Hidden Minds (11 page)

Janet used the term ‘psychological analysis’ to describe his methods. It is a term that has many contemporary variants, such as psychoanalysis or analytical psychology. However, these latter terms were employed to describe specific schools of psychotherapy associated with specific figureheads. Janet never attempted to form a school of psychotherapy. Moreover, he never used the term ‘psychological analysis’ with the intention of giving his approach a ready handle. He used the term as a simple and modest description of the process he used. That is to say, the methods he endorsed were geared towards
analysing
the
psychological
world of a given individual. A second stage, synthesis, would always be necessary if treatment was to be successful. Once the psychotherapist had established which parts of the mind had been ‘split off’ or dissociated, the task in hand would then be to reintegrate them.

Janet’s work at Le Havre and the Salpêtrière was outstanding. He invented what we would now recognise as psychotherapy and linked his treatments to a specific model of psychopathology (i.e. a model of how symptoms develop). Central to his model was what he called the subconscious. Without retrieving and modifying subconscious material, hysterical symptoms would persist.

Janet continued to investigate the mind and write about its mechanisms for the rest of his life. Just before he died he completed
The Great Synthesis -
a theoretical framework within which he believed all human behaviour could be understood. It consisted of over twenty volumes and dozens of scientific articles. In addition, he found the time to write some highly regarded books on philosophy. He also wrote on diverse subjects such as the evolution of moral and religious conduct, social behaviour, graphology, the paranormal, Francis Bacon, medical history, and criminology (to name but a few key areas). Janet was also something of a speculator. He believed, for example, that one day, men would invent the ‘paleoscope’ (or what H.G. Wells later called a time machine). He suggested that the world should learn a common language (an idea that eventually became esperanto), and predicted the use of powerful mind-altering drugs in clinical practice (what he then called ‘narco-analysis’ and what we would now call pharmacotherapy).

In most histories of psychology and medicine, Janet is usually mentioned in passing as a pupil of Charcot who studied hypnotism and experimented with it in the context of hysterical phenomena. His actual achievements -which were monumental – are almost entirely forgotten. This has prompted the Janet scholar Henri Ellenberger to write:

To date, Janet’s hidden city has yet to be properly excavated.

The year 1893 was an eventful one. Janet was awarded his MD thesis and Charcot, the Napoleon of the neuroses, the prince of science, died. He had been receiving hate mail for years predicting his imminent death from a heart attack. One of his colleagues – intimate enough to know of his angina pectoris- must have been very happy on 17 August. Janet had lost both a teacher and a powerful patron.

It was also in 1893 that an article titled On the psychical mechanisms of hysterical phenomena: preliminary communication’ was published in Vienna. It is a paper of enormous historical importance in the annals of medicine and psychiatry. The ‘Preliminary communication’ is traditionally regarded as the first description of a psychological treatment of hysteria. It contains a passing reference to the work of’the two Janets’. The authors were obviously familiar with the writings of not only Pierre but his less famous brother Jules; however, the general tenor of the piece is that the authors’ only significant debt is to the Napoleon of the neuroses. In their concluding paragraph, their acknowledgement is unequivocal: ‘… we have taken a step forward along the path first traced so successfully by Charcot…’

The ‘Preliminary communication’ was well received by many commentators all across Europe. Even Janet welcomed its publication; however, his cordiality was unmistakably tempered with a liberal helping of sang-froid. ‘1 am happy to see’, wrote Janet, ‘that the results of my already old findings have been recently confirmed by two German authors, Breuer and Freud.’ Little did he realise that these two German authors were destined to take all the credit for discovering the role of the unconscious in mental illness. Moreover, one of them – Sigmund Freud – would become a figure of such enormous cultural significance that his overwhelming presence would eclipse Janet’s life and work completely.

