Freud and His Subjects:

Dora and the Rat Man as Research Participants

Jonathan Banda
MEHU 6386 (Psychoanalysis, Consciousness, and Neuroethics)
February 19, 2013
1




Introduction
The works of Sigmund Freud have generated controversy since the moment they were
published, some over 100 years ago. Todays scholars continue to debate the validity of Freuds
theories and methodology, while his case studies continue to be widely read and critiqued from
various academic fields. In light of the pervasive discomfort many express regarding Freuds
treatment of his patients, I think it is worthwhile to ask whether taking Freuds cases out of
context (and reading them as a work of literature, for example) lends to a misrepresentation of
his work. For example, Janet Malcolm has observed that in recent years the major Freudian
case histories have taken on a new life as sorts of found objects of the literary academy. She
continues: Removed from their own contexts and placed in that of literary modernism, they
have undergone the transformation that patchwork quilts, Shaker chairs, Yale locks, and other
vernacular and folk-art forms underwent when removed form their context and scrutinized in the
light of twentieth-century Functionalism.
1
That is not to say that Malcolm is suggesting that
Freuds case histories are vernacular: they stand as complicated works of psychoanalytic
theory. I do think, however, that Malcolms own ambiguity towards these new interpretations of
Freud reveal a discomfort towards modern critiques that take up Freuds studies in ways that he
never envisioned. In that way, these critiques may expect more from Freuds work than is
reasonable; hence, Freuds works are often characterized as deficient, perhaps unfairly. With
trepidation of continuing that tradition, this essay will explore Freuds works as interactions
between a scientific researcher and research subject, specifically in the cases of Dora and the Rat
Man. I hope to show that the general discomfort that many feminist scholars and others have


1
Janet Malcolm, JAPPELLE UN CHAT UN CHAT, The New Yorker, April 20, 1987,
http://www.newyorker.com/archive/1987/04/20/1987_04_20_084_TNY_CARDS_000348514.
2


expressed about Freuds treatment of Dora may also lie in the manner in which Freud conducted
his research, ignoring the basic ethical principles that we consider essential to human research
today, some which may have been standard even in his time.
Freud the Researcher
While most view Freud as a physician, his first love was research. Most of his medical
school studies at the University of Vienna were spent in the physiology laboratory of Professor
Ernst Brcke whose methodology and scientific philosophy had an enduring impact on the way
that Freud later approached his patients. As outlined by Peter Gay in his biography of Freud,
2

Brcke subscribed wholeheartedly to positivism, which held that all aspects of humanity
(including thought and behavior) could be subjected to the same methods of investigation that
were used in the natural sciences. By the time Freud studied in Vienna, this system of thought
held sway among academics. As Gay notes, his [Freuds] commitment to Brckes
fundamental view of science survived his turn from the physiological to the psychological
explanations of mental events.
3
Freuds passion for research slowed his progression towards his
medical degree, and though he intended to continue as a researcher, financial pressures forced
him into medical practice.
4
However, Freud never gave up his identity as a researcher. Instead,
he moved his laboratory to the analytic environment; the couch became his lab bench. Freuds
private practice and the influx of cases of hysteria and other psychological disorders provided
him with a steady stream of research subjects from which he could collect his data and test his
theories. We must also acknowledge that Freuds psychoanalytic project differed substantially


2
Peter Gay, Freud: A Life for Our Time, 1st ed. (W. W. Norton & Company, 2006), 34-
38.

3
Ibid., 35.

4
Ladislaus Z. Vogel, Freuds Early Clinical Work, American Journal of Psychotherapy
48, no. 1 (Winter 1994): 94.
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from what we would consider to be standard research practice today. At times, it does not
appear that Freud had a set protocol for his investigations, nor did he document data
systematically: session notes were not taken during Doras treatment, while it appears they were
during the Rat Mans treatment. Freuds role as a physician, I would argue, was always
secondary to his role as a researcher. His duties to science superseded his duties to his patients.
This inherent conflict of interest that the physician-researcher faces continues to be a bioethical
issue even today.
Research Ethics in the Time of Freud
Before continuing with an analysis of Freuds cases, one might pause to question the
status of research ethics during his time. Ethical principles in research (and even medicine) are
not static; they have evolved over history. It would hardly be fair to judge Freud from the
perspective of the extensive codes and regulations that regulate research today. However, there
are certain ethical values in medicine and research that may not have seemed as foreign to Freud
and other physician-researchers of his era. Controversy in the late 1800s led to the
promulgation of research guidelines in 1900 by the Prussian government.
5
In 1898, Albert
Neisser, a physician-researcher at the University of Breslau, was accused and fined by the Royal
Disciplinary Court for injecting serum from syphilis patients into other patients (mostly
prostitutes) to test a potential vaccine. The case was widely reported and publicly debated, at
least in the academic community. After commissioning a report from leading German
physicians of the time (including Rudolf Virchow), the Prussian minister for religious,
educational, and medical affairs advised via a directive to all hospitals and clinics (known today


