"E." and FreudIf the early phase of "E."'s treatment provided valuable grist for Freud's pre-psychoanalytic theorizing, the concluding months seem to have confronted him with transferential material of a strikingly psychoanalytic sort. In February, 1899, Freud introduced a discussion of "E."'s core symptom into an important letter in which he drew an analogy between dreams and hysterical attacks as expressions of paired oppositions in which the meaning "is a contradictory pair of wish-fulfillments" (Masson, 1985, p. 345):
Do you know why our friend E., whom you know, blushes and sweats as soon as he sees one of a particular category of acquaintances, especially at the theater? He is ashamed, no doubt -- but of what? Of a phantasy in which he figures as the deflowerer of every person he meets. He sweats as he deflowers, working very hard at it. An echo of the meaning [of this symptom] finds a voice in him, like the resentment of someone defeated, every time he feels ashamed in the presence of someone: "Now the silly goose thinks I am ashamed. If I had her in bed, she would see how little embarrassment I feel!" And the period during which he turned his wishes into this phantasy has left its mark on the mental complex that produces the symptom. It was during the period when he studied Latin. The auditorium of the theater reminds him of the classroom; he always tries to get the same regular seat in the front row. The entr'acte is the school "breather" [
Respirium], and the "seating" stands for "
operam dare" ["to make every effort"] in those days. He had an argument with a teacher over that phrase. Moreover, he cannot get over the fact that, later, at the university, he failed to pass in botany; now he carries on with it as a "deflorator." (Masson, 1985, pp. 345-346)
Rudnytsky (1987, p. 60) noted how closely the account of "E."'s botanical symbolism here replicates Freud's own as reported in the (disguised) case material of his paper on screen memories (Freud, 1899), and in the associations relating anxiety over performance in high school botany to masturbation and sexual intercourse in the "Dream of the Botanical Monograph" (Freud, 1900, p. 171). Patient and therapist enjoyed a remarkable congruence of psychodynamics, and the subjective associations of each informed the ongoing therapeutic dialogue.
The next apparent reference to the case, on December 21, 1899, is the one tied directly to Freud's own dream of being billed in connection with his father (see below), which he had apparently reported verbally to Fliess:
I am not without one happy prospect. You are familiar with my dream which obstinately promises the end of E.'s treatment [among the absurd dreams], and you can well imagine how important this one persistent patient has become to me. It now appears that this dream will be fulfilled. I cautiously say "appears," but I am really quite certain. Buried deep beneath all his fantasies, we found a scene from his primal period [before twenty-two months] which meets all the requirements and in which all the remaining puzzles converge. It is everything at the same time -- sexual, innocent, natural, and the rest. I scarcely dare believe it yet. It is as if Schliemann
12 had once more excavated Troy, which had hitherto been deemed a fable. At the same time the fellow is doing outrageously well. He demonstrated the reality of my theory in my own case, providing me in a surprising reversal with the solution, which I had overlooked, to my former railroad phobia. For this piece of work I even made him the present of a picture of Oedipus and the Sphinx.
13 My phobia, then, was a fantasy of impoverishment, or rather a hunger phobia, determined by my infantile greediness and evoked by my wife's lack of a dowry (of which I am so proud). You will hear more about this at our next congress (Masson, 1985, 391-392).
This remarkable passage places "E." at the center of a web of significance for Freud: half-remembered pre-oedipal experiences of erotic longing and stimulation, and an adult neurosis combining sexual frustration and fear of impulses. A "surprising reversal" indeed, as the early maternal experience by which Freud had been haunted in his self-analysis resonated with "E."'s material, although we never learn the details relating "E."'s neurosis to Freud's anxiety concerning railways. Freud's impatience to successfully conclude the treatment is also manifest. The following month Freud reported that "E."'s "second real scene is coming up after years of preparation," that he might be able to confirm the details by asking the patient's older sister, and that he suspected a third scene concealed behind the second (Masson, 1985, p. 395). Here the parallels between "E."'s analysis and Freud's own are explicit. Both displayed pre-oedipal ties -- involving in both cases a "seductive" nursemaid -- which left greedy ambition as characterological evidence. Both neuroses expressed themselves partly in a fear of travel by train, and each man's analysis was to be represented by the fateful encounter of Oedipus with the Sphinx.
