Dora: An Analysis of a Case of Hysteria Themes by Sigmund Freud The Inability to Conceal Unconscious Desires "When I set myself

the task of bringing to light what human beings keep hidden with him,...I thought the task was a harder one than it really is. He that has eyes to see and ears to hear may convince himself that no mortal can keep a secret. If his lips are silent, he chatters with his finger-tips; betrayal oozes out of him at every pore." The quote demonstrates Freud's conviction that despite repression, unconscious desires eventually work their way to the surface. A common example of this phenomenon is what is now known as the Freudian slip or parapraxis. A person will make a verbal mistake that reveals an unconscious thought or emotion. A person may call his spouse by a different name, exposing his attraction for another woman. Unconscious desires are also expressed by nonverbal communication. Freud tells of an instance, in which Dora plays with her handbag during therapy, opening it and repeatedly inserting her fingers. Freud concludes that the handbag was a representation of the female genitals, and Dora's playing with the handbag expressed her desire to masturbate. Sexual Trauma as the Primary Cause of Hysteria In the very first pages of Dora:An Analysis of a Case of Hysteria, Freud asserts that the origins of hysterical symptoms are to be found in the patient's sexual life. Throughout the case study, Freud traces Dora's symptoms back to unresolved sexual issues. Her irritated throat is caused by her identifying with Frau K. and imagining her and her father, engaged in oral sex. Her loss voice is due to her longing for Herr K. when he periodically leaves her alone at B--. Her appendicitis was rooted in her imagining that she was pregnant after her incident with Herr K. Freud's emphasis on sex is consistent with his other work. Freud believed that the libidinal drive was one of the prime motivators of human behavior. In addition, one of his most important and controversial contributions to modern psychology was his assertion that from infancy children began to have sexual desires. Transference The phenomenon of transference was one of Freud's most significant discoveries. Freud found that people create templates of people whom they have met and place new people into those templates. For example, if one's father was critical and mean, one may have the tendency to think that all older men are critical and mean. In addition, Freud discovered that the people had a need to reproduce elements of the old relationship with the new person. If a person associates older men with his unkind father, then that person may treat older men in a hostile fashion. During psychoanalysis, it is common for the patient to redirect emotions and sexual feelings held for one person to the therapist. Although transference appears to inhibit therapy, it can also be a useful tool. A psychoanalyst could get the patient to realize that he or she was transferring emotions and thus could work through problems that had been confined to the unconscious.

The Struggle Between Patient and Analyst Throughout the case study, Dora disagrees with Freud's interpretation of her life. She insists that she is not in love with Herr K. although Freud remains convinced on this point. Dora finds herself in a particularly frustrating and helpless situation as Freud claims to know Dora's unconscious better than she does herself. As the psychoanalyst, he allegedly has the tools to uncover hidden desires, and this authority gives added weight to his analysis. Even when Dora says "No," Freud can conclude that she really means "Yes, claiming that there is no thing at all as an unconscious "No." This obvious struggle between Freud and Dora in the course of her case has been a point of interest in later studies of the case study. Feminist critics, in particular, have interpreted Freud's insistence on the correctness of his readings of Dora's unconscious - outlandish though they seem at times - as patriarchal and belittling. Homosexuality In a footnote to the case study, Freud argues that he underestimated Dora's homosexual love for Frau K. and calls this attraction, "the strongest unconscious current in her mental life." It is unsurprising that Freud realizes the intensity of Dora's homosexual feelings only at the end of the case study. Although Freud challenged contemporary notions of homosexuality, it remained an abnormal and somewhat unexplained phenomenon in his theory of sexual development. Unlike other psychoanalysts of his day, Freud did not view homosexuality as an illness and did not believe that it could be cured. Freud moved forward common thinking on homosexuality, but could not integrate it completely in his narrative of sexual development, the Oedipus complex. For Freud, the Oedipus complex is the source of sexuality as feelings that were held for one's parent are later redirected to other members of the opposite sex. While the Oedipus complex explained heterosexuality, Freud lacked an equivalent theory of homosexual development. Dreams The focus of Dora: An Analysis of a Case of Hysteria is dream analysis. Freud believes that Dora's dream will provide insight into her unconscious desires and thus help to resolve her hysterical symptoms. Freud's method for interpreting a dream is to allow the patient to retell the dream and to associate it freely to its elements. The technique of free association is notable in its flexibility. Meanings are discovered during the course of psychotherapy as the patients say whatever comes to mind. Although at times Freud is content with discovering a dream's meaning, in other instances he appears more fixed in his interpretations. For instance, in Dora's first dream, Freud insists that the jewel-case is a symbol for a vagina and thus rejects any alternative meaning. Repression and the Unconscious The unconscious can be thought of as a storage area for repressed desires. Despite their place outside of conscious thought, these desires are full of emotional charge and constantly seek a means of expression. For a hysteric, repressed desires are manifested through his or her symptoms. In the case study, Freud aims to uncover Dora's repressed desires and thus stop their unconscious expression on her body

