Carlo Bonomi. Journal of the American Academy of Psychoanalysis. Volume 26, Issue 1. Spring 1998.
In The Interpretation of Dreams (Freud, 1900, pp. 544, 619) and in The Psychopathology of Everyday Life (Freud, 1901, pp. 198-199) there are several clinical vignettes that show Freud in the unusual role of psychotherapist to young boys. In such cases his approach was rather uniform and simple. A first phase was characterized by early onanism and consequent severe threats were regularly assumed, so that puberty could be viewed as a revival of the genital stimulation, now strenuously opposed by the ego. Freud’s specific idea was that the punishment with which the child had been threatened, was now used by the boy for reproaching himself in retrospect. A simple explanation of the unconscious struggle, technically based on the transformation of images into thoughts, was sufficient for putting the neurosis to an end. Freud was so convinced of the validity of the schema that he applied it to explain the attacks of night terrors in a 13-year-old boy, the case history of whom he knew only from the pediatric literature. Notwithstanding the scarcity of information, he dared the following reconstruction: The boy had been threatened with severe punishment because of early masturbation; with the onset of puberty the temptation had revived and the struggle for repression had taken over the previous threats (Freud, 1900, p. 568).
Despite the simplicity of this schema, while narrating the only two vignettes reported in detail, Freud twice incurred the same sort of slip. In the first case, while relating the boy’s material to the mythological castration of Kronos by Zeus (Freud, 1900, p. 619), he did not immediately realize that the mythological atrocity was committed not by Zeus on his father Kronos, but by the latter in his father Uranus. In the second case he wrote “Tarquinius Superbus” instead of “Tarquinius Priscus,” again substituting the name of the son for that of the father (Freud, 1901, pp. 198-199). The first error was analyzed in The Psychopathology of Everyday Life. Freud explained it as the effect of a sort of counter-will: He wanted to conceal something, but what he wanted to suppress succeeded against his will in gaining access in the form of an error (Freud, 1901, p. 218). Freud also suggested that the error was ultimately related to the derivatives of repressed thoughts connected with his dead father. The question was not over, however, as he had repeated the same kind of error-the Tarquinius slip-just a few pages before.
Freud realized the second slip and its similarity to the previous one, only a few years later, in 1904. Then, he remarked that it concerned the question of castration. Now, these two early slips offer the opportunity to question the origins of Freud’s ideas about infantile onanism and castration, and to explore certain aspects of the historical context in which psychoanalysis originated, which were either avoided or suppressed in Freud’s later reconstruction. Instead of psychologizing Freud’s slips, in this article I use them to restore significant historical links, which shed a new understanding on his first steps. First, a special emphasis will be given to Freud’s neuropediatric training with Adolf Baginsky, as it represents an ignored episode of his studies and a very significant link with the 19’h-century history of the medicalization of onanism. It will be argued that Freud met “castration” in Baginsky’s teaching and clinical practice, and that this experience was traumatic to him. Second, will show that Freud’s early opposition to sexual etiology represented a reaction to the medical practice of castration. Third, the overcoming of Freud’s initial opposition to sexual etiology will be discussed.
Retrospect: An Ignored Teacher of Young Freud
The reported clinical vignettes date from the late 1890s, but Freud’s involvement with nervous children goes back much farther. For 10 years, from 1886 to 1896, Freud worked with children three times a week in the department for nervous disturbances at the Public Institute for Children’s Diseases in Vienna, which was directed by Max Kassowitz. This position permitted him an extraordinarily rich experience, as the number of consultations per year progressively grew from 6,000 in 1886 to 17,400 in 1898 (Hochsinger, 1938). During those years Freud conducted important research on cerebral palsy, publishing many works on the subject. The idea has prevailed that his work with children was merely “neurological” (and neuroanatomical), in the modern sense of the world. But this is a misunderstanding, because in 1886 the whole spectrum of psychic disturbances was assumed to be directly or indirectly related to the “nervous system.”
The institute was completely reorganized by Kassowitz in 1886. It was enlarged and divided into various departments, according to the arising spirit of medical specialization. For this reason Kassowitz asked a young neurologist-Sigmund Freud-to take over the new department for nervous diseases, despite his ignorance about children and the fact that nervous and psychic disturbances in children had been, until that moment, a matter for pediatricians. Those years were characterized by enormous and rapid transformations. The basic distinction between “nervous” and “neurological” disorders began to be more and more clearly established, and childhood began to elicit the interest of psychiatrists. The first book on psychic disturbances in children written by a psychiatrist appeared 1 year later (Emminghaus, 1887), and in the last decade of the century psychiatrists collaborated with pedagogues on the creation of a new discipline, the “pathological pedagogy.” All these transformations occurred after Freud had begun to work with children, and it is therefore not surprising that he chose to train briefly with a pediatrician on nervous disturbances in children, before accepting the post offered by Kassowitz. The pediatrician was Adolf Baginsky, and the training took place in March 1886, during a trip to Paris and Berlin, immediately after his studies with Charcot. In Berlin Freud attended the polyclinic for ill children run by Baginsky every afternoon for 3 weeks, and followed the lessons with demonstrations held by Baginsky in the polyclinic three times a week. The courses were on the pathology and therapy of infantile illnesses and on the dangers to which children were exposed in schools. The winter semester terminated on March 15, and a letter to his fiancee, Martha Bernays, of March 19 Freud regretted not to be able to remain for the vacation courses (Bonomi, 1994a). Soon after, he began his private practice in Vienna and announced the treatment of infantile nervous diseases among the services offered. He would also hold lessons on this topic in the Kassowitz Institute in Vienna, during 1887-1892 (see Gicklhorn and Gicklhorn, 1960).
