I
Several of the contributors to this series of “Autobiographical
Studies”[2] have begun by expressing their misgivings at the unusual
difficulties of the task they have undertaken. The difficulties in my
case are, I think, even greater; for I have already more than once
published papers upon the same lines as the present one, papers which,
from the nature of the subject, have dealt more with personal
considerations than is usual or than would otherwise have been
necessary.
I gave my first account of the development and subject-matter of
psychoanalysis in five lectures which I delivered in 1909 before Clark
University at Worcester, Mass., where I had been invited to attend the
celebration of the twentieth anniversary of the foundation of that
body.[3] Only recently I gave way to the temptation of making a
contribution of a similar kind to an American collective publication
dealing with the opening years of the twentieth century, since its
editors had shown their recognition of the importance of psychoanalysis
by allotting a special chapter to it.[4] Between these two dates
appeared a paper, “On the History of the Psycho-Analytic Movement,”[5]
which, in fact, contains the essence of all that I can say on the
present occasion. Since I must not contradict myself and since I have no
wish to repeat myself exactly, I must endeavor to construct a narrative
in which subjective and objective attitudes, biographical and historical
interests, are combined in a new proportion.
I was born on May 6th, 1856, at Freiberg in Moravia, a small town in
what is now Czecho-Slovakia. My parents were Jews, and I have remained a
Jew myself. I have reason to believe that my father’s family were
settled for a long time on the Rhine (at Cologne), that, as a result of
a persecution of the Jews during the fourteenth or fifteenth century,
they fled eastwards, and that, in the course of the nineteenth century,
they migrated back from Lithuania through Galicia into German Austria.
When I was a child of four I came to Vienna, and I went through the
whole of my education there. At the Gymnasium I was at the top of my
class for seven years; I enjoyed special privileges there, and was
scarcely obliged to pass any examinations. Although we lived in very
limited circumstances, my father insisted that, in my choice of a
profession, I should follow my own inclinations. Neither at that time,
nor indeed in my later life, did I feel any particular predilection for
the career of a physician. I was moved, rather, by a sort of curiosity,
which was, however, directed more towards human concerns than towards
natural objects; nor had I recognized the importance of observation as
one of the best means of gratifying it. At the same time, the theories
of Darwin, which were then of topical interest, strongly attracted me,
for they held out hopes of an extraordinary advance in our understanding
of the world; and it was hearing Goethe’s beautiful essay on Nature read
aloud at a popular lecture just before I left school that decided me to
become a medical student.
When, in 1873, I first joined the University, I was met by some
appreciable disappointments. Above all, I found that I was expected to
feel myself inferior and an alien, because I was a Jew. I refused
absolutely to do the first of these things. I have never been able to
see why I should feel ashamed of my descent or, as people were beginning
to say, of my race. I put up, without much regret, with my nonadmission
to the community; for it seemed to me that in spite of this exclusion an
active fellow-worker could not fail to find some nook or cranny in the
frame-work of humanity. These first impressions at the University,
however, had one consequence which was afterwards to prove important;
for at an early age I was made familiar with the fate of being in the
Opposition and of being put under the ban of the “compact majority.” The
foundations were thus laid for a certain degree of independence of
judgment.
I was compelled, moreover, during my first years at the University, to
make the discovery that the peculiarities and limitations of my gifts
denied me all success in many of the departments of science into which
my youthful eagerness had plunged me. Thus I learned the truth of
Mephistopheles’ warning:
“Vergebens, dass ihr ringsum wissenschaftlich schweift,
Ein jeder lernt nur, was er lernen kann.”[6]
At length, in Ernst Brücke’s physiological laboratory, I found rest and
satisfaction—and men, too, whom I could respect and take as my models.
Brücke gave me a problem to work out in the histology of the nervous
system; I succeeded in solving it to his satisfaction and in carrying
the work further on my own account. I worked at this Institute, with
short interruptions, from 1876 to 1882, and it was generally thought
that I was marked out to fill the next post of Assistant that might fall
vacant there. The various branches of medicine proper, apart from
psychiatry, had no attraction for me. I was decidedly negligent in
pursuing my medical studies, and it was not until 1881 that I took my
somewhat belated degree as a Doctor of Medicine.
The turning point came in 1882, when my teacher, for whom I felt the
highest possible esteem, corrected my father’s generous improvidence by
strongly advising me, in view of my bad financial position, to abandon
my theoretical career. I followed his advice, left the physiological
laboratory and entered the General Hospital[7] as an “Aspirant.” I was
soon afterwards promoted to being a junior physician, and worked in
various departments of the hospital, amongst others for more than six
months under Meynert, by whose work and personality I had been greatly
struck while I was still a student.
