Thursday 30 May 2019

THE FLESH OF GOD

THE FLESH OF GOD: A Study in Liminality





Psilocybe mexicana is the name of a fungus native to Guatemala, Mexico, and Costa Rica. It was called by the Aztecs  teonanácatl  meaning fungus of the god. Modern Urban dictionaries claim the words “God’s flesh” are used in contemporary sub-cultures with reference to this hallucinogenic mushroom.

One traditional “gift” associated with its use, is the ability to see through living human flesh. This penetrating visualisation was particularly prized because it allowed the Viewer to scan for organic signs of sickness . It was a tool of healing. Maybe; but I suspect the gifts yielded by god’s flesh were multivalent. It is unlikely the gift would be under human control for solely beneficent purposes.  A visitation from the god or gods could well be mind-blowingly scary.




The United States' Department of Agriculture website is a mine of information about the mushroom and its history. In the cartoon above, what seems to me a very intimidating god visits the mushroom eater. A hungry, if not blood-thirsty, god approaches from behind oblivious to the sitter, naively concentrating on his fungi delight.

Whatever the purposes of this mushroom in Aztec cultures, there are a number modern counterparts worth commentating upon. First is the notion that others -be it people (living or dead), aliens, jinns, gods, animals, technocrats, machines, robots, technologies- can see through my body. Nothing is hidden. Viewing my “inside”  means the intimately private and hidden becomes inspectable -viewable- without permission, control, consent. There was an outbreak of anxieties about  such "penetrative vision" when medical x-ray machines were first introduced; only to reawaken yet again when x-ray body checks were introduced at airports. Be that as it may, medical x-rays usually involve consent and manipulation by a whole team of medical operatives. Airport body scans tend to be hurried with conveyor-belt rapidity and seem somewhat banal.



what do passport control officials see?? are the images stored??

But nevertheless there are terrifying and irrational aspects of being scanned: i) what is going to be seen -is the New-Viewed going to be nasty for me, others, the world? ii) what dangers occur if the scanner-technology malfunctions and, for instance, teleports my internal organs to iii) what happens to the New-Viewed content -is it destroyed, stored, retrievable, and by whom? Such fears were brilliantly exploited by David Cronenberg 's movie released in 1981 called Scanners. In this terrific movie the scanners were not machines, but human beings with a host of highly developed special gifts: empathy, telekinesis, psychokinesis, mind control, thought-reading. The scanner people could use their gifts to help maintain "security" both for one's Others as well as other's Others. They could also function aggressively, offensively to eliminate subjects. The New-Viewed are liquidated in the very act of penetration by viewing within a mere ten seconds of the initial gaze. A majestic -explosive- advertising poster plays mercilessly with all these fears. The earth is populated by billions of humans, but a mere 237 scanners could take-over and control the entire planet. 


thoughts and viewings can  terrify, control, kill, subjugate.

Opposing beneficent creativity, the New-Viewed are transfigured into oblivion by a creative act of annihilation. A theme already well-explored in religions and therapies promising new creation is reversed.

Fantasies of inspection and  surveillance are incredibly important for human groups: they bind, control, and destabilize. They also perform similar offices for individuals. Being watched over by beneficent gods, teachers, sate leaders -to name but a few- may be supportive of subjectivity. But the performance of such stabilisation is creaky and subject to the logic of fantasy whereby the scanner changes into its terrifying opposite. Enantiodromia is worthy of considered restatement -not only at the level of phantasy- but socially and politically as western democracies crave populist leaders who will become the new Beneficent Ones. Cronenberg's Scanners needs to be watched alongside The Lives of Others by Florian Henckel von Donnersmarck: scanning is ambivalent. Surveillance technology can thankfully be subverted and even used against itself. Two great hesitations about scanning and surveillance theories are prompted by the observation, first, that both demand great consistency in the workings of real things. This belief in the uniformity and reliability of things -natural or otherwise- is a folk belief. Conspiracy and surveillance theories depend upon regularity -even if that regularity is a perverse one set up to intimidate, subjugate, harass. Second the expectation of consistency of human agents is an even bigger folk belief. The notion that surveyors and scanners can implement a state mechanism that will endure for ever by subduing and subjugating populaces or groups, is short-sighted. It severely lacks historical perspective which inevitably turns state surveillance into farce. Surveyors themselves become bored with their operations, envy their viewed, become slip-shod, forget about unpredictables. Serendipities and human fashions undermine such grand designs. As do unpredictable events of nature. The great mistake of paranoid surveillance theories, like their cousins conspiracy theories, is they desire assured knowledge of the paranoid status quo much that their own subjectivities become its chief architect. Hence the fascinating serious of uncartesian equations: 

I am surveyed therefore I exist
I  exist therefore I know
I know therefore the surveyors, scanners, and surveillance apparatchiks exist.
Surveillance needs Others,

Jules Cotard was a minor figure in the history of medicine, Astonishingly the delusions he interrogated are now enjoying an unpredicted renaissance in both clinic and culture. The fantasies collected by this nineteenth century neurologist coalesced to form a very particular set, best called in English delusions of nihilism. The nihilism in question is a fundamentalist, unshakable, belief that one's "inside" is dead -or at the very least has severe organ-deficits, irredeemable malfunctions, enormous craters, black holes, hidden defects. These are destroying, tormenting and killing their bearer alive.