Because Freud never mentioned Baginsky’s teaching in any significant way, not even in his report on his studies in Paris and Berlin (Freud, 1886), this experience has not been considered relevant for the history of psychoanalysis. It deserves to be noted, however, that in the letter to Martha of March 10, 1886, in which he formulated the wish to dedicate his professional life to sick children, while expressing a certain contempt for the personality of Baginsky, Freud jokingly wrote that he couldn’t reveal to her the “secrets of children’s diseases.” What were those “secrets”?
Adolf Baginsky obtained a degree in medicine in 1866 and was appointed “Privatdozent fur Kinderheilkunde” in 1882. In 1877 he published the work that made his reputation: the Handbuch der SchulHygiene (Handbook of Scholastic Hygiene), which went to a second edition in 1883. According to Baginsky medicine had to remain primarily oriented toward therapy, therefore he strongly criticized the “therapeutic nihilism” of medicine as a “natural science,” which, by focusing on microscopic anatomy instead of the suffering whole organism living in social communities, turned the human body into an isolated object of research. The emphasis on the strict dependence of the child on a social milieu was a distinctive mark for pediatrics, but in 1877 Baginsky’s emphasis on public hygiene was based on the idea that the community was the source of the most dangerous illnesses: the epidemics. The point is that he also conceived of masturbation in children as an “infection.” Rohlender (1899) would list Baginsky as among the 19th century champions of the moral struggle against the spread of onanism in modern times. In his handbook of scholastic hygiene, the considerations about onanism were included in the chapter on the “Illnesses of the Nervous System.” Baginsky stated that “masturbation appears in the earliest infancy, already in babies” (Baginsky,1877, p. 465), and conceived it as a contagious illness because “certain external stimuli are able to produce the evil and seduction [Verfuhrung] plays here a very big role” (Baginsky,1877, p. 465). He stressed the great excitability of the nervous system in early infancy, and mainly based his views on the reflex neurosis theory. Because of the great excitability, “insignificant stimulations coming from the periphery, which in adults pass without traces … are able to produce violent explosions by reflex … With the advancement of the psychic development the excitability by reflex [Reflexerregbarkeit] becomes lower” (Baginsky, 1877, p. 443). Though sharing the emphasis put by Griesinger on the “mistakes of upbringing” as the main cause of mental disorders in children, he suggested that “sexual excesses of children” had to be taken into account as a direct causal element, not only because of the loss of semen, which “weakens the whole organism,” but also because of “the frequent excitation of the central nervous system” (Baginsky, 1877, p. 451). He mainly conceived masturbation as a peripheral source of such excitation, and criticized the emerging tendency to reverse causes and effects and to assume onanism as a mere consequence of the morbid state of the nervous system. Thus, on the basis of his own observation, Baginsky declared himself unable to exclude sexual excesses as “causa movens” of chorea (Baginsky, 1877, p. 457), and believed that “the states of excitation which start from the genitals” were very significant for epilepsy (Baginsky, 1877, p. 461).
