Accounts of Freud’s treatment of individual clients were key to his work, including the development of psychodynamic theory and stages of psychosexual development. Whilst the psychoanalyst’s use of case studies to support his ideas makes it difficult for us to prove or disprove Freud’s theories, they do provide fascinating insights into his day-to-day consultations with clients and offer clues as to the origins of his influential insights into how the human mind functions:
Perhaps the best known case study published by Freud was of Little Hans. Little Hans was the son of a friend and follower of Freud, music critic Max Graf. Graf’s son, Herbert, witnessed a tragic accident in which a horse carrying a heavily loaded cart collapsed in the street. Five year old Little Hans developed a fear of horses which led him to resist leaving the house for fear of seeing the animals. His father detailed his behavior in a series of letters to Freud and it was through these letters that the psychoanalyst directed the boy’s treatment. Indeed, the therapist and patient only met for a session on one occasion, but Freud published his case as a paper, Analysis of a Phobia in a Five-Year-Old Boy (1909), in support of his theory of the Oedipus complex and his proposed stages of psychosexual development.
Little Hans’ father relayed to Freud his development and noted that he had begun to show an intense interest in the male genitals, which the therapist attributed to him experiencing the phallic stage of psychosexual development. During this stage, the erogenous zone (the area of the body that one focuses on to derive pleasure) switches to the genitals. At this stage, signs of an Oedipus complex may also be observed, whereby a child competes with their father to retain their position as the central focus of their mother’s affection. Freud believed that this was supported by a fantasy which Little Hans had described, in which a giraffe and another, crumpled, giraffe entered the room. When the boy took the latter from the first giraffe, it objected. Freud believed that the giraffes symbolised his parents - the crumpled giraffe represented his mother, whom he would share a bed with when his father was absent, and the first giraffe was symbolic of his father. Children may also develop castration anxiety resulting from a fear that the father will castrate them in order to remove the threat that they pose to the parents’ relationship.
The boy’s fear of horses, according to Freud, was caused by a displacement of fear for his father onto the animals, whose blinkers made them resemble the man wearing his glasses.
Freud believed that Little Hans’ fear of horses disappeared as his described fantasies that indicated the resolution of his castration anxiety and an acceptance of his love for his mother.
Dr. Sergeï Pankejeff (1886-1979) was a client of Sigmund Freud, who referred to him as “Wolf Man” owing to a symbolic dream which he described to him. Freud detailed his sessions with Wolf Man, which commenced in February of 1910, in a 1918 paper entitled From the History of an Infantile Neurosis.
Wolf Man first saw Freud having suffered from deteriorating health since experiencing gonorrhea at the age of eighteen. He described how he was unable to pass bowel movements without the help of an enema, and felt as though he was separated from the rest of the world by a veil.
Freud persuaded Wolf Man to undergo treatment until a set date, after which their sessions should cease, in the belief that his patient would lower his resistance to the therapist’s investigation. Wolf Man agreed, and described to Freud the events of his childhood.
Initially, Wolf Man had been an agreeable child but became combative when his parents returned from their travels. He had been cared for by a new nanny whilst they had been absent and his parents blamed their relationship for his misbehavior. He also recalled developing a fear of wolves, and his sister would taunt him with an illustration in a picture book. However, Wolf Man’s fears extended towards other creatures, including beetles, caterpillars and butterflies. On one occasion, whilst he was pursuing a butterfly, fear overcame him and he was forced to end his pursuit. The man’s conflicting account suggested an early alternation between a phobia of, and taunting of, insects and animals such as horses.
Wolf Man’s unusual behavior was not limited to a fear of animals, and he developed a zealous religious worship routine, kissing every icon in the house before bed time, whilst experiencing blasphemous thoughts.
Wolf Man recalled a dream which had caused him some distress when he had awoken. In the dream, he was laid in bed when he looked out of the window and noticed six or seven white wolves sat in a tree outside. The wolves, which had tails that did not match their bodies, were watching him in his room.
Freud linked this nightmare to a story which Wolf Man’s grandfather had told him, in which a wolf named Reynard lost his tail whilst using it as bait for fishing. He believed that Wolf Man suffered from castration anxiety, which explained the fox-like tails of the wolves in the dream, and his fear of caterpillars, which he used to dissect. The man had also witnessed his father chopping a snake into pieces, which Freud believed had contributed to this anxiety.
The obsessive thoughts of Rat Man were discussed in 1909 paper Notes upon a Case of Obsessional Neurosis. Rat Man’s true identity is unclear, but many believe him to have been Ernst Lanzer (1978-1914), a law graduate of the University of Vienna.
Rat Man suffered from obsessive thoughts for years and underwent hydrotherapy before consulting Freud in 1907, having been impressed by the understanding that the psychoanalyst had professed in his published works. The subject of his thoughts would often involve a sense of anxiety that misfortune would affect a close friend or relative and he felt that he needed to carry out irrational behavior in order to prevent such a mishap from occurring. The irrationality of such thoughts was demonstrated by his fears for the death of his father, which continued even after his father had passed away.
Freud used techniques such as free association in order to uncover repressed memories. Rat Man’s recollection of past events also proved useful to Freud. He described one occasion during his military service, when a colleague revealed to him the morbid details of a torture method that he had learnt of. This form of torture involved placing a container of live rats onto a person and allowing the animals to escape the only way that they could - by burrowing through the victim.
