Hilda Reilly's Blog: The Writing of Guises of Desire - Posts Tagged "freud"

“Dear Hilda R., I`m sorry but I just can`t stand biographical novels. For the historian, they are a pollution, plain and simple. So I do not see I can be of any help to you. Sincerely, ------------”

I received the above email from a well-known Freud historian in response to a request I had made for help while researching Guises of Desire,a biographical novel based on the life of Bertha Pappenheim, the 'founding patient' of psychoanalysis. Interestingly, it homed straight in on the essence of my project. When I set out to write the book my aim was as much investigatory as creative. I wanted to find out what kind of picture would emerge if the account provided by her doctor, Josef Breuer, was brought to life. I was also curious to see if this picture would be credibly consistent with the ideas which Breuer and his friend Sigmund Freud developed on the basis of that account. In the event, I found that the process of narrativisation turned out to be a research tool in itself.
My primary sources were two case histories written by Breuer:
• the 1882 Case History, addressed to the director of the clinic where Bertha was hospitalised after Breuer stopped treating her
• the 1895 Case History, which appeared in Studies on Hysteria, published jointly by Breuer and Freud.
I decided to focus primarily on the 1882 history as the 1895 one was produced more than ten years after the events. Moreover, appearing in the public domain, it would have avoided any features which might identify the patient. A third consideration was that, consciously or unconsciously, it may have been massaged to fit the theories being developed by Freud and Breuer.
My first obstacle was the style of the 1882 history. I found it garbled and rambling, and the terminology imprecise. Although it is true that the case history as a genre was still undeveloped in the 19th century, I have read a number of medical articles from the period from journals such a Brain, The Lancet and The British Medical Journal without encountering any of those problems.
At a more practical level I found that the work of dramatising the case history forced me to examine it from a perspective which had possibly never been brought to it before. The following are just a few examples:
• Breuer (1882) refers to his observations of Bertha’s behaviour during the Hannukah festival of 1880. Because I needed to incorporate details of Jewish daily life in my narrative, I consulted a Jewish calendar for the years in question. In doing so I found that Hannukah, which is a moveable festival, occurred in November of 1880, before Breuer’s treatment of Bertha was underway.
• At times Bertha spoke only in English. Breuer (1895) claimed to have communicated with her in this language, and described her English as ‘admirable’ and ‘excellent’. Yet there is no evidence from Breuer’s educational records, listed in detail by his biographer Albrecht Hirschmuller, of his ever having learned English although his study of other languages is noted.
• The presenting symptom was a severe cough, one which lasted during Bertha’s illness until the original problem (hearing dance music while she was caring for her sick father) was discovered. This cough, diagnosed as hysterical, was reportedly triggered every time Bertha heard rhythmic music. But given that Bertha was housebound for much of this period, in a pre-gramophone/radio era, it is difficult to see how she could have been exposed to the sound of music, apart perhaps from the occasional barrel organ in the street. How, I wondered, could the cough have occurred with such frequency in these circumstances that it was judged severe and requiring medical attention?
• Bertha apparently reported 15 instances of deafness brought on by shaking. Breuer claimed it stemmed from her being shaken by her brother on one occasion when she was listening at the door of her father's sickroom. Again it is difficult to see how she could have had the experience of being shaken at all subsequently when she was ill and housebound.
It is interesting to consider those findings in light of the view expressed in the email above. It would suggest that, in the case of Bertha Pappenheim at least, the ‘historical’ version has no right to claim the veridical high ground.
David Lodge, in The Practice of Writing, discusses the novelist’s struggle between ‘a desire to claim an imaginative and representative truth for their stories’ and ‘a conviction that the best way to secure and guarantee that truthfulness is by a scrupulous respect for empirical fact’. Those were my two guiding principles.

As I neared the end of my novel, the need to decide on a title grew pressing. I had already been through several working titles: Bertha P (unlikely to attract attention, in fact, guaranteed not to); The Story of Bertha P (not much better); A.K.A. Anna O (well, I suppose the name Anna O is more recognizable than Bertha P, but not widely so, and there was also the problem of punctuation: should it be aka, AKA, a.k.a., A.k.a or A.K.A?).

Then the phrase The Various Guises of Desire came to me out of the blue. Now this I really liked. Pleasingly euphonious, with subtle hints of eroticism; perhaps the thinking woman's Fifty Shades of Grey. But could I be accused of misrepresentation? After all, my novel isn't a bodice ripper.

