How a Fabrication Differs from a Lie

Mikkel Borch-Jacobsen writes about Der Fall Freud: Die Geburt der Psychonalyse aus der Luge

  • Der Fall Freud: Die Geburt der Psychoanalyse aus der Lüge by Han Israëls, translated by Gerd Busse
    Europäische Verlagsanstalt, 247 pp, DM 30.00, May 1999, ISBN 3 434 50454 0

‘Was Freud a liar?’ Ever since Frank Cioffi had the audacity to ask this question in 1973, it has continued to rock the world of psychoanalysis. Till then, things had been so simple. Children of the ‘Freudian century’, we had all learned to venerate in Sigmund Freud a man of ‘absolute honesty’ and ‘flawless integrity’, as his loyal biographer Ernest Jones called him. How many times were we told that? It was his passion for truth that enabled him to confront the demons of his own unconscious and to lift the multisecular repression that weighed on sexuality, despite the ‘resistance’ of his patients and the attacks of his colleagues. It was this scientific probity, too, which made him acknowledge his error about the fantastic ‘scenes’ of incest and sexual molestation that his patients had been bringing to him, despite the stinging professional setback that this represented for him. In Freud, science coincided with the moral fibre of the scientist, whose edifying biography we never tired of reading: Anna O.’s miraculous ‘talking cure’, the break with Josef Breuer regarding sexuality, the solitary crossing of the desert, the painful abandonment of the ‘seduction theory’, the heroic self-analysis, the tearing away from the transference on Wilhelm Fliess, the stoicism in the face of his colleagues’ attacks.

It is a nice story, but we now know it to be nothing but a vast ‘legend’ (Henri Ellenberger). One after another, historians of psychoanalysis have come forward to show us that things did not happen in the way Freud and his authorised biographers told us. No, Anna O.’s ‘talking cure’ never was the ‘great therapeutic success’ later vaunted by Freud. No, Breuer in no way denied the role of sexuality in the neuroses. No, Freud was not as intellectually isolated as he claimed, and the reactions of his colleagues were far from being unfavourable at the beginning. On the contrary, many of them – notably his friend Fliess – had a deep interest in sexuality, including infantile sexuality. Wrong again that Freud’s patients ever spontaneously told him pseudo-memories of infantile sexual seduction: it was Freud himself who extorted these scenes of perversion, despite the patients’ vehement protests. Freud had lied to us; we could no longer trust him. The era of suspicion had begun. Suddenly, scholars started to notice that he disguised fragments of his self-analysis as ‘objective’ cases, that he concealed his sources, that he conveniently antedated some of his analyses, that he sometimes attributed to his patients ‘free associations’ that he himself made up, that he inflated his therapeutic successes, that he slandered his opponents. Some even go so far as to suggest – supreme lèse-majesté – that Sigmund cheated on his wife with his sister-in-law Minna. The defenders of psychoanalysis are indignant and speak of gutter-press journalism, of paranoia, of ‘Freud bashing’, but they are obviously on the defensive.

It is one thing, however, to plumb the depths of Freud’s rewriting of history, another to understand its motives. Why on earth did the founder of psychoanalysis feel the need to tell all these fibs? Was it sheer boastfulness? A childish desire to establish his originality and intellectual priority? A shrewd marketing strategy? A way of promoting a personality cult within the movement he had created? In a book published in Dutch in 1993 and now translated into German as Der Fall Freud (it could be translated into English as The Freud Case: The Birth of Psychoanalysis out of Lying), the historian Han Israëls proposes an explanation that has at least the merit of simplicity. Freud, Israëls claims, was so confident in his first theories that he publicly boasted of therapeutic successes that he had not yet obtained. When they did not materialise, forcing him to revise his theories, Freud had to explain why he had abandoned them without being able to give the real reason: that would have entailed admitting that he had committed serious scientific fraud. Just like a child who has been caught in the act, he resorted to further lies, accusing the others of having lied to him. It was all the fault of that Victorian, Breuer, who had concealed from him Anna O.’s ‘transference love’ and its disastrous outcome. Or again, it was the fault of his female patients, who had told him all this nonsense about their daddies. By blaming it on convenient fall guys, Freud even allowed himself the luxury of changing his failures into victories. After all, was it not he who had managed to unearth the secret reason for all the lies he had been told? The myth of the hero was launched.

