In the large packet of papers that Masson left at my hotel, one item stood out from the rest in its shock value. It was a quiet, restrained, and devastating forty-page paper, written not by Masson but by, of all people, the late Max Schur, who had been Freud’s personal physician during his final years in Vienna and London and had then emigrated to New York, where he took up psychoanalysis. Schur’s paper, published in 1966 in an obscure volume called Psychoanalysis — A General Psychology, and innocuously entitled “Some Additional ‘Day Residues’ of ‘The Specimen Dream of Psychoanalysis,’” tells the horrifying story of a patient of Freud’s named Emma Eckstein, who had come to him in 1894 with hysterical symptoms, and to whom he had indirectly caused severe and near-fatal injury. The story emerges from ten unpublished letters of Freud to Fliess, which Schur had come across while reading the complete Freud-Fliess correspondence. (Anna Freud had given him special permission to study it for a biography of Freud he was writing.)

The “specimen dream” appears in Freud’s The Interpretation of Dreams (1900) as an example of how a dream may be taken apart and analyzed; it evidently was the first dream (dreamed by Freud on the night of July 23-24,1895) that he thus anatomized and interpreted. It is a dream of guilt and self-exoneration. The wish at its center (according to Freudian theory, every dream is a wish-fulfillment dream) is Freud’s wish to get himself off the hook in regard to a patient — not Emma but a later patient pseudonymously named Irma — whom he is not sure he has done well by, and, at the same time, to put the blame on several of his colleagues. “Day residues” is the term Freud used to signify the events of the day or days preceding a dream which are its données; Schur stretches the meaning of the term to include events that happened weeks, or even months, before the dream was dreamed. He argues that Freud did not go far enough in his dream analysis, and that beyond Irma there lies Emma, whom Freud had begun to treat, or mistreat, the previous winter. It was Freud’s practice at that time to send his hysterical patients to his friend Fliess for consultations, to determine whether their trouble wasn’t, after all, physical rather than mental—specifically, whether it wasn’t nasal. Fliess had developed a bizarre theory of the nasal origin of various gastrointestinal, neurological, and (above all) sexual disorders, which he treated by the application of cocaine to the nasal membranes and/or by surgery on the turbinate bone and the nasal sinuses. If one finds it hard to believe that Freud should have endorsed such an obviously crackpot theory and quackishtherapy, one should remember that to his contemporaries Freud’s own theories seemed equally lunatic, and his therapy equally disreputable. Freud’s use of Fliess as a confidant and a source of emotional and intellectual solace has been likened to the use that a patient makes of his analyst — with the important distinction, however, that since Freud wasn’t paying Fliess money for listening to him, he had to pay in the currency of reciprocal sympathy and support.

Freud had sent Irma to Fliess for an examination to see whether her gastric pains might be of nasal origin, and the examination evidently had been negative, since no mention is made of any nasal treatment for Irma. Emma was less fortunate. After being examined by Fliess, who had come from Berlin to Vienna at Freud’s request for this purpose, Emma underwent nasal surgery by Fliess. A few days later, Fliess returned to Berlin, and then the trouble started. Emma began to suffer intense pain, swelling, and bleeding; a foetid odor came from the cavity. On March 4, 1895, Freud wrote to Fliess, briefly and helplessly telling him of these developments. Then, on March 8, Freud broke the following horrendous news to Fliess: I wrote you that the swelling and bleeding wouldn’t let up, and that suddenly a foetid odor set in along with an obstacle to irrigation…. I arranged for Gersuny [a prominent Viennese surgeon] to be called in, and he inserted a drain, hoping that things would work out if discharge were reëstablished. Otherwise he behaved in a rather rejecting way. Two days later, I was awakened early in the morning — quite profuse bleeding had started again, with pain, etc. I got a telephone message from Gersuny that he could come only in the evening, so I asked R. [an ear-nose-and-throat specialist] to meet me at Miss Emma’s apartment. This we did at noon. There was moderate bleeding from the nose and mouth; the foetid odor was very bad. R. cleaned the area surrounding the opening, removed some blood clots which were sticking to the surface, and suddenly pulled at something like a thread. He kept right on pulling, and before either of us had time to think, at least half a meter of gauze had been removed from the cavity. The next moment came a flood of blood. The patient turned white, her eyes bulged, and her pulse was no longer palpable. However, immediatelyafter this he packed the cavity with fresh iodoform gauze, and the hemorrhage stopped. It had lasted about half a minute, but this was enough to make the poor creature, who by then we had lying quite flat, unrecognizable. In the meantime, or actually afterwards, something else happened. At the moment the foreign body came out, and everything had become obvious to me, immediately after which I was confronted with the sight of the patient, I felt sick. After she had been packed, I fled to the next room, drank a bottle of water, and felt rather miserable. The brave Frau Doktor then brought me a small glass of cognac, and I felt like myself again.