About Case Study in Psychoanalysis Psychoanalytical casuistry is perhaps the most exciting domain of psychoanalysis. This is because when reading a case analysis, we see haw and why, and are usually inclined to apply the psychoanalytic methods of approaching the psychic disorders upon ourselves. The casuistry published on this site, nevertheless, is no easy job. For lay persons (beginners or others without any prior experience with the psychoanalytic statements) much of our psychoanalytic work may seem rather uncertain. That is why case publishing requires a lot of skill from us, the more so as the unconditional discretion rule regarding the personal life of those subjects of such cases must also be met. In addition, the specific conditions for website publication impose a limitation of editing space so that no comprehensive account of the patient personal history will therefore be available. Everything is limited to a few hints the author of the article (and of the analysis too) provides hoping to render the background of the case as complete as possible. The following is the first case that shows how we actually approach our patients A Case with a Legacy: By I.D. Hora The best method to acquire the psychoanalytical technique is to allow yourself to be psychoanalyzed. Just as with swimming, there's nothing you can do unless you go beyond theoretical information and dare dive to see the why and the how for yourself... No matter how much we tried to simplify things, when the uninitiated are introduced to psychoanalyzed cases, we have to keep in mind that eloquence alone cannot replace the live experience of self-analysis. Our readers will certainly understand the impediment. An example of successful analysis in record time will get us somewhat acquainted with the psychoanalytical technique. Several other illustrations will follow, without pretending to bring the subject to a close. Ours is the case of a lady we shall call Amelia, about 35, married and the mother of a 10-year old; she works for an important company in X. The woman complains of a troublesome symptom: persistent insomnia. "persistent", as it defies any kind of

conventional treatment. "Night after night, I make desperate efforts to sleep". She succeeds towards dawn, when, actually exhausted, she finally falls asleep. To her sleeplessness, there adds a weird mood of apprehension, an uneasiness psychoanalysts use to call anxiety. My question is: - What brings about this condition? - Something like an anticipation; as if I were expecting something and were not sure what... - Would you please try to remember some circumstance when you experienced the same thing? I insist. - Exams, maybe, when I was at school? Or, Christmas Eve rather, when I used to wait for Santa. Or, why not, when I would plan a trip or a celebration and would eagerly count every minute to it... - Any trouble at work, I ask, any tests, exams for a higher position or things like that? - None, came the unwavering reply, nothing special. I then inquire about Amelia's economic standing. I find both she and her husband earn enough to make a decent living. There would be room for some additional income, though. "You know how it goes", she adds, " the more you have, the more you want". I consider the associations Amelia has made concerning her anxiety. Exams, Christmas, Santa, family celebrations and reunions with friends etc. Anxiety is obviously a state of anticipation, just like when you are looking forward to an extremely important event you crave for. But what could that event be? Let us also keep in mind her insomnia, suggesting the same powerful, irrepressible experience. Sleeplessness and anxiety go hand in hand. Both are indicative of an intense concentration of emotions towards a certain direction we expect a lot from... Psychoanalysts often need moments of insight, more precisely the feeling they know what a certain case is about. Theirs is an intuitive job (which we also call empathy). That "clairvoyance" urges us to articulate it and, obviously, ask patients the key question giving instant clarification to the nature of their disturbance. In this case, the question I asked was: - Do you happen to have a dying relative, are you looking ahead to some inheritance? The answer was immediate, betraying Amelia's bewilderment: - Yes! It's my uncle, she assured me, he's over 80 and he's awfully rich! - Are you his heiress? - His one and only heir!, she specified. - Your case is solved then, I replied. Your eagerness to get the inheritance is to blame for both your insomnia and your anxiety. Given your uncle's age, you think the long dreamed-of moment for getting your heritage is drawing nearer by the day. Hence your anxious anticipation and sleeplessness, betraying your wish for this