Jules Cotard 1840-1889


 It is worth considering what ones “insides” might signify. Associations will naturally vary from culture to culture and person to person. Inside and outside, like purity and danger, are rich foundation structure in most anthropologies.  Being loved by a Kurdish speaker, for example, involves sharing one’s offals and tripes with one's beloved. Kurds will love their darling’s liver or kidneys. A devoted couple will desire to share lungs -as well as kidneys and various other internal organs. None of this is at all sinister. In this culture eating ones beloved's innards is as natural a desire as relishing a fine-dining experience.


On the other hand there are terrifying sets of beliefs about one’s “insides”. For instance ones body might have holes, omissions, gaps. A limb or organ might be missing. One’s insides may be disappearing at such an alarming rate that one’s own very existence is becoming attenuated, compromised, threatened. May be I am rotting from the insides-out Such were the narratives described by Cotard's researches about somatic delusions. So fascinating was he to French society that he makes  an appearance in À la Recherche du Temps perdu. . Miss X was the first patient this Parisienne doctor met with nihilistic delusions, she claimed to have no brains, no nerves, no chest, no stomach, no intestines. Her predicament was greatly magnified because Miss X was convinced she was eternal and would live for ever in this condition. This is not too far removed from the modern horror territory of the living dead. Miss X eventually starved herself to death.





Such imaginings are not the sole prerogative of psychosis. They are present in dreams and everyday fantasies too.....with varying degrees of intensity or terror. For example, one's body might be rotting from the inside out. Reproductive organs maybe defective or compromised in someway, neural mechanisms missing. More commonly people go to doctors convinced they are suffering from cancer, HIV-related illnesses, brain tumour or some other life- threatening malady.



Contemporary psychotherapeutics have focused upon external body “image”; with increased demands to alter or improve one’s body with tattoos, cosmetic procedures, or even quite radical and dangerous surgery. Cotard warns there are internal body images too with equally devastating impacts for individuals. These should never be neglected at the expense of external body images and fantasies. Human beings are bodily entities that are vulnerable and destructible: it is not surprising that anxiety is one of the great factors in human living.

The French word "délire" (as  in délire des négations) posses more subtitle nuances than the English nihilistic delusion. Whereas the English delude is derived from Latin meaning play, deceive, cheat or fraud, the French delire posses less moralistic overtones. In before the invention of modern agricultural machinery, using the plough was- and still is- a somewhat hazardous and unpredictable undertaking. To delire occurs when the plough jumps its furrow (lire) - an everyday experience in the lives of agricultural workers and no great tragedy. On the other hand, when horses were used with the plough, there was the occasional terror when -in  the Lancashire dialect of my grand father- a horse took boggart, that is became wildly out of control; a truly dangerous situation. In a future writing I intend to write more about the word delusion and its modern usage which privileges insanity, psychosis, florid phenomena. 

Suffice it to say here that "delusion" itself is a liminal concept. It is often used to demarcate different dimensions. Its's philological root is that of a "threshold" or thresholds (limen). There are also transformational liminal states such as dusk and dawn during which day disappears into night; and then dissolution of the night by day. One of the most notable sculptural achievements of liminal a process, is that of dawn and dusk situated appropriately in the funeral chapel of the Medici in Florence.  Michelangelo's sculptures are such an appropriate memorial for a place marking the transition between life and death.










The notion of a liminal concept, or a liminal category, fluctuates at thresholds. Delusion is one such concept. It supposedly demarcates the area of normality (neurosis) from that of madness (psychosis). How easier it would be for mental health practitioners if that were the case. For actual subjects, however, becoming and being shade into one another. This was excellently commented upon in a BBC documentary about depression. It featured the former Blair media spin doctor Alistair Campbell. Campbell's supportive elder brother suffered from schizophrenia; this was a great source for upset, gratitude and loss in Campbell's life. In the BBC Documentary Depression and Me he told of period in his early professional career when his behaviour distressed colleagues so much that he was visited by two policer officers. He was then taken to a psychiatric hospital in London for treatment. Looking back at that time Campbell identifies his states then, with that of his bother. He wondered whether he too was becoming schizophrenic, like is bother. Campbell calls these distressing events his one -and only period of psychosis- despite continuing to experience periods of  profound melancholia from time to time. Why doubt his testimony?

Before leaving Cotard there is one more weighty consideration. The delusions discussed here involve other liminalities, namely  the boundary (or boundaries) between inner and outer. Instead of being a reliable "container" with its "contained contents": both container and contents become compromised, permeable, insecure, fragile. What should belong "inside" and "hidden" is in danger of leaking out, becoming visible, infringed, or impinged. 

To my way of thinking, this is central to "trauma". Insides and outsides become confused, uncontrolled and disarrayed. Decades ago I heard a nurse speak of a patient in Winwick Psychiatric Hospital. He had eaten hallucinogenic substances like the mushrooms mentioned above, but had experienced "a bad trip". His body was now an orange. He was terrified of any physical contact with humans. Why? They might want to peel him. The operative notion here is extreme vulnerability. Basic, elementary, protection is easily flayed; leaving an individual exposed, raw, penetrable. There is no defence, security,  personal safeguarding for the internal jelly-like substance of conscious oozing matter. 