I didn't think so. In fact, it seemed to me highly apt. I don't agree with a lot of Freud's thinking but I do believe he was onto something with his ideas about what he unfortunately termed 'polymorphous perversity', which looms large in my version of the Bertha Pappenheim story. It also chimed with my thesis that Bertha's absence states were associated with a form of temporal lobe epilepsy and that during them she experienced states of mystical rapture.

I put it to the vote on my blog and on facebook. To my disappointment, no one came out in favour of The Various Guises of Desire. On the other hand, several people suggested Guises of Desire as a better alternative.

In the meantime, I had been toying with other ideas.

The Viennese Patient. Catchy enough but what about its significance? Bertha Pappenheim was undoubtedly Viennese - or was she? Her mother was born in Germany and her father in Hungary - but so too were most of the patients of early psychoanalysis. Bertha does not stand out particularly by virtue of her Viennese-ness. Once I'd realised this, the title lost its attraction for me.

I next considered Becoming Anna O. Incorporating Anna O into the title would make it meaningful to a wider range of readers and throw it up more frequently on Google searches. Then I discovered a book titled Becoming Anna. It's not a good idea to give a book a title which is the same as, or similar to, that of another book. Plus, this title was open to the same arguments made against the following one, suggested by a blog reader:

From Bertha P to Anna O.

I thought carefully about this one before deciding that it only covered part of the story. Yes, it summarises Bertha's passage from normal (for the time, place and social setting) young woman to patient treated for a multi-stranded medical condition as depicted by Breuer. But the novel goes beyond that, postulating more than is suggested in the case study and ending when Bertha is nearing the end of her later, and highly successful, professional life. I didn't want her identity to be subsumed into that of the case study.

At the same time I was thinking about the kind of artwork I'd like to see on the cover. That, along with the title, is crucial to getting a book noticed.
The first idea that came to mind was Klimt, a Viennese artist of about the same period as Bertha. I started looking at his paintings. Much as I liked them I felt that they were too well known and too 'strong' in a way which would risk eclipsing the image of the novel itself. Then I came across his sketches. I knew at once that here I would find something which encapsulated the essence of my story. Most of all it was the eroticism conveyed by many of his drawings of naked or semi-nude young women. It struck me that this, above all, is what my novel is about. I was reminded of writer Terri Marie's advice on choosing a title, that it was awaiting discovery and when recognized would instill you with confidence and catalyse the energy of the book - 'like a light shining through the window'. So it was with the Klimt sketches.

I hadn't realised until this point how important the undercurrents of eroticism in my novel are. I had seen it more as simply a many-faceted story. Now I could see that the main driving force is the steadily increasing erotic charge (albeit not always in guises which we would immediately recognise) which leads to the dramatic culmination.
The whole process of searching for title and artwork was like subjecting the content of my novel to study under a microscope. It homed in on what it is principally about, clarified it and enabled me to sum it up.

And in the end I went with the crowdsourced option:
Guises of Desire

"Hysterical a[phasia]…. is characterized by its completeness or, rather, by its absolute character. It is not that the patients are restricted to the use of individual words, but that they are completely speechless, indeed voiceless; not a sound, not a cry comes about."
Sigmund Freud, Aphasie 1888

