Examples of psychoanalysis in practice.
What Are Case Studies?
Case studies are detailed accounts of individual experiences.
They are an essential part of psychoanalysis and have been instrumental in shaping psychoanalytic theory and practice. In fact, Freud’s theories are mostly based on case studies of his patients and those of his colleagues. This is also what has led to criticism and concern.
While case studies allow for in-depth examinations of individuals, they should not be used to make generalizations about larger groups of people. This is because they lack population validity – the results of one person can’t be generalized to the wider population. Yet that is what Freud often did.
Anna O. and the Talking Cure
The case of Anna O. is a landmark in psychoanalytic history that helped Freud develop his theories on repression, hysteria, and the talking cure.
Anna O. was a pseudonym for Bertha Pappenheim. Suffering from hysteria, she experienced paralysis, hallucinations, and language disturbances.
Initially, she was a patient of Joseph Breuer. He treated her using hypnosis to uncover repressed memories and soon discovered that Anna’s symptoms temporarily went away when she recounted traumatic events.
However, two years into the treatment, Anna claimed Breuer impregnated her and went through an imaginary childbirth. Breuer stopped treatment due to fear but later shared his findings with Freud. To Freud, this was proof that the cause of hysteria was not physiological, as was then widely believed, but originated from within the mind.
Though originally planning to be a medical scientist, Freud saw the value in Breuer’s treatment of hysteria and urged him to write about his discovery. Breuer refused at first but eventually gave in one decade later and they published their joint publication, Studies on Hysteria.
Over time, however, Freud’s insistence that hysteria was caused by sexual repression as well as his rejection of hypnosis, eventually pushed the men apart.
Little Hans and the Oedipus Complex
The case of Little Hans is about a young boy who developed such an extreme phobia of horses that he could no longer leave the house. His real name was Herbert Graf.
Freud’s research on child sexuality was still going on when he met Little Hans and his father, Max Graf, who was a big fan of Freud’s work. The father wrote a series of letters to Freud detailing his son’s behavior and fears, and Freud directed the boy’s treatment based on this correspondence. Despite only meeting Little Hans once, he eventually published the case with the title, Analysis of a Phobia in a Five-Year-Old Boy, in 1909 to support his theories of the Oedipus complex, castration anxiety, and psychosexual development.
Freud believed that Little Hans’ phobia represented repressed desires for his mother and jealousy toward his father. As the treatment progressed, the boy became specifically scared of horses with black harnesses around their mouth and blinkers on. Freud saw this as a symbolic representation of the father’s mustache and glasses.
Dora and Transference
The case of Dora, a pseudonym for Ida Bauer, is another pivotal study in Freud’s psychoanalytic career.
At 18 years old, Dora suffered from hysteria and showed symptoms such as coughing fits and a loss of voice. Freud attributed these physical manifestations to repressed emotions stemming from traumatic experiences involving her father and Herr K.
Freud’s analysis delved into Dora’s dreams, uncovering unconscious desires and conflicts. One dream involved her being rescued from a burning house, which Freud interpreted as symbolic of her desire to be rescued from her situation.
Transference played a significant role in this case; Dora developed strong positive and negative emotions toward Freud during therapy sessions. Over time, Freud came to appreciate the potential usefulness transference could have for the therapeutic process. However, their sessions ended abruptly when Dora stopped treatment prematurely due to Freud’s views on her sexuality.
The Rat Man and OCD
A classic psychoanalytic case study is Freud’s Rat Man, whose obsessive thoughts about rats led to uncovering repressed guilt related to his father-figure relationships and sexual desires.
The Rat Man was a pseudonym for Ernst Lanzer. Freud diagnosed him with OCD – known as obsessional neurosis at the time.
Freud observed that the Rat Man had developed an intense fear of rats due to unresolved childhood trauma, which he expressed through obsessive thoughts and compulsive behaviors. His symptoms included intrusive thoughts about rats and irrational fears surrounding his loved ones’ safety. More specifically, he feared that they would endure painful physical punishments that involved the use of rats.
Freud’s analysis revealed that these anxieties stemmed from unconscious guilt, and he published his findings in 1909 as, Notes Upon A Case of Obsessional Neurosis.
The Wolf Man and the Primal Scene
The Wolf Man was a pseudonym for Sergei Pankejeff.
Freud later described this case as “…one of the most valuable of all the discoveries that I had the good fortune to make” and believed that “such enlightenment can only come about once in a lifetime.”
As an adult, Pankejeff suffered from debilitating depression and anxiety, which Freud attributed to repressed memories of early trauma. A key aspect of this case was the analysis of a childhood nightmare involving a herd of white wolves sitting in a tree outside the bedroom window, sending “messages with their eyes”. Terrified, Pankejeff woke up screaming, and a long period of intense anxiety started.
At the time, Pankejeff had been approaching the height of his Oedipus complex, and Freud interpreted the dream as symbolic of primal fantasies and unresolved Oedipal conflicts.
The term ‘primal scene’ describes a shocking childhood experience, which according to Freud, usually involves children seeing their parents having sex – be it real or imagined.
Freud believed that Pankejeff woke up in a state of intense castration anxiety that night, which was then expressed in an oral aspect: as a terror of being eaten by a wolf.
Although Freud proudly exclaimed he had cured Pankejeff, the Wolf Man continued struggling with psychological difficulties throughout the rest of his life.