Why do you tear me from myself?
Marsyas in Ovid Metamorphoses VI

One of the most violent scenes in the entire opus of Titian's art was painted in his eighties. Here the satyr Marsyas is being flayed alive. The torture is being inflicted because of his liminality. As a satyr in mythology he was already liminal with both human and animal characteristic. Satyrs also lived in the wild woodlands, eyrie places, and mountains. They loved cavorting, sex and drinking. Marsyas' offence was to liminize a crucial ontological boundary -that between gods and non-goods. In Ovid's series of poems about transformations, the Satyr, who possessed exceptional  musical abilities as a flute player, invited Apollo to become contestant in a musical play-off. Perhaps he was drunk at the time. The outcome was gruesome.

For centuries plays about Satyrs were important and highly popular in Greek theatre. They were staged alongside tragedies and comedies in classical times. In fact they could well be termed tragicomic plays -or perhaps burlesques and even farces. Strange how much of this, popular and liminal genre of drama is now lost


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In Catholic Christianity monks and nuns treasured a very special hymn at Ascension-tide; the feast commemorating what seemed to be the final journey of Jesus and his body. Already he had been tortured and put to death. Astoundingly his tomb was empty and he appeared with a recognisable, but different resurrected body, to his former associates. Eventually this resurrected body disappeared from view; put positively it/he "ascended"





The ancient hymn for the Ascension of Christ,  Aeterne Rex Altissime, contains this remarkable verse:

Tremunt vidéntes ángeli
versam vicem mortálium;
culpat caro, purgat caro,
regnat caro Verbum Dei.

Translated into English in the nineteenth century by a remarkable priest-scholar called John Mason (1818-1866), these verses read:

Yea, angels tremble when they see
how changed is our humanity;
that flesh hath purged what flesh had stained,
and God, the flesh of God, hath reigned.

However there is something odd here. The Latin text speaks of the Word of God reigning; there is no reference to God's Flesh. After much research, it can be safely concluded that there was a Latin text which contained the audacious anthropomorphism for centuries. First citied in the ninth century It is well attested in the three main traditions of Latin Catholic worship -Roman, Sarum, and the Visigothic Mozarabic tradition of Iberia. 

Tremunt videntes Angeli
Versa vice mortalium:
Culpat caro, purgat caro,
Regnat Deus, Dei caro.

This verse is attested in all of them and even managed to withstand the liturgical revisions of Urban VIII, a cultured but militaristic pope, with only minor amendment.


Tremunt videntes angeli
Versam vicem mortalium:
Peccat caro, mundat caro,
Regnat Deus Dei caro.


Even here in Urban's rendition, the flesh of God still manages to reign.


NOTES


There are a variety of scans and scanners used in contemporary medicine; some for diagnostic purposes, some in treatment, others for both. These are MRI, CT, PET/CT,  X-ray, Ultrasound, Bone Density, Fluoroscopy.

British Broadcasting Corporation 2018 A History of Delusions  
https://www.bbc.co.uk/programmes/m0001d95

British Broadcasting Corporation 2019 Alistair Campbell: Depression and Me https://www.bbc.co.uk/programmes/m0005btv

Chandra Kiran and Suprakash Chaudhury 2009  Understanding Delusions Industrial Psychiatry Journal Volume 18 India

Versions of the Ascensiontide Hymn Æterne Rex Altissime are published online by Saint Augustine's Lyre https://tosingistopraytwice.wordpress.com/2017/04/09/aeterne-rex-altissime/ 

See further "Aeterne Rex altissime." The Canterbury Dictionary of Hymnology. Canterbury Press, accessed June 4, 2019, http://www.hymnology.co.uk/a/aeterne-rex-altissime.


Wednesday 22 May 2019

formation for psychoanalysis


Looking at Francis Bacon's painting: Oedipus and the Sphinx


There are many reasons why an individual might want to become an analyst. One might be turned on by trendy intellectuals or theorists -like Zizek- who have been influenced deeply by psychoanalysis. One may wish to "do good", influence, control, or heal the Other(s) in some way or other. There is also that mix of envy, resentment, gratitude, jealousy which influences most career choices, as well as fascination, curiosity, and feeling driven 

Not least there is money. Increasingly people turn to psychoanalysis as an alternative to the short-term, time-limited, and over-subscribed therapies offered by health care economics and the powerful ideologies that support them. Simply because of over exposure and tired promises, cognitive behavioural therapies, rationalising psychotherapies, and person-centred approaches too appear less attractive to both punters and practitioners.


In psychoanalysis such desires, wishes, hopes, and projects are addressed during a very long, systematic preparation -at once clinical, intellectual , and emotional. This is called formation. 


Ad hoc crisis-intervention -responding to immediate needs- can be addressed quite successfully by most therapies and counselling. There may well be clients who are keen only to address such pressing needs and desire no extended analysis or further attention. Maybe too, there are therapy seekers who are not able to bring formal analysis to a conclusion. These need to believe their professional -or somebody similar to their listener- will always be available when required for support.  To repeat myself an analyst is not necessary to address these therapeutic needs:  most counsellors or therapists do this well enough.




******************************************


 So why should anybody practice analysis?? 


