Was Dora ‘ill’? Vrij Nederland (2 November 1985)

Was Dora ‘ill’?

Anthony Stadlen

Copyright © Anthony Stadlen 1985, 1989, 2020

[Vrij Nederland, 2 November 1985, Dutch translation ‘Was Dora wel ziek?’ by Han Israels.
Was Dora ill? In Spurling 1989: Vol. 2, 196-203.
Spurling, L., (ed.) (1989) Sigmund Freud: Critical Assessments. London:  Routledge.]

Freud’s ‘Dora’ case published in 1905 is the principal paradigm case for his theory of ‘hysteria’. It is therefore important to evaluate it.

In its first sentence Freud claims he will ‘substantiate my assertions made in 1895 and 1896 on the pathogenesis of hysterical symptoms and the psychical occurrences in hysteria through the detailed communication of an illness- and treatment-history’ (my translation).

Freud is claiming that:
(1) Dora was ‘ill’;

(2) her ‘illness’ was ‘hysteria’;

(3) his theory of its ‘pathogenesis’ is ‘substantiated’ by this case.
These are Freud’s central claims in the case. He makes many other claims but I shall not consider them here.

These central claims, implicit in Freud’s first sentence, have not been made explicit in the literature on the ‘Dora’ case. They have therefore not been properly examined.

The crux is Freuds claim that Dora is ‘ill’. For, if she is not ‘ill, she can have no ‘hysterical symptoms’; and there can be no ‘pathogenesis’. Thus, if she is not ill, the case can not substantiate’ any ‘assertions . . . on the pathogenesis of hysterical symptoms’ by Freud or by anyone else.

Claim 2 can not be true unless Claim 1 is. Claim 3 can not be true unless Claims 1 and 2 are. How may we test the truth of Claim 1?

Freud’s claim that Dora was ‘ill’ was implicit in his first sentence. It must first be made explicit as we have just done. Then it must be tested as an hypothesis.

In even the most critical literature on the ‘Dora’ case it has simply been presupposed.

Freud does not try to justify the claim that Dora was ‘ill’. He does not, indeed, state it as a claim. For him it is an assumption: even a self-evident truth.

He does try to show that this or that physical complaint or emotional response of Dora’s is an ‘hysterical symptom’. He also asserts that her response on one particular occasion is itself sufficient ground for him to regard Dora without hesitation (‘unbedenklich’) as an ‘hysteric’. Thus he diagnoses this response of Dora’s as pathognomonic of ‘hysteria’.

He does not assert that she is ‘ill’ and try to prove it. He speaks, instead, repeatedly, of her ‘illness’. His discussions of her ‘hysteria’ reinforce his implied claim that she is ‘ill’. They reinforce it because Freud is making another unstated assumption: that ‘hysteria is an illness’.

The diagnosis of ‘hysteria’, as Freud makes it, means this. Dora complains of, or appears to suffer from, physical ailments and emotional distress. Freud denies that the ailments are genuine. He denies that the distress is justified. Her ailments, he says, are not a physically determined result of organic illness. Her distress, he says, is not a socially intelligible response to interpersonal conflict. Thus his diagnosis of Dora’s ‘hysteria’ is an allegation that Dora is irrational.

But this is not all. Freud is not merely alleging that Dora is irrational. He is not even merely alleging that she is irrational in a particular way: ‘hysterically irrational’. ‘Hysterical irrationality’ might perhaps be a useful category. It would then be an empirical question whether this category applied to Dora.

No. What Freud is alleging is that Dora’s alleged ‘hysterical irrationality’, which – he alleges – mimics genuine ‘illness’ and justified distress, is itself the result of an actual ‘illness’ from which Dora suffers. This actual ‘illness’, he alleges, is ‘hysteria’.

Thus he says not merely that Dora’s physical ailments are not genuine. He says, rather, that she is suffering from a genuine ‘illness’, ‘hysteria’, which makes her imitate other genuine illnesses. And he says not merely that Dora’s emotional distress is not justified. He says, rather, that it is her ‘illness’ that is responsible for her unjustified distress and unjustifiably distressed behaviour.

Freud is saying that Dora is irrational; that she is ‘ill’; and that her irrationality is a result of her ‘illness’.

Let us now make a start at testing Freuds claims. We must look at some of his examples of Dora’s ‘illness’. We must ask, in the first place, whether these examples show her to be even irrational.