According to Baginsky onanistic children suffered from underdevelopment of the musculature, appetite and sleep disturbances, rachitic changes, slow dentition, lowering of the forehead, larger fontanelles, and so on. Sometimes those symptoms were lacking, however, and
Therefore what one sees is only that in boys the penis is more developed than normally, the prepuce longer, evidently lacerated, often wounded and almost swollen; and that in girls the external genitals are reddened, sometimes with mucous and purulent secretions. Sometimes the sources of the evil are to be found in stimulation byworms sometimes in lasting constipation, or finally in abuse by filthy nursemaids and nannies, who want to calm down the children by playing with their genitals. However, in other instances it is not possible to observe any trace of all this; therefore one can only assume that a stimulus originating from the central nervous system brings the hand toward the small genitals. (p. 466)
But Baginsky was not an enthusiastic supporter of the idea that masturbation could be caused by central sources, and added:
The evil is in any case of the worst kind since through the continuous excitement of the central nervous system it brings the fallen child more and more down. Since it provokes a complete vicious circle, radiating from the center to the periphery, and damaging the center from the periphery, it ruins in the long run the functions of the brain and brings ultimately to the most severe forms of illness, to epilepsy and psychosis. Evidently in such cases the [science on pathology is no more able to separate causes and effects … Every onanist is a danger for those who are pure, because his example is contagious and masturbation has, more than other evils, the tendency to spread. (p. 467)
Baginsky also reported having once put a wedge between the legs, and tied up the feet of a 11/2 -year-old baby, to prevent his onanistic movements, and added that “for other children other measures are necessary, according to circumstances” (Baginsky, 1877, p. 467), but did not specify which. Nevertheless, it should be noted that Ludwig Fleischmann (1878), discussing the same questions, in the same period, and in a similar way, recommended circumcision in boys and clitoridectomy, the cutting of the labia, and the cauterization of the vagina in girls. Baginsky also stated that “the therapy of psychosis and hysteria is indicated by the etiology” (1889, p. 492) in the 1889 edition of his Textbook of Pediatrics (Lehrbuch der Kinderkrankenheiten), where hysteria is discussed separately and masturbation is listed among its causes. The statement is to be found in a more complete form in the 1884 article “On Hysteria in Children” (Cber Hysterie bei Kinder) by Samuel Schafer, which reproduced a doctoral dissertation inspired by the practice and teaching of Baginsky, and was published in the pediatric journal edited by Baginsky. In the study it was claimed that the main cause of hysteria was to be found in bad sexual habits, primarily onanism, it was stated that the diagnosis of onanism was mainly based on the examination of the genitals, and that an important cause of hysteria was represented by “the illnesses and abnormalities of the urogenital apparatus, such as congenital phimosis, the agglutination of the prepuce with the gland, an inflamed and stretched clitoris” (Schafer, 1884, p. 402). According to Schafer, “all these conditions are able to produce a special nervous state by reflex, which can also be healed by the elimination of the cause” (Schafer, 1884, p. 407). What did “elimination of the cause” mean within such a precise context? A similar view is presented in an 1881 article on hysteria in children written by Henoch, the most prominent pediatrician in Berlin. Henoch was much more critical toward sexual etiology then Baginsky was, nevertheless in the article the enuresis and functional paralysis in a 7-year-old boy were traced back to the “continuous stimulation of the genital nerve.” Such a continuous stimulation was furthermore compared to the “morbid state of the sexual organs,” which were able to produce hysterical paralysis in women, and finally to the consequences of phimosis, which, as Henoch put in the conclusion, were healed by “the operation” (Henoch, 1881, p. 1009).
Summarizing the significant information, Baginsky found masturbation in children and babies, believed in the morbid consequences of the evil, was critical toward the medical trend to reverse causes and effects, and opposed the “therapeutic nihilism.” It is also important to point out that he considered the morbid effects of onanism within the framework of the reflex neurosis theory, and that such a theory permitted to assimilate the genital stimulation in children to the morbid states of sexual organs in women, to localize the cause of the neurosis, and to eliminate it. All these elements led to the conclusion that surgical operation of the genitals were part of his teaching when Freud visited him. Let us now turn to the general historical context, focusing first of all on the medicalization of masturbation.
The Historical Context
According to Stengers and Van Neck (1984), the medical belief in the morbid physical and moral consequences of onanism during the 18th century, dominated with no exceptions between 1815 and 1875, and encountered increasing opposition after 1875, finally entering into a phase characterized by a very slow, but progressive dissolution. The opposition was theoretically supported by the reversal of the relationship between causes and effects: From 1875 onward it was increasingly claimed that masturbation was not a cause but an effect-a symptom-of a morbid condition of the brain. According to Rene Spitz (1952), the treatment of masturbation was mainly harmless until 1850, whereas from 1850 to 1880 the recommendation for surgical treatment prevailed. The turn of mid century was significant also because of the enlargement of the focus of the medical observations of women and children. During the first half of 19′ century, onanism was indeed reported by pediatricians to occur in children between the ages of 7 and puberty, and was mainly related to the second dentition. Because of the general irritation of the nervous system, dentition was thought to be as a predisposing cause, which multiplied the effect of the local stimulation on the genital parts. But around the middle of the century an important turn took place, which was signaled in Germany by the work of Behrend (1860): The evil began to be found in very little children, even babies, and seduction began to be regularly listed among its causes. The manipulation of nannies, the sleeping together with an elder person of the family, and games with playmates were presented as typical situations in which the evil could be transferred to the child. The effect of seduction was also conceived in purely physiological terms, as stimulation of the genital part was not different, in principle, from the many other irritations or inflammations usually listed among the causes of masturbation in children, like intestinal worms, rough clothes, congenital phimosis, leucorrhea, inflammations of the clitoris, and so forth. Finally, the “diagnosis,” which was made by the examination of the genitals, was followed by the question of “treatment,” and here we often find a discussion about the “operation”-that is, circumcision, infibulation, amputation of the clitoris, cauterization of the entrance to the vagina, and so on.