In a certain sense I nevertheless remained faithful to the line of work
upon which I had originally started. The subject which Brücke had
proposed for my investigations had been the spinal cord of one of the
lowest of the fishes (Ammocoetes Petromyzon); and I now passed on to the
human central nervous system. Just at this time Flechsig’s discoveries
of the non-simultaneity of the formation of the medullary sheaths were
throwing a revealing light upon the intricate course of its tracts. The
fact that I began by choosing the medulla oblongata as the one and only
subject of my work was another sign of the continuity of my development.
In complete contrast to the diffuse character of my studies during my
earlier years at the University, I was now developing an inclination to
concentrate my work exclusively upon a single subject or problem. This
inclination has persisted and has since led to my being accused of
one-sidedness.
I now became as active a worker in the Institute of Cerebral Anatomy as
I had previously been in the physiological one. Some short papers upon
the course of the tracts and the nuclear origins in the medulla
oblongata date from these hospital years, and my results were regularly
noted down by Edinger. One day Meynert, who had given me access to the
laboratory even during the times when I was not actually working under
him, proposed that I should definitely devote myself to the anatomy of
the brain, and promised to hand over his lecturing work to me, as he
felt he was too old to manage the newer methods. This I declined, in
alarm at the magnitude of the task; it is possible, too, that I had
guessed already that this great man was by no means kindly disposed
towards me.
From the practical point of view, brain anatomy was certainly no better
than physiology, and, with an eye to material considerations, I began to
study nervous diseases. There were, at that time, few specialists in
that branch of medicine in Vienna, the material for its study was
distributed over a number of different departments of the hospital,
there was no satisfactory opportunity of learning the subject, and one
was forced to be one’s own teacher. Even Nothnagel, who had been
appointed a short time before, on account of his book upon cerebral
localization, did not single out neuropathology from among the other
subdivisions of medicine. In the distance glimmered the great name of
Charcot; so I formed a plan of first obtaining an appointment as
Lecturer on Nervous Diseases in Vienna and of then going to Paris to
continue my studies.
In the course of the following years, while I continued to work as a
junior physician, I published a number of clinical observations upon
organic diseases of the nervous system. I gradually became familiar with
the ground; I was able to localize the site of a lesion in the medulla
oblongata so accurately that the pathological anatomist had no further
information to add; I was the first person in Vienna to send a case for
autopsy with a diagnosis of polyneuritis acuta. The fame of my diagnoses
and their _post mortem_ confirmation brought me an influx of American
physicians, to whom I lectured upon the patients in my department in a
sort of pidgin-English. I understood nothing about the neuroses. On one
occasion I introduced to my audience a neurotic suffering from a
persistent headache as a case of chronic localized meningitis; they
quite rightly rose in revolt against me, and my premature activities as
a teacher came to an end. By way of excuse I may add that this happened
at a time when greater authorities than myself in Vienna were in the
habit of diagnosing neurasthenia as cerebral tumor.
In the spring of 1885 I was appointed Lecturer on Neuropathology on the
ground of my histological and clinical publications. Soon afterwards, as
the result of a warm testimonial from Brücke, I was awarded a Traveling
Fellowship of considerable value. In the autumn of the same year I made
the journey to Paris.
I became a student at the Salpêtrière, but as one of the crowd of
foreign visitors, I had little attention paid me to begin with. One day
in my hearing Charcot expressed his regret that since the war he had
heard nothing from the German translator of his lectures; he went on to
say that he would be glad if someone would undertake to translate the
new volume of his lectures into German. I wrote to him and offered to do
so; I can still remember a phrase in the letter, to the effect that I
suffered only from _l’aphasie motrice_ and not from _l’aphasie
sensorielle du français_. Charcot accepted the offer, I was admitted to
the circle of his personal acquaintances, and from that time forward I
took a full part in all that went on at the Clinic.
As I write these lines, a number of papers and newspaper-articles have
reached me from France, which gave evidence of a violent objection to
the acceptance of psychoanalysis, and which often make the most
inaccurate assertions in regard to my relations with the French school.
I read, for instance, that I made use of my visit to Paris to
familiarize myself with the theories of Pierre Janet and then made off
with my booty. I should therefore like to say explicitly that during the
whole of my visit to the Salpêtrière, Janet’s name was never so much as
mentioned.
