Hilda Reilly's Blog: The Writing of Guises of Desire, page 2

Giving a Voice to the Unvoiced

The author of a biographical novel treads through a historical minefield. Get a fact wrong and the historians are up in arms; the validity of the entire work is compromised. Yet there is always more than one side to a story and in the past it has usually been the male side that has been able to make itself heard. This is particularly true of the medical case history. Here it is the doctor's voice which has always been to the fore, and again, until fairly recently, this has been a male voice. Medical historian Roy Porter draws attention to what he calls the 'patient-shaped' gap in medical history, pointing out that histories of epilepsy and hysteria exist, but none by epileptics and hysterics.
When I set out to write a novel about Bertha Pappenheim, the young woman diagnosed as hysterical who later came to be considered the 'founding patient' of psychoanalysis, it was with the hope that I might contribute to the filling of this gap. Of course, I can't know exactly how Bertha felt or thought; we are separated by a wide gulf of time and culture. But I could research the case to the best of my ability and put forward a reasonable hypothesis, which is no less, after all, than her own doctor was doing, not to mention the many therapists since then who have written about her.
My feeling from the beginning was that Bertha's condition was due to a multiplicity of factors, the principal one being neurological. One of the advantages I have had over earlier writers, including Bertha's own doctor, Josef Breuer, is that much more is now known about neurological disorders. In the 1880s, the time of her illness, there was still a general ignorance about this subject, even among the medical fraternity. In the case of Bertha, it now seems likely that a number of her symptoms could be attributed to a form of temporal lobe epilepsy, as suggested by Alison Orr-Andrawes.To get an idea of what it could be like to be experiencing such symptoms I researched personal accounts of present-day sufferers. This not only helped me in fleshing out the lived experience of Bertha, it also strengthened my suspicion that she did indeed have this form of illness.
It is likely that Bertha also had psychological problems as she was an intelligent young woman deprived of educational and career opportunities. With the greater understanding we now have of women's frustrations in this respect is not difficult to imagine how this could have impacted on her emotional state. She was also undoubtedly affected by the large amounts of chloral hydrate and morphine which she was taking, something which Breuer admitted but did not discuss in relation to her symptomatology. Finally, there was very probably a iatrogenic element. There is every indication that the 'talking treatment' generated a strong transference, with Bertha becoming extremely dependent on Breuer emotionally. Again, this is not something dealt with in the two published case histories.
The biographical novel can never claim to be as faithful to reality as an autobiography — though how many of those are true representations rather than accounts of how the author would like to be perceived? — but at least it can give a voice to the unvoiced, those who, for whatever reason, were unable to tell their stories themselves.

Fiction, truth and theory

Last year a BBC news article drew attention to a number of myths about the sinking of the Titanic that have been perpetuated by the various film versions. Stories such as the blocking of the escape routes of the steerage passengers, or of the band playing 'Nearer, My God, to thee' as the ship went down, based on flimsy or non-existent evidence, have proved too popular to allow the record to be set straight. Film makers, unwilling to let truth stand in the way of a good story, have felt free to impose their own agenda on the events.
Bertha Pappenheim has been similarly traduced. It seems now to be an integral part of her history that, shortly after Breuer stopped treating her, he was called back urgently to find her in a state of pseudocyesis (hysterical pregnancy), imagining that she was giving birth to Breuer's child.
Few people would still maintain that Bertha was cured when Breuer's treatment ended in 1882. It is known that shortly after his final visit Bertha was admitted to a clinic in Switzerland where she remained for several months, being treated for morphine addiction and recurrences of earlier symptoms. Further spells of hospitalisation followed. Yet the story of the hysterical pregnancy is still widely subscribed to, particularly by therapy professionals and academics who find in it a rich seam of interpretations to be mined according to their own particular school of thought.
Anna O: Fourteen Contemporary Reinterpretations provides some interesting examples. There we find:
• James Masterson M.D. wondering if the pseudocyesis signified 'a breakthrough in which the patient was finally able to accept the feminine role involving impregnation and childbirth', or if it represented 'a virgin birth', or the 'condition on which she could separate from Breuer, or 'the enactment of what she most feared - that a man would seduce, impregnate, and abandon her';
• Joseph Martorano, psychopharmacologist, speculating that medication would have lessened the transference and thus probably prevented the pseudocyesis;
• Anne Steinmann, psychoanalyst, claiming that 'with a female analyst it is quite unlikely that Anna O. would experience the hysterical childbirth she did when working with Breuer, as her sexual fantasies would be explored directly';
• Hyman Spotnitz, psychiatrist and psychoanalyst, putting forward the theory that the pseudocyesis was a recreation by Bertha of the recent pregnancy of Breuer's wife.
The pseudocyesis first made its appearance in a letter from Freud to Stefan Zweig in 1932. In it, Freud outlined the story as something he had reconstructed on the basis of what he had guessed as a result of something he had remembered Breuer telling him in a different context. So already the links in the chain of reasoning are looking tenuous. Freud went on to say that he had been so convinced of the truth of his conjecture that he had published it somewhere. The 'where' of the publication was never specified, but Freud backed up his claim to its veracity by saying that Breuer's daughter had shown the account to her father shortly before his death and that he had confirmed it. However, there is no record of any such account ever having been published by Freud.
The story finally entered public circulation with the appearance of Ernest Jones' biography of Freud in the 1950s. Since then it has gone from strength to strength in providing grist for the psychoanalytic mill, despite being shot down by medical historians such as Albrecht Hirschmuller and Henri Ellenberger.
Did Freud believe in his own 'reconstruction'? Possibly. Even if he didn't, he may have felt that it embodied a more general truth, the propagation of which justified the lie.
I think that something dramatic may well have happened at the end of Bertha's treatment by Breuer. Like Freud, I have my own theory about it, and the ending of

Guises of Desire
is based on this theory. But I don't expect it will ever be taken as gospel. Nor should it be. It is simply my theory.

On Historical Validity

“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.