In this period clitoridectomy was also recommended as a cure for nervous and psychic diseases in women, and in 1872 a new surgical technique for removing the ovaries, which was presented as a cure for nervous and psychic disorders as well, was introduced by the gynecologist Alfred Hegar. As James Israel ironically stated in 1880, “the bold attempt to conquer that protean demon of hysteria by the extirpation of both ovaries; that is, by the castration of women,” finally made it possible to overcome “therapeutic nihilism” by an “era of therapeutic activity” (Israel, 1880/1986, p. 138). As were many others, Israel was, however, opposed to castration. It is interesting to note that the opponents did not deny the healing effect of castration, but gave a psychological explanation for it. For example, Liebermeister stated that “castration, extirpation of the clitoris and similar operations are definitively to be rejected, when not required by local illness,” since the “general healing effect” that was to be expected by such operations could be obtained also with “insignificant operations like the cauterization of the clitoris, the extraction of blood from the vagina, and so forth” (1883, p. 2149).
Nevertheless, castration was increasingly performed, and it really began to spread precisely during the period of Freud’s studies in Paris and Berlin. The new flourishing was prompted by Hegar’s (1885) work on “The Relationship of Sexual Illness to Nervous Diseases and Castration in Neurosis” (originally in German). In Friedrich Merkel’s (1887) dissertation, entitled “A Contribution to the Study of Castration in Neurosis” (“Beitrag zur Casuistik der Castration bei Neurosen”), the castration of hysteric women is defined as the most discussed problem of the time, and 35 works are cited, all referring to female castration and published from the summer of 1886 until the end of the year. In these few months, the number of cases of female castration quoted in the literature rose from 180 to 215 (Merkel, 1887). Ten years later, in the most detailed and impressive medical review of the topic, Kromer would state that the women operated on had in the meantime become “legions” (Kromer, 1896, p. 4).
The spreading of the treatment took place despite theory, as suggested by Jolly ( 1892), who wrote: “in spite of the fact that the theory of hysteria has been, with the passing of time, moving away from Romberg’s definition of it as a reflex-neurosis originating from the genitals, and toward a psychic conception of the disease, the contemporary vain sacrifice of a great number of ovaries has once again demonstrated that this idea enters practice only very slowly” (Jolly, 1892, p. 855). The article by Jolly was on hysteria in children, and in it Charcot’s view of hysteria as a disease “de I’imagination” was discussed and further developed. Significantly, Jolly criticized the inclination to search for the seat of hysteria in genitals, claimed that “hysteria does not come from the uterus,” and argued that “the manifestations of hysteria appear much before sexual maturation, in boys as well as girls. Therefore they have nothing to do with diseases of the uterus and, with the exception of a few cases, nothing is to be expected from a gynecological treatment” (Jolly, 1892, p. 843).
The years around 1870 represented the climax and turning point of the “great fear of masturbation.” The spreading of surgical operations on genital organs was not only an extreme expression of such a fear, but also the element that prompted a vast cultural reaction. The reversal of the cause-effect relationship between peripheral stimulation and the central nervous system represented a first reaction. Because the surgical treatment was an etiological one, that is, was based on the “indicatio causalis,” the best opposition to it consisted in demonstrating that hysteria didn’t depend on the genitals. The opponents were therefore proponents of a central-nervous conception, mainly based on heredity, which progressively shifted into a more and more “physic” conception. This shift enabled a psychic treatment of hysteria, as well as many other practical and theoretical changes; for instance, the examination of the genitals was substituted by a psychic inquiry under hypnosis. Ultimately this shift resulted in an enlargement of the idea of sexuality, which by losing its traditional “seat” became an expression of the whole personality.
This cultural process corresponds to the transition from the anatomopathologic explanation of the abnormalities of sexual life to the psychiatric explanation of perversions, which occurred in the years 1870-1905. According to Davidson (1990), this transition passed through the three structural (chronologically blurred) stages of (a) the genital localization, (b) the cerebral localization, and (c) the purely functional conception of the sexual instinct, and resulted in a structural change of the meaning of “sexuality.” Sexuality, as Davidson has convincingly argued, could emerge as a basic category of human experience and as a privileged object of psychological knowledge only thanks to a certain divorce from “sex”, that is, from the genital organs (Davidson, 1987, 1990).
Finally it should be stressed that precisely the opposition toward the practice of castration played a basic role in promoting the divorce between “sexuality” and “genitalia.” As Freud put it in a statement that appeared only in the first edition of the “Three Essays on the Theory of Sexuality”: “sex glands do not constitute sexuality, and the observations on castrated males merely confirm what had been shown long before by removal of the ovaries-namely that it is impossible to obliterate the sexual characteristics by removing the sex-glands” (Freud, 1905, p. 214, n. 2). It is rather significant that female castration (the removal of the ovaries) was given as the primary evidence of what Freud would later present as the “divorce” of sexuality “from its too close connection with the genitals,” which permitted the building of a broader view of sexuality, inclusive of its infantile forms (Freud, 1925, p. 38). Not less significant is the fact that this sentence, which represented a direct reference to castration and a crucial link between the origins of psychoanalysis and their medical background, was suppressed in the later editions of the “Three Essays.”