This pattern of deception seems to have begun very early in Freud’s career, even before the beginning of psychoanalysis. In this regard, Israëls sheds new and disturbing light on the so-called ‘cocaine episode’, Freud’s first great professional fiasco. In an article published in July 1884, Freud championed that newly introduced substance, recommending it for ailments as diverse as digestive disorders, seasickness, neurasthenia, facial neuralgias, asthma and impotence. Based on information published in medical journals in the United States, he also recommended the administration of cocaine in the treatment of morphine addiction and stated that he had successfully cured a case of this type: ‘During the first days of the cure [the patient] consumed [i.e. orally] 3 dg of cocainum muriaticum daily, and after ten days he was able to dispense with the coca treatment altogether.’

In March of the following year, Freud repeated this claim in a lecture given to the Psychiatric Society of Vienna and published it a few months later. He was still talking about the same patient, but bizarrely, both the duration of the treatment, the dosage of cocaine and the method of administration had changed. The patient now

took about 0.40 g of cocaine per day, and by the end of 20 days the morphine abstinence was overcome. No cocaine habituation set in; on the contrary, an increasing antipathy to the use of cocaine was unmistakably evident … I have no hesitation in recommending the administration of cocaine for such withdrawal cures in subcutaneous injections of 0.03-0.05 g per dose, without any fear of increasing the dose.

Freud’s patient was very fortunate, for when Albrecht Erlenmayer, an eminent specialist in morphine addiction, tested Freud’s method on his own patients, they did not get any better. Worse yet, Erlenmayer strongly warned against the dangers of cocaine habituation. Dr Freud, he wrote, had added to morphine and alcohol ‘the third scourge of humanity, cocaine’. The slap in the face was monumental. Forced to respond, Freud justified himself by declaring in an article that Erlenmayer’s results were altered by his administering the cocaine subcutaneously, not orally, as Freud had prescribed. No one seems to have pointed out at the time that it was that very method that he himself had enthusiastically recommended in his 1885 article. After that, Freud ‘forgot’ the compromising article and never mentioned it again among his publications. Apart from a few veiled allusions in The Interpretation of Dreams, where he accused his patient of having given himself injections of cocaine against his advice, Freud was never to return publicly to this subject.

And for good reason. As was revealed in the early 1950s, in an article by Siegfried Bernfeld and in the biography by Jones, to whom Anna Freud had given access to Freud’s letters to Martha Bernays during their engagement (the famous and classified Brautbriefe), things had in reality gone exactly as Erlenmeyer predicted. Freud’s patient was none other than Ernst von Fleischl-Marxow, one of his colleagues and friends who was using morphine to combat excruciatingly painful neuromas due to the amputation of several fingers, and his detoxification treatment, which started at the beginning of May 1884, had been a complete disaster. After hardly a week, Jones tells us, Freud and his colleagues Obersteiner and Exner found Fleischl lying on the floor, ‘almost senseless with pain’. Not only had Fleischl continued to take morphine, but after Freud gave him cocaine injections in January 1885 in an attempt to fight the pain, he started injecting himself with ‘enormous doses’ of that substance (1 gram per day). By June, Fleischl had developed a ‘delirium tremens with white snakes creeping over his skin’ and had to be sent to the countryside by his family. He died six years later, addicted to both morphine and cocaine.

Reading Jones’s report, one gets the impression of a tragic mistake, which Freud bitterly reproached himself for (indeed, this is the explanation given by the ever trusty Jones for Freud’s later denials regarding his use of the needle: these ‘could only have been unconsciously determined’ by his feeling of guilt). Until now, however, it has not been possible to gain access to the letters on which Jones relied, because of the impenetrable censorship exercised by the Sigmund Freud Archives. Israëls’s book fills this gap. By a stroke of luck such as seldom occurs in the life of a researcher, he happened to stumble across the transcripts of nearly 300 of these Brautbriefe, which were sleeping in the drawers of the Sigmund Freud Copyrights, the commercial branch of the Freud empire. The story he found there is, as one would expect, singularly more complex and bizarre than that told by Jones.

Jones carefully omitted to note that, at the moment of writing his first article on cocaine, in mid-June 1884, Freud could not have entertained any illusions about the treatment which he presents to his readers as a success. The treatment had begun on 7 May 1884 and, even if it had seemed promising during the first couple of days, Freud wrote as early as 12 May: ‘With Fleischl things are so sad that I cannot enjoy the cocaine successes at all.’ The cocaine, which Fleischl took ‘continually’, did not prevent him from suffering extreme pain and having ‘attacks’ that left him nearly unconscious. Significantly, Freud added: ‘Whether in one of these attacks he took morphia, I do not know, he denies it, but a morphinist … cannot be believed.’ On 20 May, cocaine having suppressed neither the pain nor the withdrawal symptoms, the physician Theodor Billroth tried a new operation on the stump and recommended to Fleischl ‘to take considerable amounts of morphia … and he was given he does not know how many injections’ (letter of 23 May). A month later, Freud triumphantly wrote in his article that ‘after ten days he was able to dispense with the coca treatment altogether.’ He only forgot to mention that it was because the treatment had been a complete fiasco!