In my post of 3 May I quoted Josef Breuer's description of Bertha Pappenheim's aphasia. It was of a complex nature and varied over the course of her illness, ranging from the typical telegrammatic speech of Broca's aphasia to the complete loss of her mother tongue, at which stage she could only express herself in other languages, mainly English. How then, in view of Freud's already published view about hysterical aphasia, could he and Breuer be subscribing to the idea that her aphasia was hysterically induced?
Freud was clearly enchanted by his own theories about hysteria, so much so that it seems almost to have constituted a default diagnosis for him. Once convinced that a patient suffered from hysteria nothing would budge him from that conclusion.
In the case of Frau Emmy von N (the second of the cases reported in Studies on Hysteria) the patient displayed, in addition to depression and insomnia, a set of symptoms which would nowadays be recognised as associated with Tourette's syndrome: random interjections and clacking sounds, agitated finger movements, convulsive facial tics and neck spasms. Freud, treating her with the cathartic method developed in discussion with Breuer, elicited from his patient a number of traumatic childhood memories, after which her vocal tics 'were strikingly improved' although they 'were not completely relieved'. This limited success turned out to be 'not a lasting one'. There is nothing surprising in this. Tourette's symptoms are well known to wax and wane, quite independently of any treatment.What is surprising is that Freud didn't even consider the possibility of a neurological cause here as he had known Gilles de Tourette while working with Charcot in Paris, at the very time when de la Tourette first published a paper on the disorder which was to bear his name.
A later, and much more serious, misdiagnosis was made in the case of a fourteen-year-old girl, known only as M-l, who suffered from abdominal pains. Freud diagnosed her as an 'unmistakable' case of hysteria, which he claimed cleared up 'quickly and radically' under his care. The girl died two months later of sarcoma of the abdominal glands.
Freud was still loath to relinquish the hysteria diagnosis. The girl had indeed been a hysteric, he maintained. The hysteria, instead of creating its own symptoms, had simply appropriated for itself the existing pains produced by the sarcoma.
This 'mixed aetiology' explanation has served on other occasions as a get-out clause in the history of hysteria. We see it too in the case of Frau Emmy von N. Finding that the neck spasms were continuing unabated Freud declared that they did not form part of the hysterical picture but were a form of migraine, therefore of organic origin and not susceptible to the cathartic treatment.
It's difficult to see how the mixed-aetiology explanation could be applied to solve the question I started this post with but given Freud's belief in his ability to wriggle Houdini-like out of any diagnostic bind he found himself in he would surely have come up with some rationale.

There is no record of Sigmund Freud ever having met Bertha Pappenheim, certainly not in a professional capacity. However, this has proved no obstacle to the common misapprehension that she was his patient.
Often when I mention that I’ve written a book about Anna O, people will say something along the lines of: ‘Oh, yes, she was one of Freud’s patients, wasn’t she?’ This isn’t really surprising as she is so intimately connected with the history of psychoanalysis. In a sense, she was, as she is sometimes described, ‘Freud’s Anna O’. Her case is the foundation stone on which Freud started to build his theories; and without Freud, Bertha Pappenheim would be known only for her later success as a pioneering feminist and social worker.
Some people may think that it doesn’t matter whether or not Freud was her doctor, in the same way that some people think that it doesn’t matter whether Shakespeare or someone else wrote his plays and sonnets. It matters very much, in fact, and this is why it’s surprising that the misconception about Anna O even extends to the psychotherapy community.
A cursory Google search threw up a few interesting items.
A webpage titled Student Resources in Context has Bertha being treated by both Freud and Breuer simultaneously. In this version the collaboration starts with Breuer telling Freud about Bertha. It goes on to say that ‘during daily visits to Freud and Breuer, the doctors discovered that some of her symptoms were alleviated merely by discussing her memories and the feelings they created in her’. Finally, Freud alone is given credit for the cure with the claim that: ‘When Freud encouraged Anna O to recall a given situation and express the reaction she had earlier repressed, her symptoms vanished.’
Psychotherapist Humair Hashmi goes further. Anna O, he claims, began to express affection for Breuer and tried to put her arms round him. This so alarmed Breuer that he passed the case on to Freud. Nothing daunted, Freud, ‘the fearless pioneer that he was’, regarded this as a challenge and interpreted it as a manifestation of transference which could be used as a means of effecting a cure. Hashmi goes on to say:‘This is what Freud did in Anna’s case.’
An even more surprising misrepresentation is one I discovered when I came across a Wall Street Journal review of a show called Dr Freud’s Cabaret in which Freud takes to the boards with a number of his most famous patients. The show starts with an Anna O number called Chimney Sweeping (Bertha Pappenheim’s term for the talking she did with Breuer) and the review describes how ‘Anna O would hold Freud’s hand while she told him fairy stories and dark fantasies that helped alleviate her psychosis.’ Investigating this further I found that the idea for the show had germinated when the writer was reading Studies in Hysteria as research for a novel. So far so good, but the fact that she had done this research makes it even more puzzling that she could then flout the truth by portraying Anna O’s treatment as being with Freud rather than with Breuer. Artistic licence, you might say. Perhaps. But what really takes the biscuit is that the show was put on at the Freud Museum in London which seems to have been quite comfortable with helping to perpetuate the myth that Freud was Anna O’s patient. It would all be so much neater if she had been, after all. The fact that she was not is possibly, for them, what Al Gore might term ‘an inconvenient truth’.