From the very beginning Freud was well aware of Janet’s priority. But posterity was at stake. Subsequently, whenever Freud had the opportunity, he would describe misleading and distorted versions of Janet’s ideas in his own works. He was tireless in his personal attacks onjanet, and even accused him of antisemitism.

In the April of 1937 Janet was passing through Vienna and requested a meeting with Freud. By that time, Freud was recognised the world over as the father of psychotherapy – the man who had unlocked the secrets of the mind. The man who had discovered the unconscious. They were both old men, and after a lifetime of enmity, much needed to be said.

Freud, the cultural icon, refused to see him.

O
n one of the hottest summer evenings of 1883, the young Sigmund Freud called on his friend and colleague Josef Breuer. In his dealings with Freud, the older man had come to assume the manner of a kindly uncle. Subsequently, when Breuer insisted that Freud should take a bath, his imposition was received with good humour. In fact, Freud later wrote to his fiancee, Martha Bernays, that Breuer had not only insisted that he take a bath, but Breuer had also chased him into the tub. It is clear from the tenor of Freud’s letter that he did not consider Breuer’s behaviour disrespectful, embarrassing, or improper. Clearly, as far as Freud was concerned, Breuer’s avuncular conduct was perfectly acceptable.

When Freud finally emerged, having sloughed off the accumulated grime of the stifling day, he made his way upstairs to enjoy an evening meal with Breuer. Both men were at ease and sat in shirtsleeves, discussing medicine. In this atmosphere of relaxed bonhomie, the conversation drifted toward nervous problems and ‘strange cases’.

Breuer had mentioned the name of Bertha Pappenheim before; however, on previous occasions, he had never divulged the details of her case in full. This was probably because Pappenheim was a friend of Martha Bernays and Breuer was no doubt concerned about breaching professional confidence; however, on this particular evening in 1883 Breuer decided to reveal all. But he was still uneasy, not confident that he was doing the right thing. He urged Freud not to discuss Pappenheim’s history with his fiancee (or at least to refrain from doing so until they were married).

As night descended Breuer gave Freud an unexpurgated account of his involvement with Bertha Pappenheim. Hearing Breuer’s story changed Freud’s life and, as a consequence, the cultural climate of the twentieth century. As after-dinner conversations go, this was one that really mattered.

Bertha Pappenheim was an educated and creative young woman whom Breuer had accepted as a patient over two years earlier – in December 1880. Pappenheim’s treatment had lasted for well over a year, so Breuer’s memories of her (especially during the latter part of her treatment) were relatively fresh.

The first of Pappenheim’s symptoms had appeared while she was nursing her father (who was suffering from an illness that eventually proved to be fatal). She was a devoted daughter and spent many testing hours by her father’s sickbed. Indeed, the onset of her own illness had a negligible effect on her administrations. She persevered, caring for her father without complaint, but in due course the strain began to take its toll. Pappenheim’s symptoms became more severe, and additional (rather florid) ones began to develop. Two months before her father’s death she could no longer look after him. She had become too ill herself. Reluctantly, she relinquished her nursing duties.

When Breuer accepted Bertha Pappenheim for treatment she was already suffering from many symptoms that were assumed to have a hysterical (i.e. non-physiological) origin. These included headaches, loss of hearing, coughing, squinting, impaired vision, paralysis of several parts other body, anaes-thesiae, and general weakness. As her illness progressed, her symptoms became even more bizarre. She lost the ability to speak German and subsequently could only converse in English, French, or Italian. She suffered from extreme mood swings, exhibited a second (less respectful) personality, and stopped eating and drinking for extended periods. She even suffered from hallucinations. These tended to occur during the day and appeared to be linked by a supernatural theme. Thus, Pappenheim was frequently haunted by spectral black snakes, skulls, and skeletons – the macabre and terrifying trappings of an imaginary Gothic crypt.