Fleischl had quickly started taking cocaine again – if in fact he had ever stopped. On 12 July, shortly after the article appeared, Freud mentioned in passing that he was taking cocaine ‘regularly’. On 5 October, he wrote: ‘Interesting … that he [Fleischl] has received a request from the big manufacturer Merck in Darmstadt, whose attention has been drawn by his large coca consumption, and who wanted to know what he knew about the value and effects of the substance.’ Compare that with what Freud told his audience five months later, in his lecture of March 1885: ‘No cocaine habituation set in; on the contrary, an increasing antipathy to the use of cocaine was unmistakably evident.’ One understands why Jones, when summarising this passage, felt the (unconscious?) need to add this pious parenthesis: ‘This was before Fleischl had suffered from cocaine intoxication.’

What is most shocking in all this is not that Freud lied through his teeth, but that he seems not to have noticed. As Israëls notes, he continued to consider Fleischl’s treatment a success despite all the proofs to the contrary. Three days after Billroth’s operation, he wrote to Martha: ‘Until then he [Fleischl] had managed excellently with the cocaine. So the cocaine has stood the test very well’ (23 May 1884). Likewise, when it became evident that Fleischl had become addicted, Freud obstinately refused to admit his error: ‘Since I have given him the cocaine, he has been able to suppress the faints and he could better control himself, but he took it in such enormous quantities … that in the end he suffered from chronic intoxication’ (26 June 1885). In other words, it was the patient who had ruined the experiment. Such complete indifference to reality is staggering and it in-
evitably reminds us of what Freud himself later described as the ‘omnipotence of thoughts’. Clearly Freud was so convinced of the correctness of his theory that he was ready to modify the facts when they didn’t conform.

By the same token, it becomes difficult to reduce Freud’s lies to cynical scientific frauds, designed to promote or protect his career. After all, his articles were going to be read by his colleagues and seniors: Breuer, Exner, Billroth and Obersteiner, who had all witnessed the Fleischl fiasco at first hand. Freud must therefore have convinced himself of his imaginary success, otherwise he would not have so recklessly invited their criticism. Similarly with his response to Erlenmayer: as Israëls points out, it was insanely risky to lie so transparently when anyone – especially Erlenmayer – could at any time confound him by citing his own article. Even supposing that this was a brilliant bluff, one must concede that it presupposes an uncommon confidence in the magic of words. No wonder Freud became the theorist of fantasy, wish-fulfilment and primary narcissism: he himself had a remarkable propensity to hallucinate his theories, to dream up clinical data.

Israëls finds this magic behaviour everywhere in Freud and makes it the key to the properly mythical birth of psychoanalysis. Officially, Freud dated psychoanalysis to the day when Breuer managed to eliminate the hysterical symptoms of his patient Anna O. by having her narrate the traumatic events which had started them off. Israëls explodes this version, as others have done before him. In reality, as we know from a letter Freud wrote to his fiancée, Breuer had terminated Anna O.’s treatment because his wife was jealous of the somewhat overzealous interest he was showing towards his patient. He then placed Anna O. in a private clinic, where she continued to display the same hysterical symptoms as before. She made three more visits to clinics between 1883 and 1887, and it was not till the end of the 1880s that she began to improve, the ‘talking cure’ evidently having played no role in this recovery. This did not prevent Freud from making false claims for the ‘method’ of his friend Breuer, starting in 1888, at a time when nothing allowed him to think that Anna O. would get better and he himself had not yet applied the cathartic method to a single one of his patients. In an encyclopedia article that Israëls does not quote but which adds grist to his mill, Freud evoked Breuer’s ‘method’ and continued: ‘This method of treatment is new, but it produces curative successes [Heilerfolge] which cannot otherwise be achieved.’

Once again, Freud was indulging in wishful thinking and proclaiming successes that never were. And, once again, he had to rewrite history when this bragging was not justified. Disappointed with the cathartic method, Freud had indeed broken with Breuer shortly after the publication of Studies on Hysteria. But then, how to explain this turnaround if the method achieved such brilliant results? The solution, as pieced together by Israëls, consisted in recognising its meagre results while blaming them on Breuer’s alleged resistance to admitting the role of sexuality in the aetiology of hysteria. This was a particularly blatant (and thus irrational) untruth, since anyone could read what Breuer had written in Studies on Hysteria: ‘I do not think I am exaggerating when I assert that the great majority of severe neuroses in women have their origin in the marriage bed … It is perhaps worthwhile insisting again and again that the sexual factor is by far the most important and the most productive of pathological results.’