moment to arrive as soon as possible, just as you used to eagerly wait for your Christmas presents Note. Not all cases are solved on the first session. The case above was a "fortunate one", which is a rare occasion. But let us keep one thing in mind: although aware of her own wish (to lay hands on the inheritance), the patient was unable to relate it to her symptoms; hence her concern for her own health. The meaning of her symptoms clarified, Amelia was reassured (the enigma of the disease itself is reason for concern) and she was finally able to get back her wholesome sleep. -This paper has been first published in the psychoanalytic journal OMEN, editated by the Romanian Association for Psychoanalysis Promotion. The English translation is made by Mihaela Cristea.

Billy's Dream
Billy is a 25 years old young man, a skilled worker in an economic unit. He has had a girlfriend for about 5 years and wants to marry her. He is a straight, modest man, gifted with a native intelligence. He approached me about a dream he wanted me to interpret. He knew I was dealing with psychoanalysis, that I interpreted dreams and wanted my help from the bottom of his soul. He was observing for a while some alarming changes in his life, in his way of being. From a courageous guy, proud of his physical power, he became a coward, a depressed and very confused person. The dream, he thought, must have something to do with this behavioral change. The dream, actually a short visual impression, was the following: Billy was helplessly watching a torrent of blood flooding the room through the window. It made him all wet, while he was just standing still, not knowing what to do! * We have already observed that the blocking feelings encountered at the end of the dream are also found in the awareness state. Billy became an undecided, confused man in the most common life situations. We conclude that the dream refers to his behavioral change. I ask him about the wave of blood, about its meaning. (1) He does not know what to say. He has no suggestion about this scene. It seems that our interpretation does not stand a chance. We have no association from the real life to Billy's dream. After some free discussions I find out that Billy has wanted, for a long while, to have a child with his girlfriend. For him the child is a symbol of his virile force. I also find out he could not have had this child up to now. As I insist on the subject, he tells me that he recently had again the confirmation he was not to be a father: her girlfriend had her period. So here is the interpretation of the dream: the wave of blood is an allusion to his girlfriend's period, and, implicitly, to the fact that Billy did not make her pregnant. I find out more details about his intimate problems. The fact that the blood spreads over him emphasizes the idea that he would be to blame for the negative result. (I was to find out later on, that Billy's girlfriend was to blame.) This imaginary guilt is at the bottom of his behavioral change. Billy, as many other men, associated virility with fertility. This is the reason why he lost all his self confidence and self esteem from the

moment he had again the proof that he would not have a child. It was as he had to admit he was not a man! * I published this dream with the purpose of illustrating the use of the dream analysis in the psychoanalytical work. We thus observe that Billy's dream is determined by the feelings of fear concerning his virility. But the object of this fear - the idea of virility - was repressed and the anxiety related to it remained suspended and lived as a feeling without any meaning. Unrelated to anything in particular, it is difficult, if not impossible, to remove it. But the dream and the analysis brought us up front its cause and thus we could work on it. * Conclusion: psychoanalysis approaches its cases starting from the principal of the analysis of the unconscious. The feelings, the experiences, the ideas as well as other repressed psychical contents can come back in the shape of neurotic symptoms and disorders. Also, many behavioral disorders, as it is the case here, find their roots in repression. Psychoanalysis approaches the repressed and asks the patient to integrate consciously what it is rejected from his conscious mind. The analysis of dreams is a big step in the work of integration of the unconscious, repressed, material. Notes: 1. When we work with dream in the analytical procedure, we usually collect the associations of the dreamer. See also the article on how we deal with dream in psychoanalysis here. -Paper by Jean Chiriac