Různé poznámky ohledně vědeckých výzkumů a prací, především lékařského významu (zvířecí fyziognomie, lidské tělo, kokain a jeho působení v medicíně a na člověka atd.)

Sumarizace předchozích zjištění formou přednášky/proslovu.

Sumarizace předchozích zjištění.

The second case of Studies on Hysteria is a woman performing under the alias Emmy Von V., who Freud took care of from May 1889. According to his observations, it was very easy to get her into the state of somnambulism and so he decided to use Breuer’s method since his friend described it to him in detail, although he was inexperienced in it and it was his first try. When he saw Mrs. Emmy for the first time, she lay on the sofa and her still youthful appearance was giving her enough charm despite her age. Her face was distorted by a painful grimace, though, her forehead was wrinkled, the tone of her voice too low and she often alternated between states of stammering. Her hands were tightly clasped, her facial muscles kept moving, just as the muscles on her neck. She kept disturbing her speech by a clacking sound coming out of her mouth. When she started to tell Freud about her illness, she spoke intelligibly and she showed a high level of education and intelligence. In the middle of the conversation, she fell into hallucinatory state, though, her face twisted in disgust and contempt, reaching out her hands to Freud with bend fingers and yelled at him not to come any closer to her and not to touch her (Freud later discovered that it was her defensive mechanism). At a slap, she became normal again and resumed the conversation without being aware of her hallucination. Freud got to know everything essential about her origin – her family descended from central Germany, but lived in Baltic provinces in Russia for the last two generations and owned vast estates there. Emmy was thirteenth of fourteen children from which only four children survived under the supervision of their strict mother. In her age of 23 years, she married to rich, significantly older man, who died of stroke soon after the wedding. She was forced to bring up two daughters completely alone (now in the age of 16 and 14 years) who were often ill and suffered from various neurotic problems. Emmy herself attributed her illness to these events as she withered away year by year despite several treatments and procedure she had been through all over the world. Freud advised her to disconnect herself from her daughter who had her own governess by that time, and to move to a nursing home where he could pay his entire attention to her. Emmy agreed without objections.

On 2nd May 1889 Freud visited her in the nursing home and noticed that Emmy always startled whenever anyone entered her room. He ordered to everyone to knock loudly and wait for her invitation before entering. In the following days, Emmy felt better thanks to Freud’s practice – he ordered hot baths for her and massages of her whole body twice a day. Before she went to sleep, he always lightly hypnotised her and tried to convince her that she should sleep well and her symptoms should improve. Emmy reacted more than positively and she never asked him about her hypnoid states, slept well and spent most of her days by peaceful rest in the bed. Her daughters could visit her, or Emmy could read and deal with her correspondence.

On 8th May 1889 she piqued his interest by a story she read in newspapers that made her tremble with fear – about a boy who was tied up by an apprentice and who gave him a white mouse into his mouth. The boy died of fear. When Freud hypnotised her, he found that the article in the newspapers really tells a story about a boy who was tormented to death but there was no mention about mice or rats. He came to the conclusion that Emmy had to create the association by herself in some sort of delirium after one of the doctors told her that he sent a crate of mice to Tbilisi. In the evening, she couldn’t remember anything about it, she just mentioned that she suffered from cramps in her neck in the afternoon. Freud tried to convince her in the hypnosis to talk more about her past experiences so he could find out why she associated the tormented boy with mice and rats. Although she mediated before every single answer, she was able to give him the answers during which she kept twitching and the expressions on her faces kept changing from the one of horror to the one of fear. She started talking about how her siblings threw dead animals at her which caused her first fits of fainting and cramps. Her aunt considered it as unacceptable so these demonstrations of her mental state stopped. Another traumatic experiences were dead bodies of her sister and aunt, and her brother who scared her dressed as a ghost. On a question why she kept throwing herself so much, she explained that when she was talking about all the traumatic experiences, she could see them in front of her quite lively and colourfully. Freud swore to himself to help her to free herself from these lively notions by therapy and induced this suggestion to her by stroking her eyes for a couple of times.

9th May 1889 – Emmy slept well but she started to have digestive problems after she spent too much time with her daughters in the garden. Freud advised to her to limit the visit of her daughter to two and half hours at maximum. There were also other symptoms that had origin in a shock she suffered after she leafed through an ethnological atlas and she saw American Indians dressed as animals. Freud tried to convince her in the hypnosis not to fear of the pictures but quite the contrary, to laugh at them which she did after she woke up. She kept giving out the clacking sound, though (she brought it about when she took care of her sick daughter and was forced to be completely quiet and now the tic showed when she was nervous or anxious), and especially after Breuer’s visit (she didn’t mind him) and a doctor from the nursing home (the reason of her anxiety). By the evening, she was cheerful and showed very surprising humour sense considering her social status that was directed mainly on her previous therapy which she tried to get rid of, but never found the courage to do so. That happened after a remark from Doctor Breuer but then she was horrified that she was too indiscrete. Freud calmed her down that it wasn’t like that and hypnotised her so she could tell him more about her fears. Emmy started to talk about her teenager years where she started to suffer from fear of insanity because her female cousin and her mother spent some time in an asylum, and from one of the maids who was also in the asylum, she hear horrific stories about how the patients were treated. Freud tried to fix her impressions about the asylums. Then Emmy talked about her concerns for her mother because she once found her after a stroke which mother survived but few years later, she died anyway and Emmy found her. Freud succeeded in suggesting that she should perceive these facts but shouldn’t associate them with any emotions.