But Freud went further. In On the History of the Psycho-Analytic Movement and in An Autobiographical Study, he wrote that Breuer had abruptly terminated the treatment of Anna O. when he realised that she had ‘developed a condition of “transference love”’ towards him. (In private, Freud even told an extravagant story of hysterical childbirth.) He intimated, however, that this was a ‘reconstruction’ on his part, based on remarks made in passing by Breuer. To my knowledge, Israëls is the first to note that Freud had in fact no reason to ‘reconstruct’ the story, since he knew it – or at least its kernel of truth: Breuer’s infatuation with his patient – right from the start. By proceeding in this manner, he not only suggested that Breuer had hidden the truth from his readers, but also that he had concealed it from his younger colleague, which exonerated the latter from any complicity in the misleading statements about Anna O.’s ‘talking cure’. (Freud knew, of course, that he could count on Breuer’s embarrassed silence: this lie, at least, was not risky.)

Same scenario when Freud launched his ill-fated ‘seduction theory’. In his lecture of 21 April 1896 on ‘The Aetiology of Hysteria’, he proposed that the symptoms of hysteria be attributed to sexual traumas in early childhood, and proclaimed loud and clear that ‘in some 18 cases of hysteria I have been able to discover this connection in every single symptom, and, where the circumstances allowed, to confirm it by therapeutic success.’ It seems that ‘circumstances’ never allowed in any of the cases in question, for two weeks later Freud confessed to Fliess that ‘none of the old [treatments] is completed.’ And in his famous letter of recantation of 21 September 1897, he explained to his friend that one of the main reasons he had come to doubt his theory was ‘the continual disappointment in my efforts to bring a single analysis to a real conclusion’. But since it was impossible to reveal why he had abandoned his seduction theory without revealing at the same time the truth about his famous ‘therapeutic successes’, Freud carefully avoided communicating his doubts to his colleagues. It wasn’t until 1914, after 17 years of equivocation, that he finally admitted publicly to having been wrong about the ‘seduction scenes’. No mention, however, of the therapeutic fiasco and its role in the abandonment of his theory. No, Freud had been led astray by the ‘reports [Berichte] made by patients in which they ascribed their symptoms to passive sexual experiences in the first years of childhood’, until the moment he realised that these were fantasies expressing the ‘child’s sexual life’.

This story has since become one of the high points of the Freud legend, but Israëls has no trouble showing that it bears no relation to the facts. Far from his patients spontaneously confiding stories of sexual abuse, Freud described in detail in his articles how he had to force them to admit the veracity of the scenes that he himself hypothesised. Indeed, a quick or spontaneous confession on their part would have conflicted with the theory, since Freud attributed hysteria to the repression of memories of early sexual traumas: ‘Before they come for analysis the patients know nothing about these scenes. They are indignant as a rule if we warn them that such scenes are going to emerge. Only the strongest compulsion of the treatment can induce them to embark on a reproduction of them.’ Anyone consulting one of the articles written by Freud at that time was bound to notice the fallacy of his retrospective presentation. Here again, his misrepresentation is so gross, so blatant, that one wonders how he could reasonably have hoped to put it over. Had he come to believe his own tall tales?

Israëls’s demonstration is meticulous, relentless, devastating. Even if his demystifying zeal occasionally (rarely) leads him to be unfair to Freud, his book on the whole leaves no doubt as to the answer to Cioffi’s question: yes, Freud was an inveterate liar who would not hesitate for a moment to rewrite reality if that allowed him to get out of trouble. This observation, evidently, goes far beyond simple biography. Indeed, unlike modern experimental sciences, psychoanalysis rests on ‘observations’ which, because of medical confidentiality, are not available to other researchers (unless they become patient-analysts themselves) and which, by the same token, cannot give rise to a consensus based on the possibility of replicating the experiment (except through the cloning of analysts). It is therefore absolutely crucial in psychoanalysis that the witness who reports these ‘observations’ – the analyst – is credible. As Lacan candidly recognised, this is what likens psychoanalysis to a pre-modern practice such as alchemy, which required ‘purity of the soul of the operator’. But then, if we can no longer believe in the purity of Freud’s soul, what remains of psychoanalysis? It is no accident that psychoanalysts cry out in indignation whenever Freud’s integrity is cast in doubt, even at the trivial level of his escapades with his sister-in-law: without consensus on the person of the arch-witness, the whole edifice crumbles.