R. remained with the patient until I arranged to have both of them taken to the Loew Sanatorium by S. Nothingmore happened that evening. The following day, i.e. yesterday, Thursday, the operation was repeated with the assistance of Gersuny. The bone was broken wide open, the packing removed, and the wound curetted. There was hardly any further bleeding. She had not lost consciousness during the severe hemorrhage scene, and when I returned to the room somewhat shaky, she greeted me with the condescending remark: “This is the strong sex.”

I don’t think I had been overwhelmed by the blood; affects were welling up in me at that moment. So we had done her an injustice. She had not been abnormal at all, but a piece of iodoform gauze had gotten torn off when you removed the rest, and stayed in for fourteen days, interfering with the healing process, after which it had torn away and provoked the bleeding. The fact that this mishap should have happened to you, how you would react to it when you learned about it, what others would make of it, how wrong I had been to press you to operate in a foreign city, where you couldn’t handle the aftercare, how my intention of getting the best for the poor girl was insidiously thwarted, with the resultant danger to her life — all this came over me simultaneously….

The tearing off of the iodoform gauze was one of those accidents that happen to the most fortunate and cautious of surgeons…. Gersuny mentioned that he had had a similar experience, and that he therefore used iodoform wicks instead of gauze…. Of course, no one blames you in any way, nor do I know why they should. And I only hope that you will come as quickly as I did to feel only pity. Rest assured that I felt no need to restore my trust in you. I only want to add that I hesitated for a day to tell you all about it, and that then I began to be ashamed, and here is the letter.

That this, and all other letters pertaining to the Emma episode, had been omitted from The Origins of Psychoanalysis is hard to justify from the point of view of scholarship but easy to understand from that of filial piety. Freud does not shine in this story. He doesn’t come out as badly as Fliess does, of course, but in his eagerness to exonerate his friend he betrays a callousness toward his patient that, for once, causes the reader of Freud’s letters to withhold some of his sympathy. Freud’s own dealings with Emma may well have been exemplary — or as exemplary as they could be under the circumstances — but his letters to Fliess about Emma are lacking in the quality that caused Kurt Eissler to give his review of a collection of Freud’s letters the title “Mankind at Its Best.” When, after describing the ghastly scene of the discovery of the gauze in Emma’s nose, Freud can wring his hands over “the fact that this mishap should have happened to you” (italics Schur’s and mine), the reader scarcely knows where to look.

Schur’s own idea in publishing Freud’s letters about the Emma episode was not to show Freud in a poor light but, rather, to illustrate the power of the transference in his relationshipto Fliess. It was Freud’s urgent need to believe in Fliess, to think of him as infallible, that blinded him to reality and prevented him from seeing how badly Fliess had botched the case. As time went on (and poor Emma was finally out of danger), Freud progressively downgraded Fliess’s culpability, and finally was able to persuade himself that it was Emma herself, and not Fliess, who had been at fault. In a letter of April 16, 1896, Freud promises Fliess that he will soon tell him of “a quite surprising explanation of Emma’s hemorrhages, which will give you great satisfaction,” and on April 26 he writes, “You were right; her hemorrhages were hysterical, brought on by longing.” Emma, who had (inexplicably) gone back into treatment with Freud, had revealed to him that she had a long history of hysterical nosebleeding. In a letter of May 4, Freud happily tells Fliess of Emma’s confession that in the sanatorium, after the incident of the removal of the gauze, “she began to feel restless out of unconscious longing and the intention of drawing me to her side.” He continues, “And since I did not come during the night, she renewed the hemorrhage as an unfailing means of reawakening my affection. She bled spontaneously three times, and each hemorrhage lasted approximately four days, which must be significant.” Schur dryly comments, “Nowadays, we would of course expect a careful hematological work-up to establish what kind of ‘bleeder’ Emma was. But in this letter Freud was—without mentioning it — continuing with the exculpation of Fliess! The iodoform gauze was buried and forgotten!”

