This fascinating book, which presents an early psychoanalyst’s session-by-session notes on a case of hysteria caused by severe sexual trauma and incest, offers a vivid portrait of psychoanalytic practice in the second decade of the twentieth century. Accompanying these notes are insightful commentaries by Elizabeth Lunbeck and Bennett Simon that situate the case historically and throw light on the many difficulties that both analyst and patient encountered in the treatment. The book will be of great interest to students of the history of psychoanalysis and other psychological therapies, to those interested in the history of women and gender, and to clinicians struggling with the treatment of severely traumatized patients today.
|Publisher:||Yale University Press|
|Product dimensions:||6.13(w) x 9.25(h) x (d)|
About the Author
Elizabeth Lunbeck is professor of history at Princeton University. Bennett Simon is clinical professor of psychiatry at Harvard University and training and supervising analyst at the Boston Psychoanalytic Society and Institute.
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Family Romance, Family SecretsCase Notes from an American Psychoanalysis, 1912
By Elizabeth Lunbeck Bennett Simon
Yale University PressCopyright © 2003 Elizabeth Lunbeck and Bennett Simon
All right reserved.
Rachel C., a twenty-two-year-old working woman, first saw the psychoanalyst Louville Eugene Emerson on 24 January 1912. A tall, muscular woman with, Emerson would later write, "a small, pretty and innocent face, like that of a young girl," Rachel told in this preliminary interview of her history of vomiting-for six months she had been unable to keep down either food or water-and of experiencing the return, after several years' respite, of convulsions so severe "it took several men to hold her." Rachel lived at home with her father and younger brother in a town north of Boston. She told Emerson she had been greatly shocked several years earlier, when her mother, with whom she was "absolutely bound up," had died suddenly and unexpectedly. Referred to Emerson by the Harvard neurologist James Jackson Putnam, she was, at the moment, terrified by her symptoms. She had broken her hands twice in falls sustained in the midst of convulsions, which interfered with her ability to work, and her body was constantly covered with bruises.
Thus began the psychoanalytic treatment that is the subject of this book. Two hundred and ninety-one sessions followed this first one, all but twenty-three of them within just over two years from the treatment's start. Emerson saw approximately 220 patients in the period from 1911 through 1917, some for a single session, some for extended psychoanalytic treatments. Although he kept notes on all of them, the notes he kept in this case are more voluminous and more worked over than any of his others. No other case engaged his attentions to the degree that this, his specimen case, did. He saw Rachel regularly, sometimes as often as five days a week, and he published an extended account of his treatment of her. This was, in addition, the case that his medical colleagues targeted for censure. In April 1913, with Rachel hospitalized on account of multiple hysterical symptoms, Emerson was called upon to defend not only his treatment of her but also psychoanalysis as a science and a practice, before a suspicious and critical audience of psychiatrists.
Psychoanalysis was a relatively young specialty in 1912. Although by that date Freud had been treating patients with psychoanalytic methods for two decades and had published numerous papers as well as The Interpretation of Dreams (1900), in the United States relatively little was known of him and his work through the early years of the new century. Historians customarily date the earliest evidence of American awareness of psychoanalysis to around 1906, when reports of the works of Freud and Jung began to appear in the professional literature. In 1905, for example, writing in the Psychological Bulletin, the psychiatrist Adolf Meyer lauded Jung's association test-of which Emerson, in his treatment of Rachel, would make use-and referred to Freud's "analysis" and work in interpreting dreams. The following year, he reported on several of Freud's publications, including his treatment of Dora, and recommended in especially strong terms his Three Essays on the Theory of Sexuality. The same year, the Boston psychopathologist Morton Prince founded the Journal of Abnormal Psychology, which he intended as a vehicle to serve neurologists, psychiatrists, and psychologists interested in psychopathology and psychoanalysis. The first issue featured an article by Putnam reporting on three cases of hysteria he had treated by "Freud's method of psychoanalysis"-an article Ernest Jones would later cite as the first on psychoanalysis to appear in English. Prince and Putnam were leaders of the so-called Boston school of psychotherapy, a group encompassing the city's most eminent psychologists, philosophers, psychiatrists, and neurologists that, in the years from 1890 through 1909, developed and popularized a sophisticated and scientific psychotherapeutic practice. A number of these men-Putnam, William James, Hugo Munsterberg, G. Stanley Hall, E. B. Holt, and, on at least one occasion, the ubiquitous Jones-began, in 1906, to gather weekly at Prince's home to discuss psychoanalysis, with several of them soon thereafter identifying themselves as psychoanalysts.