What impressed me most of all while I was with Charcot were his latest
investigations upon hysteria, some of which were carried out under my
own eyes. He had proved, for instance, the genuineness of hysterical
phenomena and their conformity to laws (“_introite et hic dii sunt_”),
the frequent occurrence of hysteria in men, the production of hysterical
paralyses and contractures by hypnotic suggestion and the fact that such
artificial products showed, down to their smallest details, the same
features as spontaneous attacks, which were often brought on
traumatically. Many of Charcot’s demonstrations began by provoking in me
and in other visitors a sense of astonishment and an inclination to
scepticism, which we tried to justify by an appeal to one of the
theories of the day. He was always friendly and patient in dealing with
such doubts, but he was also most decided; it was in one of these
discussions that (speaking of theory) he remarked, “_Ça n’empêche pas
d’exister_,” a _mot_ which left an indelible mark upon my mind.
No doubt the whole of what Charcot taught us at that time does not hold
good today: some of it has become doubtful, some has definitely failed
to withstand the test of time. But enough is left over, and has found a
permanent place in the storehouse of science. Before leaving Paris I
discussed with the great man a plan for a comparative study of
hysterical and organic paralyses. I wished to establish the thesis that
in hysteria paralyses and anæsthesias of the various parts of the body
are demarcated according to the popular idea of their limits and not
according to anatomical facts. He agreed with this view, but it was easy
to see that in reality he took no special interest in penetrating more
deeply into the psychology of the neuroses. When all is said and done,
it was from pathological anatomy that his work had started.
Before I returned to Vienna I stopped for a few weeks in Berlin, in
order to gain a little knowledge of the general disorders of childhood.
Kassowitz, who was at the head of a public institute in Vienna for the
treatment of children’s diseases, had promised to put me in charge of a
department for the nervous diseases of children. In Berlin I was given
assistance and a friendly reception by Baginsky. In the course of the
next few years I published, from the Kassowitz Institute, several
monographs of considerable size on unilateral and bilateral cerebral
palsies in children. And for that reason, at a later date (in 1897),
Nothnagel made me responsible for dealing with the same subject in his
great _Handbuch der allgemeinen und speziellen Therapie_.
In the autumn of 1886 I settled down in Vienna as a physician, and
married the girl who had been waiting for me in a distant city for more
than four years. I may here go back a little and explain how it was the
fault of my _fiancée_ that I was not already famous at that early age. A
side interest, though it was a deep one, had led me in 1884 to obtain
from Merck some of what was then the little-known alkaloid cocaine and
to study its physiological action. While I was in the middle of this
work, an opportunity arose for making a journey to visit my _fiancée_,
from whom I had been parted for two years. I hastily wound up my
investigation of cocaine and contented myself in my book on the subject
with prophesying that further uses for it would soon be found. I
suggested, however, to my friend, L. Königstein, the ophthalmologist,
that he should investigate the question of how far the anæsthetizing
properties of cocaine were applicable in diseases of the eye. When I
returned from my holiday I found that not he, but another of my friends,
Carl Koller (now in New York), to whom I had also spoken about cocaine,
had made the decisive experiments upon animals’ eyes and had
demonstrated them at the Ophthalmological Congress at Heidelberg. Koller
is therefore rightly regarded as the discoverer of local anæsthesia by
cocaine, which has become so important in minor surgery; but I bore my
_fiancée_ no grudge for my neglected opportunity.
I will now return to the year of 1886, the time of my settling down in
Vienna as a specialist in nervous diseases. The duty devolved upon me of
giving a report before the “Gesellschaft der Aerzte” [Society of
Medicine] upon what I had seen and learnt with Charcot. But I met with a
bad reception. Persons of authority, such as the chairman (Bamberger,
the physician), declared that what I said was incredible. Meynert urged
me to find some cases in Vienna similar to those which I had described
and to present them before the Society. I tried to do so; but the senior
physicians in whose departments I found any such cases, refused to allow
me to observe them or to work at them. One of them, an old surgeon,
actually broke out with the exclamation: “But, my dear sir, how can you
talk such nonsense? _Hysteron_ (sic) means the uterus. So how can a man
be hysterical?” I objected in vain that what I wanted was, not to have
my diagnosis approved, but to have the case put at my disposal. At
length, outside the hospital, I came upon a case of classical hysterical
hemi-anæsthesia in a man, and demonstrated it before the “Gesellschaft
der Aerzte.” This time I was applauded, but no further interest was
taken in me. The impression that the great authorities had rejected my
innovations remained unshaken; and, with my hysteria in men and my
production of hysterical paralyses by suggestion, I found myself forced
into the Opposition. As I was soon afterwards excluded from the
laboratory of cerebral anatomy and for a whole term had nowhere to
deliver my lectures, I withdrew from academic life and ceased to attend
the learned societies. It is a whole generation since I have visited the
“Gesellschaft der Aerzte.”