5
J. Vollmann and R. Winau, Informed Consent in Human Experimentation Before the
Nuremberg Code., BMJ: British Medical Journal 313, no. 7070 (December 7, 1996): 1445
1449.
4


as the Berlin Code of 1900) that required the approval of the medical director before non-
therapeutic research interventions could be carried out. In addition, non-therapeutic
interventions were prohibited if the human subject was a minor or not competent for other
reasons or if the subject had not given his or her unambiguous consent after a proper explanation
of the possible negative consequences of the intervention.
6
The directive, therefore, stressed
the importance of consent and voluntariness for participation in medical research. As a directive,
however, it was not legally binding, and it is not clear to what extent the recommendations were
promulgated among the medical research community, especially among those in private practice
like Freud.
Would Freud have known of the Prussian directive? In my opinion, it is likely that he
did, given his connections with the German-speaking academic/medical community. However,
it is not clear to what extent Freud would have felt compelled to apply this directive to his own
psychoanalytic research. On one hand, his insistence on the scientific, objective nature of his
project (in the positivist tradition) suggests that he would have seen such directives on medical
research as applying to his work. However, the controversy that stimulated the debate that led to
the Berlin Code of 1900 was decidedly biomedical in nature. Hence, it is possible that the
mostly non-physical nature of Freuds work would have divorced, from his perspective, the
Prussian requirements for medical research from his own interventions. In addition, the Berlin
Code covered non-therapeutic interventions. Freud, however, saw his experiments as treatment;
his goal was to enact a cure. Whatever the case, the Berlin Code recognized respect for
autonomy as essential to the research endeavor, a principle that can be questioned in the context
of Freuds most famous case: Dora.


6
Ibid., 1446.
5



Dora: The Non-compliant Research Subject
The case of Dora has received perhaps the most extensive criticism of all of Freuds
published cases. As Malcolm observes: The Dora casereads like an account of an operation
being performed on a fully awake patient. Thus its agony and its horror. Every reader of
Fragment of an Analysis comes away with the feeling that something awful has been done to
the girl.
7
I would not disagree with her assessment. However, the outcome (and apparent
failure) of Doras case becomes perhaps less tragic when we read the case as a research report
instead of a clinical treatment. Failure in research is to be expected, even if these failures are
rarely published. As a researcher, Freud himself recognized that duties to science/society may
sometimes overrule duties to individuals. When discussing his decision to publish the case, he
differentiates himself from persons of delicacy who would give first place to the duty of
medical discretion and instead declares: But in my opinion the physician has taken upon
himself duties not only towards the individual patient but towards science as well.
8
In
identifying his duties to science, Freud also affirms his primary role in the case as a researcher,
to test his theories on dream interpretation.
As a research case, however, Dora is deficient. Freud begins his case history
acknowledging that it is incomplete for several reasons: the treatment was prematurely
terminated, he did not explain his process of interpretation, and, lastly, a single case history
cannot fully describe a condition. The deficiency of his case, therefore, is not simply a logistical
problem, for in his conscious decision not to elucidate his process of interpretation, the picture of
Doras treatment is rendered incomplete as well. Without understanding the methodology by


7
Malcolm, JAPPELLE UN CHAT UN CHAT, 96.

8
Freud, Dora, 2.
6


which Freud reaches his conclusions, they sometimes appear arbitrary, paternalistic, and
unfinished. Freud himself acknowledges this in his preface, stating: Since, therefore, this case
history presupposes a knowledge of the interpretation of dreams, it will seem highly
unsatisfactory to any reader to whom this presupposition does not apply. Such a reader will find
only bewilderment in these pages instead of the enlightenment he is in search of.
9