Schur cites a few more references to Emma (in letters of 1897), in which Freud tells Fliess of sadistic, blood-ridden, and evidently imaginary “scenes” that Emma recounted in her analysis. “It would therefore seem that Emma was one of the first patients who offered Freud a clue to the crucial realization that what his patients had described to him as actual seduction episodes were fantasies,” Schur notes. He does not push the point. He hovers near, but does not alight on, the possible connection between Freud’s wish to believe that Fliess’s horrendous error had never happened (or, at any rate, had had no consequences) and his repudiation of a theory that traced hysteria to actual body-and soul- damaging events in favor of one emphasizing the power of fantasy. The connection that Schur skirted was the one that Masson pounced, on and held up as conclusive evidence of Freud’s intellectual shabbiness. When I met with Masson the next day, he declared, with characteristic hyperbole, “In my opinion, Emma Eckstein is the single most important person in the history of psychoanalysis. She was the first victim of psychoanalysis, and one of the great heroines of twentieth-century thought. Her story is the wedge that is going to topple psychoanalysis. When analysts read my book The Assault on Truth, in which Emma will loom very large, they will ask for my neck, I assure you. They will say, ‘He was bad enough at Yale, he was worse in those articles in the Times, and now he’s utterly impossible. The man must be murdered.’ I won’t be surprised if the analytic mafia puts out a contract on me.” He laughed gleefully, and went on, “Freud abandoned the seduction theory because he couldn’t face the truth about what Fliess had done to Emma. He needed to believe that Fliess was innocent and Emma was guilty. So he developed the theory that all patients lie — they they are made sick by their fantasies, and not by anything real that has happened to them. He gave up a very powerful theory for a lesser one in order to exculpate his friend. He did it unconsciously, of course, and he did it for other reasons as well — I went into some of those in my Yale lecture—but he did it, and ever since then analysts have been denying the realities of their patients’ lives. When Freud abandoned the seduction theory, it was the death of psychoanalysis. The received truth is that it was the birth of psychoanalysis, but it wasn’t; it was the end, and, deep down, all analysts know it was the end. That is why they all feel like such frauds. They do analysis because it’s good business, but in their innermost souls they feel utterly fraudulent. If I sat down with any analyst for a few days and grilled him and really pushed him, he would admit that he doesn’t like what he’s doing, that he doesn’t believe in it, that in some deep sense he feels dishonest. I know that’s how they all feel. I know that even Freud himself felt like that after he abandoned the seduction theory.”

stem: janet malcolm
perspectief: In the Freud Archives, a story of scandal and power-struggle in the cloistered inner sanctum of New York psychoanalysis, is one of modern literature’s most original books. It begins with such deliberateness and subtle energy that it seems as if the words had always been there, waiting for the author to discover them. The comparison that most easily – too easily – springs to mind is with a great novel, whose opening sentences are often a fatality out of which the tale unfolds along inexorable lines. But In the Freud Archives is a work of non-fiction, which means that its beginning is really an end, the end-product of an insight arrived at by means of a long journey through actual circumstances and real events. A journey, in other words, not unlike psychoanalysis itself, which is the infinitely resonating context – one should more accurately say pretext – of Malcolm’s strange masterpiece, first published in the pages of the New Yorker twenty years ago, and then as a book the following year. – Lee Siegel
titel: part one, chapter 4
bron: in the freud archives (1983, 1997)
mopw: meerstemmige encyclopedie / freud