After a period of considerable interrogation one may be left with just three reasons for psychoanalysis. First is the respect and reverence for the talking project initiated by Freud after experiencing its impact upon oneself. A second reason is a desire that this tradition should flourish: so that it remains available to new generations. Third -and finally- it is important to have people capable of supporting an analytic enquiry from its very beginning to a conclusion...... just in case people happen to need longer periods for analysis. 


An analyst, therefore, is only required where and when a sustained, long-term, commitment is needed to accompany those brave souls who wish to go beyond therapy into the dimensions of absolute difference whereby



We shall not cease from exploration

And the end of all our exploring 

Will be to arrive where we started

 And know the place for the first time.

This exploration of the place from which we begin, to which we again return at the end, and then know again for the first time, is called symptom in contemporary psychoanalysis.



******************

 Nevertheless it must be said that anybody seeking a psychoanalytic formation -must be- or even has to be- a bit daft. This robust English word, both noun and adjective, was commonly used in the Lancashire where I was born and bred. It has a variety of meanings. One meaning of the word daft is mad -crazy, insane, or -more prosaically- lacking common sense. Psychosis is not a perquisite for psychoanalytic formation -although there have been and perhaps still are- analysts who either succumbed to insanity or were well-mad before they started their psychoanalytic trajectory.


More precisely one  must be crazy in three ways:


First of all before one dare even to think of any professional involvement with others whatsoever, there is the demand that one should become a patient -or if you like- client. One needs to have some appreciation of one’s own personal craziness before listening to others. This can take quite a long time.


A second aspect of this craziness is the lack of guarantees regarding the outcome and duration of the process. To this extent psychoanalytic formation is an anti-training profoundly subverting what is commonly regarded as training in modern “psy” professions -psychology, psychiatry, psychotherapy, counselling, end of life coaching -whatever. This, to my way of thinking extends to -and simultaneously de-structures- all notions of "cure", "treatment" "outcomes". Therefore one needs to be extremely cautious with business organisations retailing the title "analyst". Inevitably they end up marketing standardised products with built-in obsolescence.


Thirdly undertaking any analysis is daft in the sense that it is risky. Freud encouraged his patients to risk speaking and thinking associationally -uttering whatever came to mind, however crazy, disturbing, obscene, or odd it may be. His belief was that this counter-intuitive way of speaking helps loosen up the customary constraints of everyday life and discourse. One therefore risked seeming to be daft. This riskiness extended to time and money as well: for a great deal of both is demanded by a procedure which offers no guarantees in terms of outcome. 


The sole justification for entering and persevering in analysis …..is that one needs it. This particularly applies those people who purchase analysis for the sole purpose of becoming psychoanalysts. Such people are invited to consider whether this aspiration may be a symptom or -using an old English medical word- “symbol” of some profound disturbance and/or need to control, help, or rectify others. After passing through such formation, one is probably unemployable by any state-financed enterprise such as the UK National Health Service.


Analysis and the practice of analysis can be daft-in yet another  interesting sense.  Carnival was not limited to continental Europeans and Latin-Americans: the annual festivities of Yuletide were once termed "daft days" wherein people could reverse political and sexual roles, indulge, frolic, get high. There is a certain amount of  fun, humour, excitement, jouissance linked to the process, practice, and theory of psychoanalysis. This too, of course, becomes an invitation for further analysis.


Just as Freud’s word for uncanniness and the uncanny - unheimlich-  may metamorphose into meaning its opposite (homely, familiar), so too with the English daft. When it was written for semlye he was and wounder dafte  -dafte here connotes “skilful” . I would certainly say that the psychoanalyst is not without skill. What these skills are and how they are best used is the task of psychoanalytic formation …. which is… I am trying to suggest… a form of anti-training.


********************

Nevertheless, some social structure is required for these ways of learning, being, living, and conducting oneself; but it cannot be a rigid structure because they too easily become ends in themselves and get corrupted by power, family, and business interests. Formation in this sense is perhaps analogous to the structures used in formation dancing!! Psychoanalytic formation involves working with colleagues  ….hopefully in sync. This is what we call a psychoanalytic school. If -or when- the sync ever stops, becomes dysfunctional, oppressive, or persecutory so that the learning system operates in a manner Bion once described as primitive or "basic" - it is then time for the music to cease,  for people to rest,  rethink,  and maybe eventually regroup.......  so that a new set is founded. So maybe temporary, finite 
structures, are now essential.





Poetry quote from TS Eliot Little Gidding,

Copyright simon fisher Monday, 2 November 2015 revised May 2019








Wednesday 8 May 2019

The Psychoanalytic Case History


Postcript and Preface

Rarely do I speak longer than thirty minutes in public

This is more than enough for me and probably for listeners as well!!  So I find it a little ironic that Lacanian practitioners are prepared to spend hours giving papers about their concepts and the fascinating inter-relations subsisting between supposedly Other concepts-  whilst the clinic itself is of varied length veering almost inevitably towards increasingly shorter sessions!  This reminds me of the infinitesimally  small in Leibniz’s calculus….. which can perdure withever smaller units whilst never reaching zero. But there is an end to analysis for some.