This letter reports the most remarkable statement of counter-transference in Freud's writing: therapist listens with growing excitement as patient's anamnesis approaches material which will exactly meet the requirements of a theoretical puzzle, compares the material produced to his own fantasies of archeological revelation, insists (against the subsequent clinical evidence) that the therapeutic results are wholly positive, credits the patient with clarifying his own infantile neurosis, and rewards him with a copy of a secretly meaningful work of art! The extent of Freud's identification with this patient is underscored by his awarding "E." a picture of Oedipus and the Sphinx. This was Freud's signature image, the scene he placed at the foot of his analytic couch (see Engelman, 1976, Plate 12) and selected as his own bookplate -- the same image Jones and the rest of Freud's inner circle chose in 1906 as the subject of his 50th birthday medallion. Freud had as a teenager identified himself with the man "who divined the famed riddle" (see Jones, 1955, p. 14; Rudnytsky, 1987, p. 62; Sulloway, 1979, pp. 479-480), and as a middle-aged man he found in "E." both an echo and a verification of his self-analytic insight. Furthermore, the "transferential" roles for Freud of "E." and of Fliess seem increasingly similar, and "E."'s termination may have enabled Freud's distancing himself from Fliess, as Anzieu suggested (1975/1986, pp. 521-525; cf. Rosenblum, 1973).
Two months later, in March, 1900, Freud's etiological argument seemed to have collapsed in "E."'s case, however, and he was consumed by doubt:
After last summer's exhilaration, when in feverish activity I completed the dream [book], fool that I am, I was once again intoxicated with the hope that a step toward freedom and well-being had been taken. The reception of the book and the ensuing silence have again destroyed any budding relationship with my milieu. For my second iron in the fire is after all my work -- the prospect of reaching an end somewhere, resolving many doubts, and then knowing what to think of the chances of my therapy. Prospects seemed most favorable in E.'s case -- and that is where I was dealt the heaviest blow. Just when I believed I had the solution in my grasp, it eluded me and I found myself forced to turn everything around and put it together anew, in the process of which I lost everything that until then had appeared plausible. (Masson, 1985, p. 403)
The patient is mentioned again in the letter of April 4th, where Freud noted that "E. will terminate treatment at Easter, having benefited enormously" (Masson, 1985, p. 408). The next letter, 2 weeks later (April 16, 1900), contains the final reference to "E." It is postmarked Vienna and begins with an ironic "greeting as ordered from the land of sunshine," and the admission that, "once again, I did not get there" (Masson, 1985, p. 408). After explaining that his announced trip to northern Italy had been cancelled because of bad weather, his companion's fear of the long return trip, and the illness of his children, Freud discussed "E."'s long-awaited termination:
E. at last concluded his career as a patient by coming to dinner at my house. His riddle is almost completely solved; he is in excellent shape, his personality entirely changed. At present a remnant of the symptoms is left. I am beginning to understand that the apparent endlessness of the treatment is something that occurs regularly and is connected with the transference. I hope that this remnant will not detract from the practical success. I could have continued the treatment, but I had the feeling that such a prolongation is a compromise between illness and health that patients themselves desire, and the physician must therefore not accede to it. The asymptotic conclusion of the treatment basically makes no difference to me, but is yet one more disappointment to outsiders. In any case I shall keep an eye on the man. Since he had to suffer through all my technical and theoretical errors, I actually think that a future case could be solved in half the time. May the Lord now send this next one. ...
Occasionally something stirs toward a synthesis, but I am holding it down.