Anyone who wanted to make a living from the treatment of nerve-patients
must clearly be able to do something to help them. My therapeutic
arsenal contained only two weapons, electrotherapy and hypnosis, for
prescribing a visit to a hydropathic establishment after a single
consultation was an inadequate source of income. My knowledge of
electrotherapy was derived from W. Erb’s text-book, which provided
detailed instructions for the treatment of all the symptoms of nervous
diseases. Unluckily I was soon driven to see that following these
instructions was of no help whatever and that what I had taken for an
epitome of exact observations was merely the construction of phantasy.
The realization that the work of the greatest name in German
neuropathology had no more relation to reality than some “Egyptian”
dream-book, such as are sold in cheap book-shops, was painful, but it
helped to rid me of yet another piece of the innocent faith in authority
by which I was still obsessed. So I put my electrical apparatus aside,
even before Möbius had solved the problem by explaining that the
successes of electric treatment in nervous disorders (in so far as there
were any) were the effect of suggestion on the part of the physician.
With hypnosis the case was better. While I was still a student I had
attended a public exhibition given by the “magnetist” Hansen and had
noticed that one of the persons experimented upon had became deathly
pale at the onset of cataleptic rigidity and had remained so as long as
that condition lasted. This firmly convinced me of the genuineness of
the phenomena of hypnosis. Scientific support was soon afterwards given
to this view by Heidenhain; but that did not restrain the professors of
psychiatry from declaring for a long time to come that hypnosis was not
only fraudulent but dangerous and from regarding hypnotists with
contempt. In Paris I had seen hypnosis used freely as a method for
producing symptoms in patients and then removing them again. And now the
news reached us that a school had arisen at Nancy which made an
extensive and remarkably successful use of suggestion, with or without
hypnosis, for therapeutic purposes. It thus came about, as a matter of
course, that in the first years of my activity as a physician my
principal instrument of work, apart from haphazard and unsystematic
psycho-therapeutic methods, was hypnotic suggestion.
This implied, of course, that I abandoned the treatment of organic
nervous diseases; but that was of little importance. For on the one hand
the prospects in the treatment of such disorders were in any case never
promising, while on the other hand, in the private practice of a
physician working in a large town, the quality of such patients was
nothing compared to the crowds of neurotics, whose number seemed further
multiplied by the manner in which they hurried, with their troubles
unsolved, from one physician to another. And apart from this, there was
something positively seductive in working with hypnosis. For the first
time there was a sense of having overcome one’s impotence; and it was
highly flattering to enjoy the reputation of being a miracle-worker. It
was not until later that I was to discover the drawbacks of the
procedure. At the moment there were only two points to complain of:
first, that I could not succeed in hypnotizing every patient, and
secondly, that I was unable to put individual patients into as deep a
state of hypnosis as I should have wished. With the idea of perfecting
my hypnotic technique, I made a journey to Nancy in the summer of 1889
and spent several weeks there. I witnessed the moving spectacle of old
Liébault working among the poor women and children of the laboring
classes, I was a spectator of Bernheim’s astonishing experiments upon
his hospital patients, and I received the profoundest impression of the
possibility that there could be powerful mental processes which
nevertheless remained hidden from the consciousness of men. Thinking it
would be instructive, I had persuaded one of my patients to follow me to
Nancy. She was a very highly gifted hysteric, a woman of good birth, who
had been handed over to me because no one knew what to do with her. By
hypnotic influence I had made it possible for her to lead a tolerable
existence and I was always able to take her out of the misery of her
condition. But she always relapsed again after a short time, and in my
ignorance I attributed this to the fact that her hypnosis had never
reached the stage of somnambulism with amnesia. Bernheim now attempted
several times to bring this about, but he too failed. He frankly
admitted to me that his great therapeutic successes by means of
suggestion were only achieved in his hospital practice and not with his
private patients. I had many stimulating conversations with him, and
undertook to translate into German his two works upon suggestion and its
therapeutic effects.
During the period from 1886 to 1891 I did little scientific work, and
published scarcely anything. I was occupied with establishing myself in
my new profession and with assuring my own material existence as well as
that of a rapidly increasing family. In 1891 there appeared the first of
my studies upon the cerebral palsies of children, which was written in
collaboration with my friend and assistant, Dr. Oskar Rie. An invitation
which I received in the same year to contribute to an encyclopædia of
medicine led me to investigate the theory of aphasia, which was at that
time dominated by the views of Wernicke and Lichtheim, which laid stress
exclusively upon localization. The fruit of this inquiry was a small
critical and speculative book, _Zur Auffassung der Aphasie_. But I must
now show how it happened that scientific research once more became the
chief interest of my life.