Furthermore, Freuds construction of the research report does not leave much room for
challenges or testing of his conclusions. His positivist convictions can be seen in his claim that
his hypothesis and conclusions were decidedly objective, following procedures that would be
used in any scientific endeavor. I take no pride in having avoided speculation; he writes, the
material for my hypotheses was collected by the most extensive and laborious series of
observations.
10
What is more, Freud claims that anyone who follows his method would arrive
at the same conclusion. But of this I am certain, Freud contends, that any one who sets out to
investigate the same region of phenomena and employs the same method will find himself
compelled to take up the same position, however much philosophers may postulate.
11
There is
no room for debate or challenge, which is even more surprising when we read later that Freud
himself acknowledges that he missed a monumental factor in Doras case: transference. This
reveals what Bettelheim calls one of the strangest contradictions in Freud: his assertion that
psychoanalysis was a science, and as such was subject to all those criteria which should apply to
scientific investigation; and his contrary insistence that psychoanalysis must be accepted as


9
Sigmund Freud, Dora: An Analysis of a Case of Hysteria (New York, NY: Macmillian,
1997), 5.

10
Ibid., 103.

11
Freud, Dora, 103.
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formulated by him.
12
Freuds dogmatic, sometimes blinding stance carried over to his treatment
of Dora.
When we consider Dora as a research subject, several problems stand out in her
encounter with Freud. First, the manner in which she came to Freud was not ideal. Her father
brought her to Freud, despite her reluctance. It is not unusual for parents to bring their children
for research participation (or medical treatment for that matter), but Dora was no child, and her
fathers motives were in his own interests instead of Doras. Doras father brought her to Freud
to cure her of her conviction that he was having an affair with Frau K. By the time she started
treatment with Freud, Dora was eighteen and had experienced attempted seduction by a much
older man. She was not ignorant of the world; Freud notes that she employed herself [] with
attending lectures for women and with carrying on more or less serious studies.
13
However,
Freud continues to infantilize her throughout his narrative, while at the same time ascribing to
her very adult erotic desires. Hence, the voluntariness of her participation in research is
questionable from the very beginning.
I would also argue that Dora did not provide informed consent (for research or treatment)
in any sense of the word. I am not implying that informed consent should have been obtained in
a formal documented procedure, as required from researchers today. However, Freuds case
study does not provide any evidence that Dora was informed of his procedures or intentions with
her treatment. She appears to have been kept in the dark about any of this. Instead of engaging
her in the process, Freud appears to dictate to her interpretations of her own dreams and thoughts
without any explanation. It is likely that Dora sensed that Freuds treatment of her did not
respect her autonomy, a frustrating experience for any patient or research subject. Hence she


12
Bruno Bettelheim, Freuds Vienna & Other Essays (New York, NY: Knopf, 1990), 49.

13
Freud, Dora, 16.
8


terminated her sessions with Freud early. However, as Peter Buckley has noted: Even when
Dora dramatically announced that she had come for her last session, Freud, apparently
nonplussed, insisted on continuing, in his scientific way, with the analysis of her second dream
rather than immediately addressing the threat to the integrity of the treatment, as would be
standard practice today.
14
As a researcher, Freud certainly should have been troubled that his
test subject expressed her desire to terminate the experiment. However, it appears that his
negation of Doras autonomy and competence translated into a disregard for these implications.
In the end, Freud promises to forgive her for her non-compliance as a research subject and
patient, for depriving him of the satisfaction of affording her a far more radical cure for her
troubles.
15
However, in light of even the most basic principles of research ethics, it is clear that
Freud is the one who owed the apology.
The Rat Man: Freuds Ideal Subject
The nature of Freuds interactions with Dora contrasts radically with his treatment of the
Rat Man, which, according to his account, was an unqualified success. Like Doras case, Freud
begins the Rat Mans case expressing his concern about confidentiality. It is in this apparently
sincere concern that I believe Freud deserves credit; confidentiality of patient and research
subject information is still a primary concern of medical ethics. It is true that the identities of
Freuds patients (e.g., Dora and the Rat Man) have been discovered by historians, but I do not
believe that Freud can be blamed for this. In my opinion, he did his due diligence to mask the
identities of his patients before publishing about them. At the same time, however, Freud did not


14
Peter Buckley, Fifty Years After Freud: Dora, the Rat Man, and the Wolf-Man, The
American Journal of Psychiatry 146, no. 11 (November 1989): 1396.