Doras physical ailments

One of her ailments was appendicitis. It was accompanied by a dragging of her right foot. At least two doctors had concurred in this diagnosis. They had been called in by Dora’s wealthy father. He would presumably have chosen competent physicians. This was when Dora was sixteen. It was about eighteen months before she started her analysis with Freud. He did not see her at the time. He does not claim to have examined her physically at any time. He does not claim to have sought, or received, reports from the examining doctors.

Freud, however, denies that Dora had appendicitis. He denies that the dragging of her foot was a genuine ailment. He asserts that both complaints were ‘hysterical’.

It is important to note that Freud does not examine the examining doctors’ evidence and find it wanting. He simply does not examine it. His assertion that these complaints were ‘hysterical’ is thus not based on evidence. Freud has neglected elementary medical procedure.

Freud, instead of referring to evidence, seeks to justify his assertion with an argument. His argument is complex. It is,however, circular.

Some words used by Dora in reporting a dream of hers remind Freud – not Dora herself – of some obscure technical terms, Vorhof and Nymphen, for parts of the female genitals. Freud admits that these are scarcely used even by physicians. He decides, however, that, since he was reminded of the words, Dora must therefore have intended them. He gives no evidence that she had ever met the words in their sexual sense. He insists, though, that she must have read them in an encyclopaedia (Konversationslexikon).

Dora says she has only once consulted an encyclopaedia. This was to look up appendicitis when her cousin had it. Freud then remembers that Dora too has had appendicitis. He reminds Dora of this. This reminds her that, after her attck of appendicitis, she could not walk properly and dragged her right foot. She tells Freud her foot drags sometimes even now. Freud writes, presumably quoting Dora, that the doctors whom she had consulted at her father s desire had been very much astonished at this most unusual after-effect of an appendicitis....

This is the first time Freud has heard of Doras dragging right foot. It is either her second last or third last session with him. He has seen her six times a week for nearly eleven weeks but he has never noticed her foot dragging. He does not observe it even now. Nor does he examine her.

Dora mentions her dragging foot only in response to Freuds pursuit of his preoccupations. This gainsays his claim that it is hysterical. So-called hysterical symptoms’ are not discreet.

At this point, however, Freud declares: Here, then, we have a true hysterical symptom. He makes it clear he means the appendicitis and the dragging foot.

Dora, he insists, had read the sexual words in the encyclopaedia when she looked up appendicitis. She then, he says, simulated appendicitis herself, using her knowledge of its symptoms from the encyclopaedia, to punish herself for reading the sexual words. Her appendicitis, he explains, symbolised Doras wish to succumb to the seduction of her fathers friend Herr K. and to give birth to his child. The dragging foot, he continues, symbolised her wish to take this false step.

Freud has, in effect, used the alleged sexual meaning of Doras complaints to prove they are hysterical; and has, then, circularly, offered the symptoms as proof that such ‘symptoms have a sexual meaning.

What clinches the argument for him is Doras telling him about her dragging right foot. He appears to take her word for it that this is a most unusual after-effect of an appendicitis. He still does not ask the doctors.

He seeks, instead, an infantile model for the dragging foot. He considers he has found it when Dora confirms that she had injured the same foot when she was seven. She says she was laid up for some weeks with her swollen foot bandaged. Freud, compounding his already circular argument, takes this as further evidence that the current weakness of her foot is hysterical.

The psychoanalyst Felix Deutsch was consulted by Dora on two occasions twenty-two years later. He noticed that she was limping slightly with her right leg. She did not complain of this; but, when asked, said she had had the limp intermittently since childhood. Deutsch took this as striking evidence that such a symptom may persist through life, whenever there is a need to use it for the somatic expression of displeasure. He did not examine Doras foot. He did not say how he knew Dora was expressing displeasure through her limp. He simply assumed the limp was hysterical.

Certain of the assertions Freud makes in the course of his argument may be empirically tested. I consulted, for instance, the various Konversationslexika in which Dora could have looked up appendicitis in 1899. Vorhof does not appear at all (either in its own right or under entry on sexuality). Nymphen is mentioned only fleetingly. Thus Freuds assertion that Dora has read both words in the encyclopaedia is empirically disproved.

Even if both words had been in an encyclopaedia this would not, of course, prove Dora knew them. Nor, if she had known them in their sexual sense, would this prove they were, in their sexual sense, relevant to her dream: they were Freuds associations. Nor, if they were relevant, would this prove her appendicitis and dragging foot were hysterical.

Freuds account of the sequence of events indicates – though neither he nor Deutsch notices this – that shortly after Dora injured her foot in childhood (and was laid up for weeks with it swollen and bandaged) she went on a mountain trip. After it she was again made to rest. Her doctor said she was now suffering the effects of Überanstrangungover-exertion or strain.        

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