Otherwise Vienna is Vienna, that is, extremely disgusting. If I closed with "Next Easter in Rome," I would feel like a pious Jew. So I say rather, "Until we meet in the summer or fall in Berlin or where you will." (Masson, 1985, pp. 408-409)
Freud was thus finally able to report the end of "E."'s treatment -- albeit somewhat short of complete symptom remission -- as an Easter event. Coincidentally, he confessed yet another postponement of his so-deeply-desired Italian travel, which he sarcastically compared to the Passover promise, "Next year in Jerusalem." The irony with which Freud reported his recurrent failure both to complete planned Italian travel and to remove the patient's symptoms is revealing. At several previous points coincident mention of this case and of planned travels had suggested a connection in Freud's mind between the patient's anamnesis and his own self-analysis. Exhilarated at completing his grand, self-revelatory
Interpretation of Dreams,Freud's confidence about his patient had been unbounded; but as doubt and disappointment over the book's reception mounted, he also lost clarity about "E." The sense of "E." as a stand-in for Freud himself, who could not travel to Rome until the oedipal current in his own personality had been dealt with seems here a strong preconscious current (see Harris & Harris, 1984; McGrath, 1986).
We are left to speculate why this particular case proved so engaging and yet so frustrating to Freud and in particular why, despite recurrent references to details of "E."'s analysis relevant to his theorizing, almost nothing in the way of specific case material from this analysis ever found its way into Freud's published writings.
14 On the basis of the varied contexts in which Freud recalled "E." in the passages cited -- his reproachfulness toward Breuer, his interest in the anal period, his fascination with bilingual puns, his fear of railway travel, his introspections about the Riddle of the Sphinx, his discovery of screen memories, and finally his ambivalence about the termination -- one may surely argue that this was an especially important case for Freud, one richly charged with transference. It seems reasonable to believe that Freud suppressed the material on "E." when it surely must have been planned for publication both in 1896 and again in 1899. This decision is perhaps justifiable on technical grounds, since as Freud noted he had made numerous mistakes with "E.," but I believe the decision not to publish also served personal needs. Freud must have been struck -- as is the modern psychoanalytically literate reader -- by the remarkable blurring of patient and therapist roles reflected in the case material. In fact Freud did not publish a case history of a male patient until the "Rat Man" in 1909, and he was to insist on the fragmentary and incomplete character of all his published cases.
15 Freud's practice had shifted during the 1890s from an essentially proletarian to a bourgeois clientele, with important consequences for the development of the notion of transference (Ellenberger, 1970, p. 419). In "E." I believe Freud found the first of his patients in whom he could readily see himself, in relation to whom he could observe the full complexity of psychoanalytic counter-transference. And it is
transference that most fundamentally distinguishes the specific-etiological from the psychoanalytic theories. Freud is beginning the arduous process of discovering that psychoanalysis is to a large extent a re-enactment of the patient's psychodynamics in the therapist-client dyad, rather than a simple recovery of repressed memories of prior traumas. In "E." Freud found someone who could, at various times in the period of transition from the seduction theory to psychoanalysis proper, both verify elements of the existing theory (e.g
., in the inter-relationship of early childhood, adolescent, and adult emotions) and inspire essential revisions (e.g
., with respect to the primacy of fantasy over experience).
Freud's later excitement about tracing "E"'s critical childhood events back to the first 24 months of life shows that the "abandonment" of the seduction theory three years previously had not lessoned his interest in the anamnesis. More importantly, the material concerning "E." ties the theorizing of the period immediately following The Interpretation of Dreams to that of the etiological papers. Freud's ambivalent emotions concerning both Jacob's death and E.'s childhood material, and the transferential dynamics of each, help to explain the realignment of thinking which made possible a coherent psychoanalytic theory.
The roles of patient and therapist had by this time blurred. This blurring -- in which the shared fantasy of analyst and analysand takes precedence over the recovery of factual material in the patient's history -- signifies the new Freudian position, psychoanalysis. The extent to which (counter-)transferential merging of analyst and analysand had occurred is, finally, most richly insinuated by Freud's own dream alluding both to "E."'s interminable therapy and his own psychodynamics following his father's death.