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 ladies, the 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.
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
the squint of its envious solitary eye ... one's feeling of
pity ...
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 2:00AM 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.
Above. © Center for Jewish History, NYC - https://www.flickr.com/photos/center_for_jewish_history/3507968224/, No restrictions.
An elderly Bertha Pappenheim
The original photograph is at the Judisches Museum Frankfurt
Video Art
Video Art
https://www.youtube.com/watch?v=pXZPuUWioK8
?uselang=de#/media/File:Sanatorium_bellevue2.JPG){kind=link}
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