Freud In Context
During the 1885-1886 study trip to Paris and Berlin, Freud came in contact with contrasting views about the role played by genitals in hysteria. The peripheral conception held by Baginsky, which permitted him to stress the importance of “seduction” in the transmission of masturbation to young children, was at that time unavoidably connected with the genital localization of the evil. Although Baginsky never referred to “the operation” in his published works, if we read his emphasis on sexual etiology within the proper context, we come to the conclusion that the surgical “elimination of the cause” was, in those years, part of his treatments. On the contrary, Charcot was moving toward a neuropsychic conception of hysteria and was among the opponents to castration. This was an important element of the young Freud’s enthusiasm for the Frenchman. In the 1886 “Report” on his studies in Paris and Berlin, Freud pointed out that the condition of hysterics was “under the odium of some very widespread prejudices,” among which was “the supposed dependence of hysterical illness upon genital irritation,” and praised Charcot for having attenuated “the connection of the neurosis with the genital system” (Freud, 1886, p. 11). He also referred to the crucial question of male hysteria precisely within this context, that is, as a proof against the genital localization of the neuroses. A few months later, when he lectured on masculine hysteria at the Vienna medical society, on October 16, 1886, Freud again associated the two topics, claiming that Charcot had the merit of showing that hysteria did not result from a disease of the genital organs, and that male hysteria was much more frequent than generally admitted (Ellenberger, 1968).
As is well known, legends and misunderstandings have long surrounded this lecture and its meaning for evaluating Freud’s early conflict with the medical establishment. As correctly argued by Ellenberger (1968/1993), the controversial question was not the onset of hysteria in males as such (since this was fully acknowledged by the time), but the idea of a traumatic male hysteria of the type described by Charcot. Now the point missed by Ellenberger is that Charcot’s neuro-psychic explanation of the traumatic genesis of the symptoms represented an attack on the reflex theory and the peripheral localization of the cause, by which the morbid state of the genitals came into the medical focus. As I have already argued in a previous work (Bonomi, 1994b), this is why many decades later Freud summarized the episode with the apparently puzzling vignette of the “old surgeon” who blamed him for not knowing that hysteria came from “hysteron”-the uterus in classic Greek (Freud, 1925, p. 15). In spite of the legendary character of Freud’s narrative, or precisely because of it, we can easily recognize the kernel of truth preserved within the vignette: The conflict with the surgical treatment of hysteria, which was flourishing precisely during that period. What is really puzzling, is why Freud did not express himself in a clear and direct way, but was so reticent and even misleading when touching on questions related to castration. In any case Freud’s aversion for sexual etiology is well reflected in his 1888 article on hysteria, in which he stated that “the influence of abnormalities in the sexual sphere upon the development of hysteria” was, as a rule, overestimated (Freud, 1888, p. 51), and the assumption that “changes in the genital really constitute so often the sources of stimulus for hysterical symptoms” is qualified as “doubtful” (Freud, 1888, p. 56). As evidence supporting this critique, Freud mentioned the occurrence of hysteria in the male sex, in “sexually immature girls and boys” and even in “women with a complete lack of genitalia” (Freud, 1888, p. 51). Let me briefly comment on the latter two points, as they have been often misunderstood.
The latter is to be understood in relation to the failures of castration in healing hysteric symptoms, and was probably inspired by the teaching of Breuer, because he once tried to cure a hysteric patient by castration, but the symptoms reappeared immediately after. Concerning the argument about the occurrence of hysteria in “sexually immature girls and boys,” it has nothing to do with the idea (common to many commentators) that, at that time, Freud still considered childhood as unaffected by sexual manifestations. Such confusion was possible because the concept of “sexuality” underwent a change precisely in those years. It might be useful to recall that an 1880 article on hysteria in children began with a similar claim, which was explained by the author: “only when the character of a functional disturbance of the womb or of a sexual disturbance in a larger sense was acknowledged in hysteria, did it become possible to understand its occurrence in children, whose sexual organs have not yet acquired their functions” (Smidt, 1880, p. 1; emphasis added). Now, the same author regarded “orgasm” as one of the main causes of the hysteria in children, but did not conceive it as a “sexual” but as a “nervous” cause, because it was the “nervous system,” and not the “sexual system,” that was affected by it. A few years later the same causes would be qualified as “sexual,” but not in an anatomical sense. Indeed, immediately after mentioning these arguments, Freud added: “It must, however, be admitted that conditions related functionally to sexual life play a great part in the etiology of hysteria (as of all the neuroses)” (Freud, 1888, p. 51). Now, onanism, orgasm, pollution, leucorrhea, enuresis were all included in such a “functional” conception.
As becomes clearer from the 1888 article on hysteria, Freud’s original aversion to sexual etiology was directed only to the strict sense of the latter, which, being based on the anatomical explanation of the abnormalities of sexual life, justified castration. More precisely it was directed to the tendency to overestimate and exaggerate this kind of cause, that is, to the contemporary tendency to find anatomical changes everywhere, which resulted in the mutilation or removal of healthy organs. Therefore, in this period, Freud embraced the strategy of reversing the cause-effect relationship between periphery and center and explained hysteria as “a mere symptom of a deep-going degeneracy of the nervous system, which is manifested in permanent moral perversion” (Freud, 1888, p. 52). Significantly, he gave such an explanation while discussing the occurrence of hysteria in children.