It was a great relief for me when twice I attended international seminars arranged by Cormac Gallagher and his colleagues in Dublin. All discoursers -whether senior, junior, intermediate- were offered a time span of thirty minutes for their talks. When they exceeded this allotted span -they were cut off. Those that wished to continue longer than half an hour did not experience this cut  as a relief!!! Obviously they could not take care of their own castration.So for my own private entertainment I offer this writing, which would gobble up much time in a public discourse.  For this reason the preface is circulated separately from the colloquium, but for those only who wish to read it.

It seems to me that a lot of discourse in the register of psychology, psychotherapy, and psychoanalysis has been masturbatory, voyeuristic. In the twentieth much was made of the Gaze in cultural theory (male or otherwise) but there is also the Voice, the Auditory,  both of which are quite capable of attracting and disseminating jouissance. In English there is an old word “eavesdropping”. In the history of the language the word is related to water dripping from the roofs of buildings ….. a drip, drip, dripping. It is an incredible word  -expressing well the monotony and delights of secret listening. On the other hand, the joys, urgency, and sacrilege of eavesdropping are well depicted in this camp painting by Laissement (1854-1921) entitled Kardinale in Vorzimmer. Its feigned poses of titivated alarm are well worth savouring




 Even more obvious is the pleasure that arises from savouring trauma through the Auditory. Whole industries are founded on it. There are too the inevitable seedy, pervy,  or "hidden" pleasures. One of my friends loved his musician wife so much, that when she succumbed to breast cancer he himself developed a distressing pseudocyesis. A friend phoned him to enquire after his and his wife’s well-being. Following customary social generalisations the enquirer asked boldly “And which breast was it -left or right?” My friend hung up.


One of the most significant concepts introduced into psychoanalytic theory by Lacan was that of jouissance.  Almost impossible to translate it denotes deep addiction to pleasures of all sorts. They naturally infest all human undertakings -religious, ethical, political as well as pornographical and medical. It is difficult to write about jouissance in psychoanalytic literature, case histories,  or everyday life without sounding moralistic, condemnatory or righteous. I am quite sure both Breuer and Freud believed their case discussions and publications represented  pinnacles of science. Nevertheless they are literally dripping with jouissances


Once I attended a  clinical seminar in London where the topic was “the cut”. The male speaker talked at length about how important this technique was for Lacanian psychoanalysis. His discourse was monotonous, wearing, and excruciating for me to listen to. Yet it continued ….and could have continued ad infinitum …..until the speaker had … had… enough. But maybe he could never have  ….had….had.. enough? I was a coward and listened for hours until everybody else was fed up too. The point is this. Jouissance can be charged with fascination for one person, tedious for another, sensational for yet another.





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A colloquium I gave recently in Cyprus began with a video from the New Yorker based on the work of one of their journalists, Rachel Aviv, published April 1 2019.  It is about a young woman, Laura, whose wealthy family enabled her to receive much professional attention and lots of medicine. Her suffering was multivalent. For myself two phrases of hers are pertinent. First is this. She doubted whether she had a “real self underneath”. Second “The pain felt so real and raw and mine”.


I now purposely use stories and videos in the public domain, because it is virtually impossible -ethically, practically, legally- to use a “case history” anymore. For me this is a welcome development. I would not want myself turned into somebody’s case history -for any purposes whatsoever: especially for a reconstruction of my supposed subjectivity to which I have no response. Such  reconstructions automatically  dissolve my various realties. Immediately they invite completion by the imaginaries and symbolic worlds of others. I have then become somebody elses’ machine for jouissance.


One case history by a professor psychotherapy in the UK, caused a minor sensation when it was published in 1987. It was about a female suffering emotional conflicts surrounding bodies and sexuality. According to his text, my colleague visited his client privately -and uninvited- whilst they were both attending a residential course He entered her room and stripped himself naked without any invitation or request from the client. As if to compound the ambiguities of this act, it was written up as a case history.


This episode -and its subsequent dissemination in a publication- generated some discussion, as well as outright condemnation. Though I have no desire to dwell on the ethical and legal debates that followed, there is one point I would like to make. The practitioner was -and still is- a devout Christian. It seems likely to me that he was re-enacting a biblical scene. He was staging a theatre of innocence. Before the so-called biblical Fall, men and women were naked.…so the story goes. This was ok for both Adam and Eve… and for God too (apparently). What happened after the Fall constitutes a new scene wherein sex, sexuality, nakedness, and 
“knowledge” are laden with guilt, shame, prohibitions, and complex jouissances. I believe my very dear colleague wished to provide his client with a prelapsarian garden of therapy -in which  innocents lack shame, guilt, or divine surveillance. My interpretation here does not suggest any denial of sexuality; rather a set of fantasies is being staged. To what extent this coupe de theatre benefited both practitioner and client is an item I cannot comment upon.


