Dora’s ‘illness’
A case for historical detection
Anthony Stadlen
Copyright © Anthony Stadlen, 1985, 2020
The Times Higher Education Supplement, 14 June 1985, p. 17
[Note, 2020
The published article was edited in a way that distorted its final argument. I have reinstated that argument, and made other small changes.]
Freud presented certain case histories, dream interpretations and analyses of slips and jokes as paradigm cases. He distinguished between true paradigms and mere examples. He used countless examples to illustrate bits of theory, but his paradigm cases were a small number of fundamental examples intended to illumine or embody a whole theory. For them he used the words Vorbild (‘model’), Muster (‘muster’, in the old sense of model example or pattern) and Paradigma.
He used Vorbild for the ‘Lucy R.’ and ‘Katharina’ cases, the dream of a child burning, the forgetting of the name ‘Signorelli’, the joke of the Schnorrer’s visit to Ostend. He used Muster for the ‘Irma’ dream, Dora’s dreams, the second telling of the Ostend joke. He used Paradigma for the reworking of the ‘Signorelli’ analysis in The Psychopathology of Everyday Life, the ‘aliquis’ analysis, the ‘Frau E. L.’ dream in On Dreams. Thus he sometimes used more than one of the three words to refer to the same paradigm case.
Freud presented these paradigms as natural-scientific and medical. In the ‘Fräulein Elisabeth von R.’ case he wrote that his case histories ‘read like novellas’; but, he wrote, ‘they demand to be read as psychiatric ones’. They have, he said, ‘one advantage’: ‘the intimate relationship between Leidensgeschichte and illness-symptoms’. The German term means ‘passion narrative’ or ‘history of suffering or tribulation’.
Thus Freud’s histories of passion and tribulation are not given for their intrinsic value but for the light they throw on the ‘illness-symptoms’. This light illumines paradigmatically the form of the relation between these two realms. Freud claimed this not only for his case histories but also for his paradigm dream interpretations and analyses of slips.
Freud thrice compared his achievement to those of Copernicus and Darwin. He claimed to have brought about the ‘third and most wounding’ natural-scientific revolution. His claims for his paradigm cases correspond exactly to Thomas Kuhn’s requirements for the paradigms of natural-scientific revolution.
Psychoanalytic training institutes take them as such. Eissler wrote in 1969: ‘Freud extracted all the paradigms that could be gained from the observations on the couch. With his death, psychoanalysis entered the phase of “normal science”...’
Some psychoanalysts today argue that Freud should not be judged by his own explicitly stated scientific criteria. Others suggest that psychoanalysis is not concerned with ‘historical truth’ but with ‘narrative truth’. This is the dethronement of truth. It is a betrayal of Freud not to take seriously his scientific aspirations.
The truth of a paradigm case study may be tested in two ways: textual analysis and historical detection.
The first step of textual analysis is to ask in which ways Freud claims it as a paradigm. There is a sequence of at least four possible ways: reporting; diagnosis; aetiology; and treatment.
The order is crucial. The case can not be a paradigm in one of these four ways unless it is a paradigm in all earlier ways in the sequence. (Correct treatment with incorrect diagnosis, for instance, is an accident: not a paradigm.) There is a fifth possible: ethics.
In the first sentence of the ‘Dora’ case, Freud claims he will ‘substantiate my assertions ... on the pathogenesis of hysterical symptoms ... through the detailed communication of an illness- and treatment-history’.
He claims, then, that Dora was ‘ill’; that her ‘illness’ was ‘hysteria’; and that his theory of its ‘pathogenesis’ is ‘substantiated’ by this case. He claims the case as a paradigm in the first, second and third ways.
He claims Dora left too soon for a ‘radical cure’ and so the case is not a paradigm in the fourth way. He does try to justify his ethics in the case, however, and thus claims it as the fifth type of paradigm.
The crux is his claim that Dora was ‘ill’. This claim has to be taken as an hypothesis to be tested. Its truth cannot simply be presupposed. It has been presupposed in even the most critical literature on the ‘Dora’ case.
The central scene of the ‘Dora’ case is well known. It happened in Herr K.’s shop. Herr K.’s wife was having an affair with Dora’s father who had been treated by Freud for syphilis. Dora was, in Freud’s words, ‘a child of 14’. Herr K. had invited her and his wife. They were to witness a church procession.
‘He persuaded his wife, however, to stay at home, and sent away his shop assistants, so that he was alone when the girl arrived. When the time for the procession approached, he asked the girl to wait for him at the door which opened onto the staircase leading to the upper storey, while he pulled down the outer shutters. He then came back and, instead of going out by the open door, suddenly clasped the girl to him and pressed a kiss upon her lips.’
Dora was disgusted. She ‘tore herself free from the man, and hurried past him to the staircase and from there to the street door.’ Freud considers this response of Dora’s sufficient ground to diagnose her ‘without question’ as an ‘hysteric’. Thus, for Freud, Dora’s disgust at Herr K.’s sexually molesting her – with, as Freud agrees, her father’s implicit permission – is pathognomonic of ‘hysteria’.
Dora alleged that there was a tacit agreement between her father and Herr K. The agreement, as she saw it, was that her father would permit Herr K. to molest Dora sexually in return for sexual favours from Herr K.’s wife. Freud says this was ‘one particular respect in which it was easy to see that her reproaches were justified’. But, while finding it easy to see that they were justified, he saw her as sick for making them.
Freud speculated that Dora felt Herr K.’s erect penis pressed against her in his shop. This did not lead him to question his diagnosis. Psychoanalysts have generally endorsed Freud’s diagnosis and pathognomonic ‘symptom’. The Encyclopaedia of Psychoanalysis explains: ‘The feeling of disgust she felt when Herr K.’s erect penis pressed against her body (at 14) probably meant that she resented the size of her own member.’
Erik Erikson in 1962 questioned ‘Freud’s assertion that a healthy young girl would under the circumstances have considered Mr K.’s advances “neither tactless nor offensive”’. He swiftly closed that line of inquiry by observing: ‘The nature and severity of Dora’s pathological reaction make her, of course, the classic hysteric of her day’; he thus endorsed Freud’s pathognomonic ‘symptom’ as do most critics of the case. A few dispute it but do not dispute the diagnosis (they do not say why they do not). A very few doubt the diagnosis but say she was ‘psychotic’. Family therapists, historians, feminists have studied different aspects of Dora’s ‘illness’. Virtually all agree she was ‘ill’.
Textual analysis thus exposes Freud’s ‘diagnostic’ method. But to evaluate his reporting, and perhaps throw further light on his ‘diagnosis’, calls for historical detection: identifying the dramatis personae, places and times; interviewing survivors and witnesses; searching archives and examining documents.
To what end? Some have already asked whether the subject of Freud’s and psychoanalysis’s principal paradigm case for ‘hysteria’ was, in psychiatric terms, an ‘hysteric’. That is an important question – as far as it goes.
But what of the crux? Almost all writers (an exception was Emil Ludwig, in his long-forgotten book on Freud) have presupposed that Dora, the subject of Freud’s most famous ‘illness- and treatment-history’, was ‘ill’.
Was Dora ‘ill’?
Is that not a question for textual analysis and historical detection?
Is it not even more important to ask why this question has not been asked than to answer it?
Is it not important to ask, and to investigate scientifically, whether the failure of so many even to ask whether Dora was ‘ill’ is an unfortunate accident or, rather, an example – even a paradigm case – of something fundamentally wrong in psychoanalysis and psychiatry?
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