Not until Freud's American visit to Clark University in Worcester, Massachusetts, in September 1909, however, was psychoanalysis known outside the ranks of these relatively few specialists. Freud lectured at Clark to a warmly receptive audience of specialists and lay people, presenting a simplified and optimistic version of psychoanalysis well suited to the tastes and capacities of his American audience. In five consecutive mornings of lectures, Freud presented his findings on hysteria and the talking cure, on free association and the analysis of dreams, on childhood sexuality, and on the dangers of sexual repression. Freud spoke at what his host G. Stanley Hall called a "psychological moment" in the United States. The lectures, soon published and widely disseminated, both launched psychoanalysis into the popular realm of social commentary and quickened its professional reception. Within the space of two years, a number of prominent neurologists and psychiatrists were identifying themselves as psychoanalysts, passionately committed to "the cause." In 1911, both the New York Psychoanalytic Society and the American Psychoanalytic Association, with Putnam its president and Jones secretary, were founded. A Boston Psychoanalytic Society followed in 1914; Putnam was once again president, Emerson a member.
Emerson was thirty-nine in 1912, a man with a checkered vocational and professional past who followed a somewhat singular-nontherapeutic and nonmedical-path to psychoanalysis. A native of Maine, he studied engineering at the Massachusetts Institute of Technology, leaving in 1896 before securing a degree to work at the Smithsonian Institution. After several years more of scientific and technical work, he enrolled as a graduate student in philosophy at Harvard in 1903, studying with William James and Josiah Royce, among others, and earning the Ph.D. for a dissertation in experimental psychology in 1907. After a year's sojourn in Europe, he assumed a temporary teaching position at the University of Michigan. There he first began to work as a clinician, seeing patients at the new Psychopathic Hospital in Ann Arbor. He also began to read widely in the psychotherapeutic literature, drawn especially to the writings of Freud and Jung. In 1911, dissatisfied with the "college laboratory psychology" he was teaching, he wrote to Putnam, inquiring about opportunities to return to Boston to study and teach psychoanalysis. He was particularly interested in questions of its "ethical and philosophical import," questions regarding which laboratory psychology, "so remote from actual life," offered little scope. Within several months, Putnam was able to secure some private funds to appoint Emerson to a half-time position in the Department of Neurology at the Massachusetts General Hospital. In 1911, Emerson moved to Boston and, in a makeshift office, jerry-rigged with two chairs and a screen on a third-floor landing, resumed the practice of psychoanalysis upon which he had embarked in Michigan. More regular appointments at the hospital followed, where he eventually graduated to occupying a large private office. In 1912, he was also appointed to the staff of the new Boston Psychopathic Hospital, where he treated, with psychoanalytic methods, a number of cases of hysteria while at the same time tangling repeatedly with the hospital director, E. E. Southard, over the scientific and philosophical validity of psychoanalysis.
Emerson returned to Boston as Putnam's protege. Putnam's philosophical idealism as well as his-to Freud's mind, characteristically American-moralism would strongly frame Emerson's readings of psychoanalysis over the course of the years during which he was an active practitioner and contributor to the psychoanalytic literature. By 1914, six published analytic papers to his credit, Emerson was exhibiting a sure and thorough grasp of the Freudian corpus, citing recently translated works, such as The Interpretation of Dreams and Selected Papers on Hysteria, as well as a range of less well known papers by Freud, Jones, Sandor Ferenczi, and others in the original German. He was as enthusiastic a reader as any of his colleagues in the emerging literature, abstracting numerous German papers for the Psychoanalytic Review and making notes for his own use of particularly significant publications. He published a further eight analytic papers before the decade was out. Six of his twelve early papers were case reports, with substantial case material presented in two others, marking him as an important contributor to the store of early published cases. Emerson identified himself and was thought of by others as a Freudian. Although to some this designation signified only that he was a psychotherapist, to others it carried more precise meaning. The psychologist William McDougall, for example, wrote Emerson asking if he would analyze some of his dreams "on Freudian lines," adding that neither Jung's analysis of his dreams nor that of another local psychoanalyst had yielded the "Freudian result" he was hopeful Emerson would be able to give him.