In the same year Charcot held a famous lesson on hysteria in boys (“A fourteen-year-old boy accompanied by his parents and his doctor”), in which it was claimed that hysteria resulted primarily from a “psychic” cause and, therefore, it was necessary to treat it psychically. This lesson, which was translated into German and edited by Freud in 1892 (Charcot, 1892), is very important for the history of psychoanalysis, because (as was pointed out by Freud in an editorial footnote added to the lesson) it prompted in Freud the idea of “counter-will,” his first model of the psychic mechanism of hysteria.
The idea of a split within the will grew later into a more elaborate psychology, yet remained a basic tenet of Freud’s reflection until the end of his life. It is therefore interesting to point out a possible hidden influence played by the teaching of Baginsky in the genesis of such an idea. In the 1883 edition of the Lehrbuch der Kinderkrankheiten, Baginsky wrote: “The children are aware of the guilty character of their actions. It is not rare to hear them, after the beginning of their perverse or criminal actions, saying things like ‘I cannot avoid it’ or ‘I had to do that’-such an awareness, obviously, does not prevent the repetition of the deed” (Baginsky, 1883, p. 379). Although Baginsky didn’t explain the sort of actions he was referring to, in the 1884 article by Schafer a case is reported “from the practice of Baginsky” that corresponds to such a description. It refers to a 13-year-old girl, the daughter of a hysterical mother, who is described as suffering from ineradicable masturbation occurring in attacks during which she didn’t lose the moral consciousness and “explained in tears that she could not avoid doing it” (Schafer,1884, p. 407). Here we can also see a prototype of the inner struggle, which would characterize Freud’s later narrative of hysteria in young boys. Unlike the examples discussed by Charcot in his lesson on hysteria in boys, such a prototype once more called attention to sexual etiology. And from 1892 onward, Freud did not only continuously develop his reflections on the psychic mechanism, but also began to investigate sexual etiology, simultaneously moving away from Charcot’s restriction of etiology to heredity. In his obituary of the Frenchman, Freud praised him for the demonstration of the psychic mechanism of hysteria, but also reproached him for having neglected the question of the acquisition of the neurotic disposition. Freud’s articulated etiological speculation was developed over the next 2 years, and in 1895 he would state in public: “In the etiology of the neuroses (at all events of acquired cases and acquirable forms) sexual factors play a predominant part and one which has been given far too little weight” (Freud, 1895, p. 123).
Overcoming the Original Aversion Toward Sexual Etiology
It has escaped the many commentators of Freud that he described his early impact with sexual etiology as an “insult.” In the final chapter of the “Studies on Hysteria,” written in spring 1895, Freud wrote: (initially) “The expectation of a sexual neurosis being the basis of hysteria was fairly remote from my mind. I had come fresh from the school of Charcot and I regarded the linking of hysteria with the topic of sexuality as a sort of insult” (Freud and Breuer, 1893-1895, pp. 259-60). In this statement Freud used the teaching of Charcot to conceal the contemporary teaching of Baginsky, which was mainly based on “sexual neurosis.” Moreover, such a statement is so puzzling that it evokes the idea that precisely the latter had been an “insult” to him. Breuer too opposed castration, and, significantly, Freud would later state that Charcot and Breuer, “the two investigators as whose pupil he] began [his] studies of hysteria,” had a “personal aversion towards [Abneigung entgegen]” sexual etiology, which he “originally shared” (Freud, 1896, p.199, translation modified by the author). Now, because being averted away from something is not less influential than being attracted toward something, we should come to the conclusion that sexual etiology, though initially opposed and rejected, did indeed play an important role in shaping Freud’s subsequent intellectual course.
The first clue of the new attitude might be found in the lecture “On Hypnosis and Suggestion,” held by Freud on April 27 and May 4, 1892. Comparing the dangers of hypnosis to the “local treatment of female illnesses,” Freud defined the latter as an “indispensable” treatment which caused damage only when applied too extensively or to unsuitable persons (Freud, 1892/1987). In this period, while collaborating with Joseph Breuer on the psychological theory and therapy of hysteria, Freud started an intense friendship and correspondence with Wilhelm Fliess, which was accompanied by a sudden surge of interest, speculation, and research on sexual noxa. Already in February 1893 Freud assumed that “every neurasthenia is sexual” (Freud,1985, p. 40). Masturbation, onanismus conjugalis, coitus interruptus, and similar “abuses” were viewed as playing the main role. At that moment Freud was struck by the idea that neuroses-although being acquired and thus preventable were “entirely incurable” (Freud,1985, p. 43). This idea would change in the next few months. In April 1893, he discussed with Fliess the work of Peyer, a Swiss urologist who had transferred from gynecology into urology the current ideas and practices about neuroses by introducing a new surgical operation on the urethra as a cure for neuroses. According to the urologist, masturbation and coitus interruptus caused an irritation of the mucous membrane of the urethra, which in turn produced stomach disturbances by reflex. Freud, who “fully recognized” the contribution of Peyer, criticized the way he derived “the reflex neurosis from minor anatomical changes of the genitals instead of from changes in the nervous system.” Nevertheless, he stated, “the urethra postica may still be a reflex organ similar to the nose” (Freud, 1985, p. 45). Before turning to the “nose,” let me point out a curious error committed by Freud. Instead of “Peyer,” he wrote “Preyer,” that is, the name of the famous author of The Mind of the Child (Die Seele des Kindes, 1882), the work that initiated the systematic observation of the child’s development. Did the substitution of “Peyer” (the urologist with “Preyer,” the investigator of children, betray the revival of averted thoughts? In any case, precisely during that period Freud was investigating certain reflexes in children suffering from enuresis at the Kassowitz institute and, a few months later, published a brief paper-the only one dealing with neurosis in children-entitled “On a Symptom Which Often Accompanies Children’s Enuresis Nocturna” (Freud, 1893).