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As far as psychoanalysis is concerned many of Freud’s foundational case histories were failures. From the outset Freud himself was an expert failure. He was a bad hypnotist that could never make it work. Cocaine was no miracle drug. On the contrary it dispensed death. His invention of the talking cure was borrowed from Breuer’s narration about  an exceedingly intelligent young lady -who was deeply upset by her father’s death and the social restrictions hampering the prospects for bourgeois Jewish women - to name but two dimensions of her distress


Bertha Pappenheim, according to the family GP, possessed “considerable intelligence” along with an  “astonishingly astute reasoning and sharp-sighted intuition”. As a young girl she was sent to attend a Roman Catholic school daily. Upon returning home, Bertha was supposed to transform herself into a dutiful and obedient daughter. Even the structure of time changed at home: it was organised by the Jewish calendar, shabbats, and family ceremonies. Whilst her younger male sibling went to a high school, Bertha’s education was terminated abruptly at the age of sixteen when she was expected to become a daily companion to her mother, perform needlework and crocheting, and assist with the preparation of kosher meals for the family…….until she was married. It was Bertha who invented to talking cure that Freud turned into psychoanalysis.The literary production  Ann O was highly selective and fragmentary. The main thrust of the case history was calculated to illustrate the real distress of the young lady and the value of “chimney sweeping” for her -a highly charged phrase which best expressed the relief and value this female patient obtained by talking to a kindly adult male who gave her lots of unhurried attention. Hopes that similar “talking cures” could be performed (or better, re-en-acted) for hefty professional fees was a highly lucrative hope. To inaugurate  a whole new science of human psychology based upon such phenomena detailed by Studies in Hysteria was an equally appetising prospect for an ambitious man greedy for fame and fortune. Another facet related to this publication was its tacit critique of the great Magister Alienist in Paris -Charcot. His theory supported the view that hysterical phenomena such as Anna O’s were best explained by hereditary degeneration. This  used to be called in everyday English “weak nerves”.




My emphases on performance, re-en-act-ment, artistic licence, and so forth, are intentional and central to this brief exegesis. Anna O herself  wrote a number of literary pieces and later translated A Vindication of the Rights of Woman into German. During her illness she spoke of (and from) her own “private theatre” with Breuer as audience. Freud too adds his own literary, dramatic touches to the book. Freud characterised the relief Anna obtained from her talking therapy as a katharsis - a word well known to Greek-speaking colleagues, readers of Freud, and old-fashioned doctors. Katharsis was a word used by Aristotle in his lectures on aesthetics. It is claimed to be one of the most important effects of dramatic tragedy for human entities. The word “entities” is used here intentionally. I doubt whether Greek philosophy had a term for what moderns call “the subject” until Plotinus. Katharsis for Aristotle seems to function within a variety of somatic and emotional registers …as well as social, aesthetic and ethical ones. He was a very clever individual!! Considering the possible meanings of katharsis  in Aristotle’s text requires much careful exposition that cannot be undertaken here. However it cannot be by mere chance that katharsis received detailed attention in the mid nineteenth century controversial work entitled  Outlines of Aristotle’s Lost Work on the Effects of Tragedy. This German book was published in 1857 by Jacob Bernays, a classical scholar who lived from 1824-1881. He was directly related the the future Frau Freud. It is Bernays’ interpretation of Aristotle that is pertinent here. He considered tragic katharsis to be an almost physiological event: a quasi-corporeal evacuation (or expulsion) of excess emotionality and passion which otherwise would seriously compromise the mechanism of the organic 
entity.


Bernays’s tragic katharsis was therefore more of a medico-somatic procedure-than anything to do with aesthetics, society, or ethics. As far as I can remember even Nietzsche -who was always much better as a classicist than philosopher- seemed to have endorsed this very “modern” mechanistic notion of tragic effect ….namely a purgation of emotions named as eleos and phobos. This was a massive modernising reduction of tragedy, art, and Aristotle!!! Nevertheless this odd development was crucial for the literary form  of “case history” which was being pioneered by Freud at this time. Case histories were felt by him to be scientific productions that illustrated both real distress and real relief -if not real cure.


The future Madame Freud, Martha Bernays, knew the Pappenheim’s reasonably well. She once empathised with the sufferings of “poor Bertha”. The recent multi-volumed Bruatbriefe -or Courtship Letters- between Freud and Martha, contain several references to Bertha. Hailing from a similar background, Frau Freud’s fate was to become a living link in that social bond assigned to many Jewish bourgeois women (daughter, mother, wife, housewife) in late nineteenth century Europe. Martha was therefore well-placed to sympathise with Bertha. The poet laureate of England, portrays this brilliantly in her own incredible art:



Ladies, for argument's sake let us say
that I've seen my fair share of ding-a-ling, member and jock,
of todger and nudger and percy and cock, of tackle,
of three-for-a-bob, of willy and winky; in fact,
you could say, I'm as au fait with Hunt-the Salami
as Ms M Lewinsky - equally sick up to here
with the beef bayonet, the pork sword, the saveloy,
love-muscle, night-crawler, dong, the dick, prick,
dipstick and wick, the rammer, the slammer, the rupert,
the shlong. Don't get me wrong, I've no axe to grind
with the snake in the trousers, the wife's best friend,
the weapon, the python - I suppose what I mean is,
ladies, dear ladiesthe average penis - not pretty ...
the squint of its envious solitary eye ... one's feeling of
pity ...

Carol Anne Duffy: Mrs. Freud.
Released in The World's Wife  1999.

Depicting the limitations, gaps, or  lacunae of past historical living with a vigorous humour is not the same as facile ridicule. Neither does it imply a reductio ad absurdum. Duffy rather invites her readers to view the tragedies of female pasts through another, different, optic. 