This description stayed with Rat Man and he began to fear that this torture would be imposed upon a relative or friend. He convinced himself that the only way to prevent it would be to pay an officer whom he believed had collected a parcel for him from the post office. When he was prevented from satisfying this need, Rat Man began to feel increasingly anxious until his colleagues agreed to travel to the post office with him in order for the officer to be paid in the order that Rat Man felt was necessary.
Freud attributed Rat Man’s anxieties to a sense of guilt resulting from a repressed desire that he had experienced whilst younger to see women he knew unclothed. As our ego develops, our moral conscience leads us to repress the unreasonable or unacceptable desires of the id, and in the case of Rat Man, these repressed thoughts left behind “ideational content” in the conscious. As a result, the subject of anxiety and guilt that he felt whilst younger was replaced with fear of misfortune occurring when he was older.
Other Influential Accounts
Whilst Freud saw many clients at his practise in Vienna, and cases such as Wolf Man, Rat Man and Dora are well documented, the psychoanalyst also applied psychodynamic theory to his interpretation of other patients, such Anna O, a client of his friend, Josef Breuer. The autobiographical account of Dr. Daniel Schreber also formed the basis of a 1911 paper by Freud detailing his interpretation of the man’s fantasies.
Anna O (a pseudonym for Austrian feminist Bertha Pappenheim) was a patient of Freud’s close friend, physician Josef Breuer. Although Freud never personally treated her (Anna’s story was relayed to him by Breuer), the woman’s case proved to be influential in the development of his psychodynamic theories. Freud and Breuer published a joint work on hysteria, Studies on Hysteria, in 1895, in which Anna O’s case was discussed.
Seeking treatment from Breur for hysteria in 1880, Anna O experienced paralysis in her right arm and leg, hydrophobia (an aversion to water) which left her unable to drink for long periods, along with involuntary eye movements, including a squint. She also found herself mixing languages whilst speaking to carers and would see hallucinations such as those of black snakes and skeletons, and would wake anxiously from her daytime sleep with cries of “tormenting, tormenting”.
During her talks with Breuer, Anna enjoyed telling fairytale-like stories, which would often involve sitting next to the bedside of a sick person. A dream that she recalled was also of a similar nature: she was sat next to the bed of an ill person in bed when a black snake approached the invalid. Anna wanted to protect the person from the snake but felt paralysed and was unable to warn off the snake.
Freud and Breuer considered the subject of this dream to be linked to an earlier experience. Prior to her own illness, Anna’s father had contracted tuberculosis and she had spent considerable lengths of time caring for him by his bedside. During this period, Anna had fallen ill, preventing her from accompanying her father in his final days and he passed away on April 1881. The trauma of caring for her father may have affected Anna, and Breuer believed that the paralysis she experienced in reality was a result of that which she had experienced in the dream. Furthermore, he linked her hydrophobia to another traumatic event some time previously, when she had witnessed a dog drinking from a glass of water that she was supposed to use. The revulsion she felt had stayed with her and manifested in a later aversion to water.
The conscious realisation of the causes behind her suffering, according to Breuer, helped Anna to make a recovery in 1882. She valued the “talking therapy” that he had provided, describing their sessions as “chimney sweeping”.
Dr. Daniel Schreber
Freud’s interpretation of client’s past experiences and dreams was not limited to the patients he saw at his Vienna clinic. German judge Dr. Daniel Schreber (1842-1911) wrote a book, Memoirs of My Nervous Illness (1903) - in which he detailed the fantasies that he experienced during the second of three periods of illness - whilst confined in the asylum of Sonnenstein Castle.
Upon reading the book, Freud offered his own thoughts on the causes of Schreber’s fantasies, which were published in his 1911 paper Notes upon an autobiographical account of a case of paranoia (dementia paranoides).
Initially suffering whilst standing as a candidate in the 1884 Reichstag elections, Schreber had begun to experience hypochondria, for which he sought the help of Professor Paul Flechsig. After six months, treatment ended, but he returned to Flechsig in 1893, bothered again by hypochondria and now sleeplessness also. Schreber recalled thoughts during a half-asleep state in which he noted that “it really must be very nice to be a woman submitting to the act of copulation” (Freud, 1911). He would eventually turn against Professor Flechsig, accusing him of being a “soul murderer”, and thoughts of emasculation also developed into extended fantasies - Schreber convinced himself that he had been assigned a role of savior of the world, and that he must be turned in a woman in order for God to impregnate with him, creating a new generation which would repopulate the planet.
In his response to Schreber’s account, Freud focussed on the religious nature of the fantasies. Whilst Schreber was agnostic, his thoughts suggested religious doubts and what Freud described as “redeemer delusion” - a sense of being elevated to the role of redeemer of the world. The process of emasculation that Schreber felt was necessary was attributed by Freud to “homosexual impulses”, which the psychoanalyst suggests were directed towards the man’s father and brother. However, feelings of guilt for experiencing such desires led to them being repressed.
Freud also understood Schreber’s sense of resentment towards Flechsig in terms of transference - his feelings towards his brother had been subconsciously transferred to the professor, whilst those towards his father had been transferred to a godly figure.