Dora: An Analysis of a Case of Hysteria
From Modernism Lab Essays
by Alex Gatlin
An Analysis of a Case of Hysteria (1905), better known simply as “Dora,” is a case study written by the neurologist and founder of psychoanalysis, Sigmund Freud, which details the condition and treatment of Ida Bauer, a woman diagnosed with hysteria and given the pseudonym “Dora." One of Freud’s most famous works, the Dora case study is typically praised for the scientific empiricism of Freud’s method, as well as for its identification of, among others, the phenomenon known as transference.
Hysteria in the Twentieth Century
Although no longer a recognized illness, hysteria (specifically female hysteria) was until the mid-twentieth century a common medical diagnosis for extreme emotional excess. Since its earliest diagnoses in ancient Greece, it was deemed an exclusively female condition, which manifested itself in a wide range of symptoms. Freud believed that hysteria stemmed from psychologically traumatic sexual experiences in the patient’s past, or from problems in the patient’s sexual life; thus, it was to be treated typically, although not exclusively, with some sort of genital stimulation. By the twentieth century, however, both men and children had been diagnosed with hysteria, leading many physicians to consider it a hereditary or psychological disorder. Despite these new findings, treatment methods typically remained unchanged.
Freud’s approach, however, sought to resolve the problem through talking. This allowed both the doctor and patient to identify the subconscious problem, confront it, resolve it, and thereby alleviate the symptoms. As medical techniques advanced, symptoms typically associated with hysteria were identified as symptoms of other diseases, such as various conversion disorders, and the number of cases of hysteria declined sharply until it was no longer recognized as an illness.
Summary of Case Study
Freud’s case study opens with a short description of his research methodology, examining the effectiveness of his new method of treatment through conversation and acknowledging the limitations, both self-imposed and unavoidable, of the single individual case study (Freud 6-7). He then proceeds by emphasizing the importance of dreams to the psychoanalytic process he will later describe (Freud 9). Freud believed that dreams were the avenue through which traumatic experiences in our past manifest themselves; by examining the individual components of a dream, he argued, it would be possible to determine the underlying traumatic experiences.
Freud begins the actual case study by providing as detailed a patient history as possible, without betraying the actual identity of Dora. According to Freud, Dora’s family, which consists of Dora, her father, mother, and brother, display traits and relationships characteristic of the Oedipus complex. This complex, Freud argues, plays an important role in the relationship between Dora, her father, and their neighbors Herr and Frau K. He notes Dora’s symptoms as those of classic hysteria and believes they began around the age of eight but truly manifested themselves at the age of fourteen. At this time, Herr K., a neighbor and friend of the family, forcibly embraced and kissed Dora, pressing his genital region on her, causing the girl to flee in disgust.
It is at this point that Freud identifies two psychological effects typically associated with traumatic events. The first is the “reversal of affect,” in which an act that typically would be pleasurably stimulating instead has the opposite effect. The second is the phenomenon of “displacement,” in which sensation felt during a traumatic experience in one part of the body is later felt in another, seemingly unaffected region.
Freud’s account next focuses on the relationship between Dora and her father. In doing so, Freud asserts that Frau K., who while nursing Dora’s father back to health from an illness began in intimate relationship with him, was also an underlying factor in Dora’s hysteria: Dora’s repressed homosexual feelings for Frau K. came to manifest themselves in a similar way to her unconscious feelings for Herr K.
In keeping with the importance of dreams to psychoanalysis, Freud next examines two dreams told to him by Dora. In the first dream that Dora relates, her family’s house has been set on fire. Dora’s father wakes her in an attempt to get out of the house; however, Dora’s mother wants to look for her jewelry case before the family leaves the house. Freud correlates the jewel-case in the dream with Dora’s genitals, which she deemed were in danger because of Herr K., who is actually represented by her father in the dream. In her second dream, Dora finds herself in a strange town looking for the train station after reading a letter from her mother saying that she must return for her father’s funeral. She sets out walking through the town, asking people along the way how far the station is and always learning that it 5 minutes away. Finally, she comes to a forest where a man tells her that the station is two and half-hours away. Although she is eventually able to see the station, she cannot reach it. Suddenly, she finds herself at home and cannot remember how she got there. Freud determines that the dream was conceived as a fantasy of revenge against her father and Frau K. Freud also connects the letter that Dora receives from her mother in the dream to a letter that she actually received from Herr K., arguing that this displacement indicates how traumatic her experiences with Herr K. had actually been.