10th May 1889 – Emmy went through a bran bath for the first time and she didn’t like it, claiming that it caused her a lot of pain. During the massage, she relaxed and while she was afraid that Doctor Breuer could get insulted by her yesterday’s behaviour, she also started to talk about her queer male cousin whose parents got all his teeth pull out at one sitting. She got into hysterics during these moments and kept repeating her defensive mechanism, then she calmed won again. Freud focused on her defensive mechanism during the hypnosis and found out that the phrases she used had an origin in her past – “Keep still” was connected to a period when she was attacked by her animal hallucinations. “Don’t touch me” reflected in a past experience where her brother grabbed her strongly in a fit caused my morphine overdoes, or when her daughter was sick that one time and almost strangled her to death. During the evening hypnosis, the focused on her stammering problem and it came into light that she got into a situation in the past when she forced herself to keep quiet so the frightened horses wouldn’t be frightened even more. After another suggestion therapy that Freud practiced in her case, she got rid of the problem. Then they talked about other cases during which Emmy got scared and they came to the understanding as to why Emmy always startled when someone entered her room. All her shocks and past traumas usually came suddenly and unexpectedly.

11th May 1889 – gynaecological examination of her daughter made Emmy very nervous and Freud had to hypnotise her. It came out that she was afraid of telling him something that could insult him the other day, but Freud explained to her that nothing like that happened. After the examination they talked about her greatest shocks and fears – especially the death of her husband and the following illness of her daughter who was a bit retarded during her childhood. Freud argued that her daughter was now an adult and she was in a very good condition by which he helped Emmy to get rid of the inner fear what would happen with the child. Then they returned to her fear from asylums and Freud once again tried to convince her that the patients were treated well. He realized, during these hypnoses, that it wasn’t good to interrupt Emmy because she was angry with him for that in her hypnoid state.

12th May 1889 – despite Freud’s expectations, Emmy didn’t sleep well and didn’t want to talk about the bad dream she had had. During the massage, she rather talked about the times she spent at the Baltic and people from the neighbouring town she entertained etc. During the hypnosis, she uncovered that her nightmares from the last night concerned her fear from animals. Freud tried to force her to the root of the problem, but she informed that they would get there when she wanted and he should let her to narrate the story. When he did so, she started to talk about her husband again, how she couldn’t believe he had been dead and how she hated her child for three years because of that, because she believed that her husband could have still been alive if she could have taken care of him, instead of lying in the bed because of this child. These events were also connected to drear of foreign people after the family of her deceased husband started a campaign against her, slandering her, printing defaming articles in the newspapers about her, and keeping accusing her that she poisoned her husband because they couldn’t stand their marriage and their happiness. Emmy relaxed after Freud told her a couple of soothing words.

13th May 1889 – Emmy slept badly again and although she was in relatively good mood, her tics returned. She spoke about her fear of animals in the hypnosis that appeared after she had been on one theatre performance and had gotten scared by a character of giant lizard. She also spoke about her digestive problems they connected with depression after her husband’s death when she ate out of duty. She also confessed that although she hated her child, no one could ever notice it and she reproached herself until this day that she had been fonder of the elder child more.

14th May 1889  - Emmy slept well finally but she complained about pains in her right leg. During the hypnosis, they returned to her fear of foreign people when she listed all the other cases of this fear. Freud saw the main problem in what had happened after her husband died, though. When he came to see her in the evening, she was anxious again. Breuer had visited her and she had startled when he came in. She considered it as inappropriate because she disparaged Freud in front of Breuer according to her opinion. Freud had noticed so far, though, that she always tried to be obliging and dutiful to comply with Freud’s wishes and when it wasn’t like that, she reproached herself. He assured her during the hypnosis that nothing happened and she shouldn’t be so hard towards herself.