In April 1893 Freud rejected once again the explanation based on minor anatomical changes of the genitals, but this time the reason was that, according to him, the nasal localization was opening a “larger point of view” (Freud, 1985, p. 45). Freud’s support of the nasal reflex neurosis theory, which was elaborated in those years by Wilhelm Fliess, has been mainly considered a bizarre and rather insignificant consequence of his idealization of his friend from Berlin. Frank Sulloway (1979) has the merit of having been the first to show that Freud’s fascination with Fliess’ ideas cannot be reduced to a mere psychological dependency, because such ideas were consistent with the scientific tradition of the end of the 19th century. In particular, the idea of a correlation between the nose and genitalia was based on the romantic notion of “vicarious menstruation” (nosebleeds were a typical example of such vicarious menstruation), which, as argued by Moscucci (1990), remained dominant in late Victorian medicine. Although the latter statement seems to be exaggerated, still the idea of “menstrualia vicaria” rested indeed on a very ancient medical tradition, according to which the possible occurrence of menstruation in men as well was acknowledged. It was already part of Galen’s reading and later flourished in the 17th century, (Pomata, 1992). Ultimately, it is this tradition that would be transformed by Freud into the psychoanalytic idea of bisexuality.
Now, the main question concerns Freud’s immediate support of the nasal localization. In my opinion such a support can be understood only by taking into account his previous aversion to the genital localization and its surgical consequences (Bonomi, 1994b). Indeed the nasal localization offered a nonmutilating alternative to treatments such as castration, clitoridectomy, and so forth, and Freud expected the nasal treatment to be harmless. Yet, symbolically speaking, it represented a displacement and a duplication of such averted practices, initially experienced as an “insult” by the young Freud.
From 1893 to the beginning of 1895 the treatment consisted only of electric cauterizations of the “genital spot” of the nose, and especially applications of cocaine on the mucous membranes. The cocaine test also represented the main “scientific” demonstration of the reflex action between nose and genitalia, as a series of pains directly or indirectly connected to menstruation and labor regularly disappeared a few minutes after the application of cocaine to the nose. Now, it is interesting that in 1885, that is, during the same period when Freud was studying the therapeutic properties of cocaine, Maximillian Herz published an article on hysteria in children in which it was suggested to use cocaine for curing the illnesses of the urogenital parts underlying hysterical symptoms. Herz, who was a close friend of Freud and very likely the person who established the link between he and Baginsky, reported the case of a 7-year-old girl affected by onanism who was cured by the twice-daily application of a solution of cocaine at the entrance of the vagina (Herz, 1885). In this respect there was also a deep continuity between the theory and practice focused on the genitals and the ones focused on the nose.
Surgical operations were suggested from the first presentation of the nasal theory, in April 1893. Fliess presented the theory in a lecture published only under his name, but prepared in strict collaboration with Freud. In the lecture Fliess included the recommendation of the surgical treatment of the nose, for those cases in which the anatomical conformation could facilitate the persistent irritation of the nasal mucous membrane. The one who provided the theoretical justification for the operation was Freud himself, who pointed out the corpora cavernosa as the source of the peripheral symptoms, and explained that the surgical treatment was aimed at reducing their volume. Later, it was Freud again who pushed Fliess to “magnify” the possibility of a peripheral localization. The reason was, obviously, that it permitted an etiological treatment of the status nervosus.
The first surgical treatment of the nose was performed by Fliess at the beginning of 1895, in Vienna, on a female patient of Freud’s.? Shortly before, Fliess wrote to his friend: “Only one more week separates us from the operation … I gladly avoid putting myself through a self-examination to ascertain what right I have to expect so much from it” (Freud, 1985, p. 107). Fliess committed an error, however, and the patient, Emma Eckstein, was at risk of death. Because the episode is well known, I won’t recall it once again. Nevertheless it should be stressed that the crisis in which Freud precipitated, and the complex aspects of it, can be understood only by taking into account the symbolic meaning of the operation. Symbolically, the patient had suffered a damaging assault on the genitals. The nasal reflex neurosis theory had permitted Freud to develop his speculations on sexual etiology by separating them from the genitalia and by diverting the meaning of the local treatment from a mutilating sexual assault. But the error and the blood caused a partial collapse of such a protective device. Let me also recall that Freud approached the operation by fantasizing the gynecological treatment as an erotic equivalent (Freud, 1985), and he fainted when a flood of blood came from Emma’s nasal cavity.
