Freud saw his new clinical procedure as a method for giving voice to wishes and impulses whose repression had failed, giving rise to unbearable internal conflict and guilt that expressed itself in nervous illnesses – somatic conversions, phobias, obsessional rituals and even paranoid psychoses.
But there is much to suggest that from the first, Freud saw in psychoanalytic method more than a way of inducing his subjects to recognize their inner deviancy. Reading his earliest clinical case histories, set out in the 1895 Studies on Hysteria, co-authored with the Viennese physician Josef Breuer, what emerges is the almost accidental discovery of a means of cultivating the patient’s own voice.
The Studies read as a kind of prehistory of psychoanalytic theory and technique, tracing the faltering path by which Freud arrived at some of his key premises regarding not only hysteria, but the structure and workings of the mind more generally. At its centre are five case histories of female patients, each displaying symptoms of bodily and mental breakdown: disturbances of vision, temporary paralyses, vomiting, auditory and visual hallucinations, tics, phobias, deliria, each frequently accompanied by unexplained pains in one or other part of the body.
These so-called ‘neurotic’ patients show some markedly borderline and even psychotic features. You might wonder how these women of the fin-de-siècle Viennese haute-bourgeoisie, with their freakish bodily symptoms and crippling social anxieties, could speak to us in the socially and sexually liberated twenty-first-century West as any more than quaint historical curiosities. There may be little resonance for a contemporary reader in the content of these women’s stories. And yet something in their histories cuts across the yawning historical gap – less what they say than their struggle to say it. Under Freud’s often uncertain gaze, these women are transformed from a sum of intractable symptoms to be resolved into individuals caught inside the impenetrable darkness and incomprehensibility of their own experience, struggling to find some kind of voice, however faltering and incoherent, to make that experience meaningful to themselves and one other. This is the struggle that I bear witness to on an hourly basis in my consulting room and that makes immediate contemporaries of these troubled voices from the distant past.
The second of the cases, ‘Miss Emmy von N.’, and the first to be treated by Freud (the previous case, Anna O., who would be retrospectively identified as the first psychoanalytic patient, was treated by Breuer), is a widow of forty. When Freud takes her on in spring 1889, she has been suffering from bouts of nervous illness for some fourteen years. She stammers and clasps her fidgety fingers tightly together, while her face and neck jerk in convulsive spasms and her mouth produces persistent involuntary ‘clacking’ noises. She seems a kind of living attestation to Freud’s summary formulation: the ego is not even master in its own house. She lives in a state of frightened subjection to the torments inflicted by her own body and mind. Her passivity seems confirmed by her ready assent to Freud’s suggestion that she leave her two daughters with their governess and convalesce in a nursing home, where he will visit her every day.
What this and the other case histories in the Studies show us is Freud’s pained efforts to wrest new ways of thinking about, and with, his patients from the imaginatively constricting terms of established psychiatry. As a relatively young and inexperienced practitioner, he follows the prescribed procedures of his day for treating hysteria in women, in this case the Weir–Mitchell ‘cure’ (a practice rendered notorious some years later by American feminist Charlotte Perkins Gilman’s fictionalized memoir The Yellow Wallpaper), in which patients were consigned to an open-ended period of total rest, ‘feeding’ and a strict moratorium on mental stimulation. To this treatment Freud adds the use of hypnosis as a means of discovering the sources of her symptoms.
For all their differences, both the rest cure and hypnosis intensify the patient’s tendency to compliance. Yet what Freud unearths in questioning her under hypnosis is that it’s this very tendency that is at the heart of Emmy’s illness. In one of their first hypnotic sessions, he asks her about the source of her terrors, and is answered with a memory from her sixth year: First when I was five years old and my brothers and sisters often threw dead animals at me. That was when I had my first fainting fit and spasms. But my aunt said it was disgraceful and that I ought not to have attacks like that, and so they stopped. What Emmy recalls, in other words, is a prohibition imposed on her most urgent and overwhelming emotional responses. Internalizing this prohibition has made her ill, torn internally by the conflicting imperatives to express and suppress her states of feeling.
Emmy’s imperative to comply inevitably extends into her role as patient. She assents without the slightest demur to her doctor’s orders, and proves an excellent subject for hypnotism, falling under his spell with the raising of a finger and the order to sleep. Hypnosis, as Freud would come to see, is a means of mastering and coercing the subject’s unconscious, of accessing it, as it were, in her absence. The hypnotic state gives Emmy the power of recall over the scenes of death and terror which have been exerting such traumatizing power over her, and enables Freud in turn to wip[e] away these pictures, so that she is no longer able to see them before her. Emmy passively submits her unconscious, in other words, to the authority and judgement of the doctor.
But as the treatment continues, something quietly remarkable starts to happen. The material that she produces, both under hypnosis and in her normal waking state, begins to interest Freud as more than a kind of psychic toxic waste that needs to be disposed of. Indeed, in spite of the claims he makes on this score, it seems that what surfaces under hypnosis, far from being wiped from her waking
consciousness, is now more readily accessible. The compulsive symptoms with
which she once responded to Freud’s questioning now give way to complete
reproductions of the memories and associated impressions of previous sessions.
These recollections, he writes, often lead on, in a quite unexpected way, to pathogenic reminiscences of which she unburdens herself without being asked to. It is as though she had adopted my procedure and was making use of our conversation, apparently unconstrained and guided by chance, as a supplement to her hypnosis.