Whatever was related or narrated -either by Sigmund, Breuer or Martha- about Bertha fails not only from lack but simultaneously from excess, surplusage. The narration of Anna O by Freud and Breuer, is overdetermined  in both its gaps and its surplus. The surplus has much to do with the propagation of psychoanalysis as with science, technique, and remedy for the alleviation of suffering. But even this surplus has lacunae.


To return to case histories: it is well known that Anna O, despite Breuer's interventions,  did not “recover” -itself an odd word full of ambiguities that invite much unpacking. In retrospect the “talking cure” was but one important episode amongst many others. After her treatment by Breuer, Bertha was admitted to  a private hospital run by the remarkable Binswanger family at Thurgau, close to Lake Constance on the Swiss-German frontier. Anna (or Bertha) was under the care of Bellevue doctors from July-October 1882 -after which she seems to have lived with her mother in Vienna for a while.


When Bertha went to Bellevue Hospital she was receiving a prescription of injected morphine -up to a maximum of 200 mg per day. In the existing case history of Anna O this is another gap. There is no mention of morphine administration. I checked with a scientific colleague about possible side-effects of long term treatment at this dose. They include hallucinations, drowsiness, vomiting, euphoria and/or sadness, addiction and constipation. For information further about Anna’s prescribed medication prior to her involuntary admission to Bellevue, there is an informative D.Med thesis by Katja  Doneith. She explains too how Breuer contacted doctors there at least nine months before Anna eventually arrived. The trails of Bertha continued well after Kreuzlingen; so much so did her condition deteriorate that a further period of hospitalisation was necessary from July 1883 until January 1884. The hospital was located in Gross-Inzerdorf. Breuer went to visit his patient there in August. He was so appalled by degree of Bertha's suffering, that he thought it best for her to die. Richard G Klein's most helpful chronology for Anna O during these years  states:


1883 (Jan 22): Letter from Martha Bernays to her sister Minna reporting that Bertha is “completely cured”.

1883 (Feb 27): Bertha P.’s 24th birthday

1883 Thurs Jul 12 visit to Breuer until 2:0
0AM discussing Bertha Pappenheim

1883 (Friday, Jul 13): Freud writes to Martha and notes that he had a long and detailed discussion with Breuer about Bertha that lasted until 2:00 AM

1883 (Jul 30): Bertha is re-hospitalized at Inzersdorf for 6 months, until Jan 17, 1884.

1883 (early Aug): Breuer visits Bertha and finds her in an appalling state. He was so disturbed by her disintegration that he wished she would die.

1883 (Aug 05): Freud write letter to Martha: “Bertha is once again in the sanatorium in Gross-Inzersdorf, I believe”. He notes that Breuer recently visited her, found her condition to be worse and wished her dead so she could be free of her suffering.

1883 (Oct 31): Freud writes letter to Martha stating “your friend Bertha is doing well”. Freud also notes that Bertha is ridding herself of pains and of her morphine addiction as well. Breuer ‘withdraws’ as Bertha’s doctor.


Freud and Breuer published Studies On Hysteria in 1895. By that time Bertha Pappenheim was aged 36. In the very same year Pappenheim had founded a fee-free school the Unentgeltliche Flickschule teaching vocational skills to unemployed and near-destitute young women. That year she also became politically active in Die Bund Deutscher Frauenvereine -a political lobbying association to improve women's rights in the new German Civil Code. Pappenheim was also a campaigner and leadings light in the Frankfurt branch of the women's movement Allgemeiner Deutscher Frauenverein. From 1895 onwards Bertha Pappenheim, translator of The Rights of Women became a dedicated social worker founding institutions, groups, nurse training, schools to address severe discrimination and penury amongst trafficked young women in particular, who serviced the burgeoning sex industry in German speaking countries. This was a very different woman indeed from that disseminated by Freud and Breuer in their case history of 1895.


It is therefore not surprising that the family, former clients, and friends of the late Bertha Pappenheim were so outraged when Ernest Jones grossly revealed the identity of Anna O in his Freud biography. Quite rightly too. Bertha  had became such a champion of women, that she was commemorated by a German postage stamp. During the de-nazification programme imposed upon Germany by the allies, Bertha Pappenheim became a role model and “Benefactor of Mankind” - justly celebrated for her contribution to social work, judaism, female emancipation, and  German-speaking culture.








Immediately before her death, the  elderly Bertha had been denounced by a young women -presumably one of her clients, who suffered from learning disabilities. Bertha had supposedly criticised Adolf Hitler. She died May 28 1936 and is buried in the Old Jewish Cemetery, Frankfurt. As far as I have been able to ascertain, Pappenheim herself wrote nothing in public of her unwanted -and unsolicited- career as Anna O nor of her treatments by Breuer and Binswanger. It is common knowledge however, that she firmly discouraged psychoanalytic treatment for any of the distressed women in her care.


Select Bibliography


Mahesh Ananth 2014 A Cognitive Interpretation of Aristotle’s Concepts of Catharsis and Tragic Pleasure. International Journal of Art and Art History December 2014, Vol. 2, No. 2, pp. 01-33

Rachel Aviv 2019 The Challenge of  Going of Psychiatric Drugs. The New Yorker April 1st 2019

Joseph Bernays (1857) Grundzüge der verlorenen Abhandlungen des Aristoteles über die Wirkung der Tragödie. Translated into English as Aristotle on the effect of Tragedy. See Oxford Readings in Classical Studies: Ancient Literary Criticism ed Andrew Laird OUP 2006.