And yet, once we have made the diagnosis of mendacity, are we really done with the ‘Freud case’? Israëls describes Freud as a specialist in damage control, clever at dressing up his therapeutic failures as advances in science. But this ignores the bizarrely puerile and mythomaniacal character of Freud’s lies, which Israëls underscores so well. Is it likely that a man who so easily blinded himself to reality would have abandoned his first theories because they were not borne out by the facts? It seems to me that Israëls places too much confidence here in the model of scientific ‘falsification’, at the very moment he reproaches Freud for having departed from it. The truth is that Freud knew from the very start that Fleischl, Anna O. and his 18 patients were not cured, and yet he did not hesitate to build grand theories on these non-existent foundations. So why would the absence of therapeutic results have caused him subsequently to abandon his theories when they had not prevented him from adopting them in the first place? It is much more likely that he abandoned them for the same reason he adopted them: because he had a new idea, a better theory. Before adopting the cathartic method, for example, Freud was already interested in Charcot and Janet’s theories about the de-suggestion of traumatic memories under hypnosis. Similarly, before abandoning the theory of seduction, he was already toying with Fliess’s biogenetic hypotheses on infantile sexuality and speculating about the origin of the incest prohibition. Contrary to Israëls’s contention, Freud’s (or Breuer’s) therapeutic results probably played no decisive role, either positive or negative, in all these theoretical developments. Even if they do account for Freud’s subsequent evasions and obfuscations, they do not explain the birth of psychoanalysis itself.

In a way, the whole situation is simultaneously much worse and much more innocent than Israëls imagines: despite Freud’s positivist rhetoric, psychoanalysis was, from the very beginning, a purely speculative (a purely ‘metapsychological’) enterprise in which facts and evidence played, at best, a role of marginal importance. In that respect, to establish that Freud lied about clinical matters is not enough to account for that ‘longest error’, psychoanalysis. We must also, as Henri Ellenberger and Frank Sulloway have done, reconstruct the theoretical context from which Freud drew his inspiration and which alone explains why he so easily mistook his speculations for reality – and, above all, why he so easily managed to convince others to do the same.

Indeed, we all but forget that Freud’s patients and colleagues swallowed his lies, including the biggest and (to us) the most blatant. Now this is precisely what must be explained if we want to account for the extraordinary cultural success of psychoanalysis: how come the fib fared so well? How did it become real for so many people in the 20th century? To attribute the becoming-true of the Freudian fable solely to the duplicity of the Great Liar is clearly insufficient. Israëls describes how Freud skewed the reality of what took place in his office, like a physicist or chemist tampering with the results of his experiments. But this ignores the fact that the human beings whom doctors and psychologists deal with are not atoms or molecules: the latter are indifferent to our theories about them, whereas the former react to these theories, be it to reject or to accept them. It so happens that Freud’s patients, for the most part, found his theories quite acceptable, so much so that it is hard to claim without further qualification that Freud lied about his clinical ‘material’. Even poor Fleischl seems to have been sincerely convinced that cocaine did him good: when the drug manufacturer Merck contacted him, believing that he was doing experiments with cocaine, he did not disabuse him and readily corroborated the findings of his colleague, Dr Freud. (As a result, Merck published an article in which he attributed these results to Fleischl!) Similarly, when Freud began to apply Breuer’s ‘method’ to his patients Emmy von N. and Cäcilie M., they rushed to confirm his theory by remembering a plethora of ‘traumas’ (in the case of Emmy von N., nearly forty in the space of nine days). And when Freud set off in quest of memories of infantile ‘seduction’, his patients – at least those who didn’t slam the office door on their way out – were quite happy to supply them. (Even though it is often difficult to discern what is Freud’s construction and what is ‘authentic’ reliving by the patients, the letters to Fliess, for the most part, leave little doubt).

It is thus one thing to say, as Israëls does, that these ‘memories’, these ‘scenes’ (and later, these ‘fantasies’) were not spontaneous, because they were the product of Freud’s theories and hermeneutic hubris. It is quite another to consider them as mere fictions, mere non-realities. The fact is that these theoretical fictions did become real in Dr Freud’s office, because of his patients’ willingness to accept his ‘solutions’. To speak of lies in regard to this fabrication of ‘psychical reality’ is too shortsighted: in the domain of psychotherapy, just as in that of human affairs in general, such a co-construction of reality is inevitable and normal. There, one never finds facts, only artefacts. In the end, if psychoanalysis must be criticised, it is not because it fabricates the evidence it adduces, nor because it creates the reality it purports to describe. It is because it refuses to recognise this and attempts to cover up the artifice.