15th May 1889 – Emmy slept well again, but she started to be anxious immediately. She explained that she had advised her daughters to used a lift in the pension both for a ride up and down. But because she didn’t trust lifts, she reproached herself for causing a threat to her daughters’ lives. Freud, who knew the pension and its owner, explained to her that the lift is safe and the owner wouldn’t make such an advertisement out of it if it wasn’t. Emmy was able to laugh at her unwarranted fears, but Freud suspected that her today’s anxiety had different roots. He started with the massage of her body, but Emmy spoke mostly about her social life in German Russia and North Germany and entertained him with many stories. During the hypnosis, they returned to her morning anxiety and it came out that she was afraid that her period was about to start and it would prevent her from having massages, but in attempt to avoid this fear, she attached to something entirely different – thus to the lift in the pension. Freud added in the footnotes that this hadn’t occurred for the first time – for example she once claimed that she didn’t want to take cold bath because they caused her a depression and when Freud convinced her through hypnosis that she wanted cold bath, she really started to take them. However, she fell into depression anyway, but later admitted that she read in newspapers reports about riots in San Domingo and her brother, who hadn’t sent any message about himself, was there. Freud came to the conclusion that during the splitting of consciousness, there is also a transfer of psychosis onto different object, most of the time seemingly irrational. Then they focused on her pains in the various parts of her body, when Emmy talked about the events when she had felt them the most. In the evening, they also focused on her fears about the family members – illness of her children, life of her newlywed brother. They talked them through in detail and Freud also gave her a couple of advises considering her pains.

16th May 1889  - Emmy slept well and she complained again about some pains, but the hypnosis didn’t reveal a thing. When Freud came to her in the evening, she was nervous and her thoughts kept running without any kind of order. She wasn’t able to answer on any of the questions he had asked her, and so he hypnotised her and started to take her words one by one to let her talk about it.

17th May 1889 – Emmy had a very good night, but the pains and anxiety lasted, she was overly cheerfully and didn’t want to talk about why she was so excited. In the hypnosis, Freud focused on animals because she saw worms in her bran bath. She began stammering again and when he asked why, she answered that it did so every time she felt frightened. She was afraid that because of the return of some of her symptoms, Freud would lose patience with her and stop his treatment, and she also worried about not thanking him for coming to visit her. Freud assured her that she was getting better, and that she was more resilient and opened to people she was close with and that was the important thing. By the evening, she was very content and hypnosis didn’t bring anything. Freud focused on the pains in her right leg then which he managed to get rid of in her hypnoid state but after she woke up, the pain partly returned.

18th May 1889 – allegedly, she hadn’t slept so well for many years. The pains still last, though.

By that, Freud completed his notes about Emmy. Because he always waited for various symptoms to appear and let the things flow, the notes were often repetitive and didn’t bring anything new. Existing notes considered as sufficient. After 7 weeks of treatment Emmy’s state improved enough that Freud allowed her to return home with that both he and Breuer would stay in contact with her in correspondence to know how she was doing. She relapsed 7 months later because her daughter started to have some uterus problems. Freud advised her to visit his gynaecologist friend who managed to help her daughter for a couple of months. After the return home, the daughter got worse and Emmy chose a different gynaecologist. She started to reproach herself because of what happened to her daughter, and she also accused Freud’d gynaecologist friend, as well as Freud himself, by which she completely destroyed the results of his treatment. The situation improved fter Breuer’s intervention, but the aversion towards Freud still lasted. She let them persuade her, though, to transfer her to a sanatorium where the main doctor was in contact with Freud and received recommendations from him how to treat Emmmy.

Sanatorium proved to be a failure, though, because Emmy refused any kind of treatment. She improved after her family relative “kidnapped” her from sanatorium and took care of her in her home. Soon after, Emmy decided to leave for Vienna and ask Freud for his help again. He found that her state wasn’t that bad as he had heard. The anxiety was replaced by confusion, moments of sadness in a particular hour and various tics. He had problems to hypnotise her because of her unpleasant experiences in the sanatorium, but he succeeded in the end. During the hypnosis he came to the conclusion that to reach the therapeutic effect, the described event must be retold fully and completely truthfully. He started to pay attention if Emmy wasn’t holding back anything or distorting the facts. He “abused” the hypnosis to make her forget on unpleasant sanatorium. He had bigger problems with “storms in her head” as she called them that were connected to the illness of her daughter, but he managed to get over them, as well. At the end of her treatment, he found out that Emmy ate a little and she couldn’t drink anything else but thick fluids, according to her words. Freud ordered to increase the food portions and drink alkaline water. Emmy agreed with that she was doing it because he said so and warned him beforehand that it was going to end up badly, because her digestive system wasn’t adapted the way to eat normally. Freud dismissed that because he didn’t consider likely that someone could be able to cause digestive problems to himself by this way. However, he found her in depression after the food and she complained about digestive problems and he came to the conclusion that the problems were caused by psychical problems.  He tried to hypnotise her but Emmy rebelled and accused him of causing her these problem, and mainly that he threw away all the progress just because he wanted to learn her eat how he wanted. Freud told her that he would leave her for 24 hours alone to think it over and consider whether the digestive problems were really caused physically or if it was a psychical problem. If she would insist on a physical problem, he would ask her to leave because he couldn’t help her anymore. After 24 hours, he found her submissive and complaint. She admitted that she thought that the digestive problems were caused by her psychical problems but just because Freud thought so, as well. Under the hypnosis, she then talked about a series of experiences that produced disgust and distaste in her (inappropriate behaviour of other at the table, her mother forcing her to eat cold meat etc.), as well as her disgust towards water (caused by experience in the childhood when her whole family suffered from digestive problems because of bad drinking water). The therapeutic effect of hypnosis showed immediately the second day.