But was this free and undirected talk a mere supplement to the hypnosis? In fact, her spontaneous elaboration of her memories seems to subvert rather than supplement hypnotic suggestion. For the hypnotized subject, there is no traffic between the unconscious and conscious regions of the mind – hypnosis depends for its effectiveness on the latter being made inert, and so on a distinctly authoritarian relationship to the subject’s unconscious. In contrast, this moment of unconstrained conversation, perhaps, as Freud’s English translator and editor James Strachey remarks in a footnote, the earliest appearance of what later became the method of free association, comes to facilitate a newly self-assertive tone in Emmy’s attitude to Freud.
But was this free and undirected talk a mere supplement to the hypnosis? In fact, her spontaneous elaboration of her memories seems to subvert rather than supplement hypnotic suggestion. For the hypnotized subject, there is no traffic between the unconscious and conscious regions of the mind – hypnosis depends for its effectiveness on the latter being made inert, and so on a distinctly authoritarian relationship to the subject’s unconscious. In contrast, this moment of unconstrained conversation, perhaps, as Freud’s English translator and editor James Strachey remarks in a footnote, the earliest appearance of what later became the method of free association, comes to facilitate a newly self-assertive tone in Emmy’s attitude to Freud.
The following session strikes a further blow against Freud’s hypnotic authority. He discovers that the general prohibition he had placed on her hallucinatory animal deliria by hypnotic suggestion had been ineffective, and that I should have to take her frightening impressions away from her one by one. In the process, he asks her about the source of her gastric pains, believing them to accompany the hallucinations. When she replies, rather grudgingly, that she does not know, he requests that she remember by tomorrow. She then said in a definite grumbling tone that I was not to keep on asking her where this and that came from, but to let her tell me what she had to say. I fell in with this, and she went on without preface.
The virtue of Freud’s response to this rebellion is that he doesn’t think to take it personally. He is, quite simply, too interested in what’s happening to worry unduly about his wounded authority as man and doctor. Emmy’s insistence that her speech must be allowed to flow uninterruptedly, and her allied refusal to let the doctor set the terms of discussion, become for him sources of insight rather than anxiety. His concern is not to recover his pride, but to explore the possibilities opened up by his humiliation. Out of this imaginative leap comes the realization, at once radically new and breathtakingly simple, that therapy should proceed by the patient telling him what she has to say, and by his listening to her.
This listening will be governed by more than close attention. It will mirror the free, undirected movement of the patient’s talk. Rather than identify in advance the information sought for, or asking her where this or that came from, he must wait to hear what she is trying, perhaps without knowing it, to tell him. It is a matter not simply of letting the patient speak her mind, but of letting her mind speak. It demands a stance of receptivity to, rather than control over, the meandering drift of her speech, a stance he will describe seventeen years later as a surrender to his own unconscious activity.
Emmy’s insistence on Freud listening to her tell what she has to say comes to be heard by him as more than an assertion of her rights as a woman or a patient. She is demanding not only that her suppressed voice be heard, but that it be listened to differently, with an ear unconstrained by existing psychiatric practices which confine and control the body and the imagination alike. She calls for a hearing for the unexpected and unknown in ourselves, for what can be heard only when we don’t already know what we’re listening for.
Later on in the Studies, Freud will discuss the surprising implications of this new mode of speaking and listening for how the case histories of the mentally ill are written about:
I have not always been a psychotherapist. Like other neuropathologists, I was trained to employ local diagnoses and electro-prognosis, and it still strikes me myself as strange that the case histories I write should read like short stories and that, as one might say, they lack the serious stamp of science. I must console myself with the reflection that the nature of the subject is evidently responsible for this, rather than any preference of my own. The fact is that local diagnosis and electrical reactions lead nowhere in the study of hysteria, whereas a detailed description of mental processes such as we are accustomed to find in the works of imaginative writers enables me to obtain at least some kind of insight into the course of that affection. Case histories of this kind are intended to be judged like psychiatric ones; they have, however, one advantage over the latter, namely an intimate connection between the story of the patient’s sufferings and the symptoms of his illness – a connection for which we still search in vain in the biographies of other psychoses.
Freud not only announces the birth of the modern clinical case history, he offers a theory of its literary form, a form that turns out to be involuntary, the effect of a kind of possession on his part by the hysteric’s speech. He tells us that his training encouraged him towards the isolation and diagnosis of the hysterical symptom, and thereby towards the submission of the hysterical patient to the rigorous clinical and conceptual discipline of the doctor. And yet in the end it is the doctor who must submit to hysteria. The cases seem unnervingly to dictate their own form, indifferent to any preference of Freud’s own, and as such render themselves strange even to their own author. The hysterical symptom simply remains mute in the face of those who would know it as a determinate, observable datum, electrical or otherwise. Doesn’t Emmy say as much when, in response to Freud’s question as to why she doesn’t know the origin of her stammer, she violently and angrily responds, because I mayn’t? What she protests against is the reduction of her inner life to the dimensions of a bald answer. In asking where her stammer originates, Freud is raising the rather more monumental question of why she is who she is. There is, Emmy shows him, no instant answer to such a question. If he really wants to know, he will have to let her tell what she has to say.
Such free-form speaking and listening, Freud implies, mock the vaunted seriousness of science by coaxing it into association with literature, and so with the kind of airy imprecision science properly defines itself against. Most worryingly of all for the doctor’s authority, it demands an immersion in the singular texture of the patient’s inner life. The symptom yields its secret only by telling its own story.
引自 精神分析的诞生：弗洛伊德如何「让无意识自己说话」以Emmy'case为例
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