In the evening, Pappenheim would enter an altered stare of consciousness very similar to self-hypnosis, uttering the words ‘tormenting, tormenting’. At this point, if a phrase she had spoken earlier in the day – while hallucinating – was repeated, she would begin to tell a story. Breuer visited Pappenheim every evening in order to listen to her stories (many of which reminded him of those written by Hans Christian Andersen). And every evening, when Pappenheim brought her story to a close, she would become calm, untroubled, and lucid.

Pappenheim was fully aware that this process was taking place, and subsequently called it ‘the talking cure’ (a term now used to describe all forms of psychotherapy). Somehow, allowing a deeper part of her mind to express itself was proving helpful. Cathartic, perhaps? But, unfortunately, the beneficial effects of the talking cure were short lived. Pappenheim’s mental state reliably deteriorated over the next two or three days and she would once again find herself thrown into the same nightmare world of sinister hallucinations.

Breuer recognised that Pappenheim’s self-induced trance state was of critical importance. It seemed to uncover a deeper stratum of Pappenheim’s mind – the place where her therapeutic stories came from. Subsequently Breuer began to consider what other benefits might arise from probing this deeper level of mind. He decided to hypnotise Pappenheim, in order to exercise greater control over her entry into the trance state, and also to experiment further with the talking cure. Listening to Pappenheim’s strange stories was all very well, but Breuer was now seized by the urge to be more proactive.

Once Breuer had hypnotised Pappenheim he asked her many questions about the nature of her symptoms. For example, he would take a symptom such as her squint or macropsia (seeing things as bigger than they actually are), and try to work out when it first appeared. This line of questioning led to an interesting discovery. Each of Pappenheim’s symptoms could be traced back to a forgotten event that had occurred while she was nursing her father.

As Breuer recovered each of these memories, the symptoms that they were associated with disappeared. Pain and sadness, trapped in some inaccessible region of the mind, had been released. It appeared that Pappenheim’s stories had been related to the operation of some spontaneous cathartic mechanism in the mind. The unhappy emotion attached to inaccessible, traumatic memories was being channelled into her melancholy narratives.

By using hypnosis Breuer had managed this process more effectively. He had devised a method of syphoning off unhappy emotions from their origin -unconscious memories.

The story of Breuer’s treatment of Bertha Pappenheim made a deep impression on Freud. And even though the next three years proved to be very eventful, Freud never forgot Breuer’s after-dinner disclosures.

In 1885 Freud went to Paris to study under Charcot at the Salpêtrière. There, seated among the doctors and dignitaries who attended Charcot’s demonstrations, Freud watched as the prince of science created and removed hysterical symptoms using hypnosis and the power of suggestion. And as he watched, memories of Breuer’s remarkable case stirred. Eager to elicit an opinion from the high priest of neurology, Freud approached Charcot and told him about Breuer’s work. But Charcot was singularly unimpressed. He responded with indifference.

Yet this did nothing to dampen Freud’s conviction that Breuer had stumbled across something interesting. Even Charcot’s indifference failed to smother Freud’s nascent plan to involve Breuer in some collaborative research.

In 1886 Freud returned to Vienna, married Martha Bernays, and went into private practice as a consultant in nervous diseases. He contacted Breuer and the two men began working together – discussing their patients and building on the slight theoretical foundation established by Breuer while working with Pappenheim. Patients with hysteria were hypnotised, traumatic memories were recovered, and improvements followed.

in 1893 Breuer and Freud published their short paper On the psychical mechanism of hysterical phenomena: preliminary communication’, which eventually became the opening chapter of
Studies on Hysteria
(1895), a comprehensive account of their pioneering treatment methods. The first and most important case cited in this historically significant work, was the case of Bertha Pappenheim – renamed Fräulein Anna O in order to protect her identity.

In the ‘Preliminary communication’ Breuer and Freud did not use the term ‘unconscious’, but its existence is definitely implied. They suggested that hidden memories of certain experiences were the root cause of hysterical symptoms; however, they somehow managed to get by without using the term ‘unconscious memories’.