Henry Chadwick (2001) Philosophical Tradition and the Self. See Interpreting Late Antiquity: Essays on the Postclassical World editors Bowersock, Brown, et al Harvard University Press


Katja Gertrud Doneith 2008 Binswangers Privatklinik Bellevue 1881-1885 Thesis for Doctor of Medicine, Medical Faculty, Eberhard-Karls-Universität, Tübingen. I would like to quote from this thesis pp. 95-104 (my translation):


Breuer's report to Binswanger on Bertha's disease, like the published version of Studies in Hysteria, suggests a slow but steady improvement in the course of the disease. However, Breuer had previously requested Binswanger to reserve a place for Bertha in a letter dated November 4, 1881. In December 1881 Breuer describes another deterioration of her mental condition. At the end of June it is said that Bertha was addicted to chlorine and tormented by convulsions, which began with strong chorea minor and increased to severe "rolling cramps " . This and an existing trigeminal neuralgia required treatment with high doses of morphine, which in turn led to a morphine dependency that Breuer wanted Binswanger to treat. Laupus' report gives brief information about the further course: the trigeminal neuralgia and the choreatic symptoms could not be controlled without further morphine, the mood showed a coming and going of hysterical characteristics. At her own insistence, the patient was "better discharged" in October. Breuer did not continue to treat the patient afterwards, but was aware of the further course of her medical history. She was to need in-patient therapy a few more times before she could devote herself fully to her literary work and her commitment as a women's rights activist and founder of the Jewish Women's Association, as well as to social work. In his studies on hysteria, Breuer published a medical history that ends with the recovery of Anna O., which was not the case if one consults the various sources on Bertha Pappenheim. Bertha still suffered at least from her trigeminal neuralgia and existing morphine dependence. 


Kermican Durmaz https://www.instagram.com/kerimcandurmaz/?hl=en

Leon Golden 1976 The Clarification Theory of “Katharsis" Hermes 104. Bd., H. 4  pp. 437-452

Albrecht Hirschmüller ( 1978)  Physiologie und Psychoanalyse: In Leben und Werk Josef Breuers. Jahrbuch der Psychoanalyse / Beihefte. A translation of Breuer's detailed referral  to Binswanger is contained in Richard G Klein's website below.

Richard G Klein ANNA O. - BERTHA PAPPENHEIM: A CHRONOLOGY OF HER LIFE AND TREATMENT https://www.freud2lacan.com/docs/anna_o.pdf

Britta Konz (2005) Bertha Pappenheim (1859-1936): Ein Leben für jüdische Tradition und weibliche Emanzipation. Campus Verlag

Elizabeth Loentz (2007) Let Me Continue to Speak the Truth: Bertha Pappenheim as Author and Activist Monographs of the Hebrew Union College

Annett Moses & Albrecht Hirschmüller ( 2004) Binswangers psychiatrische Klinik Bellevue in Kreuzlingen: Das «Asyl» unter Ludwig Binswanger sen. 1857-1880 (Marburger Schriften zur Medizingeschichte, Band 44)  Lang

Martha C Nussbaum 1986 The Fragility of Goodness: Luck And Ethics In Greek Tragedy And Philosophy Cambridge University Press

Bryan Thorne (1987) Beyond the Core Conditions. In Dryden W (ed) Key Cases in Psychotherapy. London: Croom Helm; pp 48-77


Visuals




 
Jewish Women's Archive. "Bertha Pappenheim's Gravestone." (Viewed on May 7, 2019) <https://jwa.org/media/pappenheim-bertha-3-still-image>.


 The former Bellevue Psychiatric Hospital in Kreuzlingen






The hospital was founded by Ludwig Binswanger the elder in 1857. It only ceased being a hospital  in 1980 when it was still directed by members of the Binswanger family. As well as Bertha Pappenheim other patients included Any Warburg, Ellen West and Vaslav Nijinsky who was treated by Bleuer and referred by him to Binswanger at Kreuzlingen. The photograph reproduced below is an image of Robert Binswanger, the second medical director. It was he who admitted Bertha Pappenheim following referral from her GP Josef Breuer. As well as collaborating with Freud, the kindly Breuer lent Freud money to help him establish a practice. 





Below: Scan vom 23. Mai 2005 von Peter Berger (Robert Binswanger 1850-1910)









Breuer and Bleuer were not the only doctors referring to Bellevue. Sigmund Freud also had a patient under Binswanger’s care from 1892-1894.  Below is an image of Heiim’s case notes with their file now safely deposited at the Library of  Congress Freud Archive. Gustav Heim died in 1897. He was a famous Czech politician and writer









The first committee of the Association to Promote the Care of Women taken 1904 Frankfurt AM. 
Bertha Pappenheim is seated on the first row, second from left.





An elderly Bertha Pappenheim





The original photograph is at the Judisches Museum Frankfurt




Video Art



https://www.youtube.com/watch?v=pXZPuUWioK8




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