From the perspective of Emerson's early-articulated allegiance to the primacy of ethics and his almost filial devotion to Putnam, it is hardly surprising that he consistently objected, in a Putnamesque vein, to what he interpreted as Freud's indifference to ethical and moral questions. The bonds of sympathy and obligation between Putnam and Emerson were strong. They referred cases to one another, and at times discussed their progress. When Emerson started seeing patients privately, he did so in Putnam's office, in his home on Marlborough Street. Emerson stood in for Putnam when the latter could not be present to run the psychoanalytic discussion group that met monthly at his home. Emerson and Putnam analyzed each other's dreams, and in 1912, having just read Freud's paper, "Recommendations to Physicians Practicing Psycho-analysis," in which the analytic examination of the analyst's own personality "in the form of a self-analysis" was recommended, Putnam queried Emerson as to whether "we might make some arrangement this summer to practise on each other." Long before Putnam's death in 1918, Emerson was being groomed as his successor. "You seem to be the bearer of his mantle," McDougall wrote to Emerson. Indeed, upon Putnam's death, Emerson inherited not only his moral idealism but also his patient notes.
What is of perhaps more interest than the sources and extent of Emerson's objections to Freud's amoralism-for Emerson declared these publicly-are the less obvious ways in which the exigencies and demands of psychoanalytic practice shaped his understandings of psychoanalytic concepts and technique. The difficulties Emerson encountered in trying to put into practice a technique that Freud had not explained, except in passing, since the publication of Studies on Hysteria in 1895, should not be underestimated. Even with the publication of Freud's major papers on technique, from 1911 through 1914, specific guidelines for carrying out analytic treatments evolved slowly both in Europe and the United States. Few practitioners were well versed in Freud's work and experienced in treating more than a few patients. There were no formal structures for supervision or review of ongoing psychoanalytic cases, and no consensus existed on such technical questions as the expected length of treatment, the nature of the transference, and the necessity for supervision. Freud's papers, moreover, did not offer the systematic exposition of technique that a man like Emerson, who was on his own clinically, self-taught and without the benefit of a personal analysis, might have wanted.
Emerson devoured Freud's papers on technique as they appeared, making notes to himself on Freud's recommendations and comparing them to his own practices. Consider, for example, the single issue of length of treatment. When Emerson embarked on his treatment of Rachel, it is likely he expected it would be of short duration. Indeed, within five months of the first session, he was considering her to be completely recovered. His contemporary Isador Coriat was analyzing patients for periods anywhere from one month to, in severe cases, four to six months. Freud treated his early cases relatively quickly; his analysis of Dora lasted three months, of the Rat Man one year. Yet he offered little explicit advice to novice practitioners on this and other questions, specifying in 1904, for example, the rather elastic period of from six months to three years as that necessary to treat severe cases. In 1913, in the fourth of his technique papers to be published, Freud was emphasizing the slowness of analytic work, writing that psychoanalysis was "always a matter of long periods of time ... of longer periods than the patient expects." Emerson made notes on this paper for his own use, emphasizing Freud's contention that "the question as to how long the treatment should last is unanswerable" and highlighting Freud's words on the frustrations lengthy treatment engendered: "it's natural to desire to shorten an analytic cure, but one cannot get rid of this, that, or the other symptom alone." These notes were made at least a year into his treatment of Rachel, which by that point was possibly seeming interminable to him.
In the years coincident with Emerson's treatment of Rachel, Freud was not only for the first time providing technical recommendations on the practice of psychoanalysis, but he was also beginning to profoundly modify and complicate his views, publishing, for example, his landmark papers "On Narcissism: An Introduction" and "Instincts and Their Vicissitudes." Emerson read and attempted to assimilate both, within two years publishing a paper in which he limned the erotic lives of a range of narcissistic characters and abstracting the latter paper-the title of which he rendered as "Impulses and Their Mutations"-for the Psychoanalytic Review. Emerson accepted much of what he read in the emerging psychoanalytic literature, whether by Freud or others. He assented without apparent qualms to the major tenets of Freud's sexual theories, manifesting little of the prohibiting moralism that Freud found so echt-and lamentably-American in Putnam. Emerson's reputation, both locally and, in some circles, nationally, was as an expert in difficult cases, particularly those of a sexual nature. His Psychopathic Hospital colleague Martin Peck, who was attempting to treat some of his own patients psychoanalytically in those years, wrote Emerson several times seeking advice on the sexual eccentricities of various of his relatives and patients. Emerson was, as well, attuned to issues of domestic violence, and he evaluated a number of men remanded by the courts for violence toward their wives.
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