The similarity between the nose-mouth cavity and the female genitals would be reflected, a few months later, in the Irma dream, in which the nasal corpora cavernosa were disclosed as a dreadful vagina (Bonomi, 1996). From this perspective, Freud’s 1895-1899 self-analysis, which was initiated by the Irma dream-the “specimen dream” of psychoanalysis-represented a regression into the maternal body, or, similarly, into the same corpora cave rnosa that had been initially indicated as the locus morbi. Significantly, this process was terminated by the dream of the self-dissection of the pelvis, which reflected the issue of castration underlying the Irma dream, represented the guilt by the punishment, and disclosed the unconscious meaning of the intellectual self-analysis as a symbolic enactment. But Freud’s self-castration was more than this. It was a repetition of the original trauma and a sacrifice offered to the mother-just as in the ancient fertility cults, which culminated in the priests’ bloody self-emasculation, aimed at reestablishing the fusional tie with the omnipotent Great Mother Goddess. Not by chance, the final scene of the self-dissection dream, and thus of the whole self-analytic process, was Freud’s imprisonment within the maternal claustrum, which was represented by the enigmatic symbol of an Etruscan tomb.
Two children were lying in this tomb, and in the dream Freud should have walked on them in order to pass over the abyss and reach the Promised Land. But he couldn’t achieve the ultimate goal of his self-analytic journey and remained blocked within the maternal womb-tomb. We don’t know the precise meaning of this highly evocative image, but children, ill children, also crowded the scene of the Irma dream. The main seat was a “children hospital,” the Kassowitz Institute, where the children were visited naked; two of the three doctors who visited Irma were pediatricians, and Irma herself appeared as a hysterical girl in a fragment of the dream eliminated from the main text (Freud, 1900). Here we also find a hidden associative web, which brings us back to Freud’s pediatric training with Adolf Baginsky (see Bonomi, 1994a). Again, immediately after the Irma dream, sexual assault on children became the target of Freud’s reparative efforts, and even when the seduction theory collapsed, the preoccupation for the future of children resurfaced in Freud’s dreams. In the associations of one of these dreams (“My son, the Myops”), pediatricians were made equal to Herodes, who was responsible for the “slaughter of the Innocents” (Freud, 1900, p. 443). The construction of the new idea of infantile sexuality, which progressively emerged in the following years on the ground of the divorce between sexuality and genitalia, can be seen as a strategy for making the mutilating operations on the genitals obsolete. Generally speaking, by developing the idea of infantile sexuality, psychoanalysis promoted the attenuation of the tendency to give sexual punishments to children because they played with their genitals. As we have seen, the idea that sexual punishments were iatrogenic characterized Freud’s clinical work with boys in the final period of his self-analysis. At the same time Freud himself remained prisoner of the castration anxiety from which he was striving to liberate the young boys he had in treatment. In a way this destiny was reflected in Freud’s own analysis of the self-dissection dream, when, referring to its conclusion, he wrote “perhaps the children will attain what has been denied to the father” (Freud, 1900, p. 385), repeating at a later point: “I would have to leave it to the children to arrive at the goal of the hard journey” (p. 404). As suggested by McGrath (1986), Freud was alluding to the destiny of Moses being denied entry into the promised land, in contrast to the children reaching the goal denied to the father. But the meaning of this analogy becomes sharper when considered in relation to the striven-for liberation from castration anxiety. The same destiny was reflected in the two slips that Freud incurred while narrating the way he had liberated his young patients from castration anxiety. The second slip, the one about the two Roman Kings, Tarquinius Priscus and Tarquinius Superbus, seems to be connected to the self-dissection dream as the Tarquin were Etruscan, just as the final tomb of the dream was. Concerning the first slip, the one about the castration of Kronos by Zeus, it might be interesting to point out the following connection with Freud’s pediatric training with Baginsky.
In the same letter from Berlin of March 10, 1886, in which Freud alluded to the “secrets of children’s diseases,” he also reported having visited the fragments of the Altar of Sacrifice, recently found in the Pergamon Acropolis. The mythological scenes of this altar, to which the whole cultural life of Berlin was dedicated in 1886, represented the Greek struggle between giants and Olympic gods, which originated precisely with the emasculation of Uranus. Such a struggle was traditionally viewed as the overcoming of a dark barbarian period, represented by the giants, by a new generation of humanized rulers. In a way, this struggle between an old and a new generation reflected the contemporary debate about genital localization and castration. Whereas Baginsky was the representative of the old generations, Freud would emerge as a champion of the struggle against the strict morality and narrow prejudices of the previous generation. If so, one possible meaning of the later slip was that Freud was reproaching himself for not being free from the barbarian brutality of the previous generation. As a matter of fact, in “The Interpretation of Dreams” (1900) Freud used the same mythological theme as symbol of the barbarian unconscious wishes, suggesting that the latter, though repressed, were immortal-just like the giants or Titans, who, though defeated, were still trembling under the rock.