In the end, Freud’s treatment of Dora is cut short when Dora abruptly decides to end treatment, an act that Freud believes was perpetrated out of vengeance. Freud ends the case study by examining the importance of his most important discovery, that of transferences, which Freud defines as, “new editions or facsimiles of the tendencies and phantasies which are aroused and made conscious during the progress of the analysis; but they have this peculiarity…that they replace some earlier person by the person of the physician” (Freud 106). A consequence of his new therapeutic techniques, transference involves the projection of emotions held by the patient for a person from their past onto the physician himself. In Dora’s case, Freud believes that Dora projected her emotions towards Herr K. onto him, leading her to discontinue treatment as an act of vengeance toward Herr K.
Critical Receptions and Importance of the Work
The publication of Dora sparked both praise and controversy over Freud’s methods and underlying psychoanalytic theories, while simultaneously providing the field of psychology with arguably some of its most important findings of the twentieth century. Many have criticized Freud’s practice of tracing all psychological problems back to sexual issues. In regards to the Dora case, alternative issues, such as the anti-Semitic culture of Germany and Austria during this time, could have contributed to the specific doctor-patient relationship between Freud and Dora, unintentionally affecting the dynamic between the two and Dora’s interactions with Freud.
Critics have also argued that Freud’s own inability to accept femininity, both his own and in general, limited his own ability to determine the importance of female desire. Bernheimer notes this in Freud’s inability to answer the question, “What do women want?” (27).
Finally, others have criticized the psychoanalytic method as a coercive way for the analyst, a man, to assert his own power over the patient, a female. By conforming to the whims of society and her father by conducting his research, Freud put their considerations before those of his patient. This, in turn, both biased his analysis and prevented the successful treatment of Dora.
Despite these drawbacks, the psychoanalytic techniques and their findings have influenced the various sub-fields of psychology and remain, at least in part, integral to the treatment of patients suffering from neurological disorders. Freud’s case study illustrates the powerful effect sexually traumatic experiences can have on adolescents, and also constitute the first practical analysis of the effects of bisexuality and the mouth as an erogenous zone (Decker 191). The use of talk therapy as a way to identify underlying or masked causes instituted by Freud has been accepted by mainstream psychologists as one of the best methods of treatment for psychological problems. Freud’s dream theory has also provided useful insight into the manifestation of subconscious desires through dreams, as well as a meaningful, if sometimes overly reductive, way of interpreting these dreams.
Finally, the Dora case study identified the importance of the phenomenon of transference, the process by which the patient overlays strong emotions for a person from their past onto the physician. Typically considered an obstacle to the therapeutic process, some argue that the management and resolution of these transferences is the key to lifting repression and to successful treatment. In the end, Freud himself admits that his inability to identify and resolve this transference was the probable reason for Dora discontinuing treatment (Freud 108).
- ↑ Hannah S. Decker, Freud, Dora, and Vienna 1900.(New York: The Free Press, 1991), 6.
- ↑ Sigmund Freud. Dora: An Analysis of a Case of Hysteria (New York: Touchstone 1963), 6.
- ↑ Harold P. Blum, “Dora’s Conversion Syndrome: A Contribution to the Prehistory of the fckLRHolocaust,” Psychoanalytic Quarterly 63.1 (1994): 518-19.
- ↑ Charles Bernheimer and Claire Kahne, eds., In Dora’s Case: Freud-Hysteria-Feminism. (New York: Columbia University Press, 1985), 27.
- ↑ James C. Coyne and Robin Tolmach Lakoff, Father Knows Best: The Use and Abuse of fckLRPower in Freud’s Case of Dora (New York: Teachers College Press 1993), 132.
- ↑ Phillip McCaffrey, Freud and Dora: The Artful Dream (New Jersey: Rutgers University fckLRPress 1984), 3.
- ↑ Richard D. Chessick, “Psychoanalytic Peregrinations I: Transference and Transference fckLRNeurosis Revisited,” Journal of the American Academy of Psychoanalysis 30.1 (2002): 88