15
Freud, Dora, 112.
9


appear to ask permission from his patients before publishing their case histories, which, of
course, would be best practice today.
The Rat Man case, published four years after Dora, finds Freud much more conservative
about his theories. The crumbs of knowledge offered in these pages, he begins, though they
have been laboriously enough collected, may not in themselves prove very satisfying; but they
may serve as a starting-point for the work of other investigators, and common endeavor may
bring the success which is perhaps beyond the reach of individual effort.
16
Here again Freud
signals his professional identity first as an investigator: the explorations in the Rat Man case are
intended to provide the basis for future work.
The researcher-subject interaction between Freud and the Rat Man from the very
beginning was quite distinct from that of Dora. First, the patient came to Freud of his own
accord. Freud clearly identified with the Rat Man in a way that he never did with Dora; he
describes him at the outset as a clear-headed and shrewd person.
17
Hence, the Rat Mans
participation in Freuds research program was voluntary, and Freud saw him as a competent
person deserving of substantial involvement in his own treatment. Freud also makes the terms of
involvement clear from the outset. The Rat Man is asked to agree to one condition: to say
everything that came to his head, even if it was unpleasant to him or seemed unimportant or
irrelevant or senseless.
18
Later in the case, Freud notes that the patient began to express doubts
about his technique. Here Freud pauses and takes the time to explain to the Rat Man the
concepts of the conscious and the unconscious in lay terms, using Pompeii as a metaphor to


16
Sigmund Freud, The Complete Psychological Works of Sigmund Freud: Two Case
Histories (Little Hans and "The Rat Man"), New Ed. (London, UK: Hogarth Press, 2001),
157.

17
Ibid., 158.

18
Ibid., 159.
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illustrate the process of uncovering the unconscious via psychoanalysis. The fact that Freud
made the effort to explain his technique and the theories behind them shows not only his affinity
to his patient, but also resulted in, I would argue, a process of informed consent throughout the
treatment. The Rat Man, in a sense, was in a position to participate in Freuds research
voluntarily and fully informed.
Freud has been criticized by contemporary scholars for the technique he used with the
Rat Man, but not in the same manner in which his treatment of Dora has been questioned. In
both cases, it appears that Freud minimized the role of the mother in his analysis. However, in
contrast with Dora, Freud has been criticized for getting too close to the Rat Man. In contrast
with the cold, dismissive treatment of Dora, Freud at one point provided a meal to the Rat Man.
19

According to Peter Gay: This was a heretical gesture for a psychoanalyst; to gratify patient by
permitting him access to his analysts private life, and to mother him by providing food in a
friendly and unprofessional setting, violated all the austere technical precepts that Freud had
been developing in recent years
20
This radical departure from Doras treatment could be
explained by a personal affinity with the Rat Man. Perhaps, however, Freud learned from his
prior mistake with Dora. At the end of Doras case, he asks: Might I perhaps have kept the girl
under my treatment if I myself had acted a part, if I had exaggerated the importance to me of her
staying on, and had shown a warm personal interest in her? He then concludes: I have
always avoided acting a part, and have contented myself with practicing the humbler arts of
psychology.
21
Perhaps the recognition of transference (and the later development of
countertransference) revealed to Freud that it is impossible to avoid playing a part in the


19
Buckley, Fifty Years After Freud, 1989.

20
Gay, Freud, 267.

21
Freud, Dora, 101.
11


psychoanalytic relationship. Besides those theoretical reasons, however, it is also possible that
Freud recognized the importance of treating patient-subjects as competent agents in the
therapeutic experiment to effect a successful treatment.


Conclusion
Freuds treatment of his patients, specifically Dora, when viewed from the perspective of
research ethics, is perhaps no less troubling than what a feminist critique would conclude. As we
have seen, the participants in Freuds psychoanalytic research program were treated in vastly
different ways. The failure to respect Doras autonomy and denial of voluntary informed
consent is perhaps one of the reasons why her case study is so disturbing. In contrast, the Rat
Man shows a Freud engaged in a warm, collegial relationship with a research subject. In the
feminist tradition, it would be easy to ascribe that difference to Freuds prejudices regarding the
sex, age, and educational status of the participants that translated into his treatment of them.
However, I believe that Freuds vastly different treatment of the Rat Man was due less to his
status as a man than the fact that he was a willing participant, deeply engaged and interested in
what Freud had to offer, while Dora was a reluctant participant in Freuds project.
Returning to the concern raised at the outset of this essay, are we expecting too much
from Freud in reading his cases as research reports and in the framework of research ethics? Are
we reading Freud out of context? I believe not. Freud never relinquished his professional
identity as a researcher, even when practicing as a physician. From his earlier work with Brauer
on the causes of hysteria, to his later case studies, we see a Freud deeply invested in the research
enterprise. We see an active investigator testing hypotheses and modifying theories based on
12


observations. Whether or not the study of the human mind can conform to the positivist ideal of
objective, replicable research models is not the scope of this essay, but perhaps the greatest
challenge that Freud faced in his research is that in his study of the unconscious, he was
embarking on uncharted territory (if indeed it could ever be charted). Freuds investment in
research meant that his primary duty was to science, not his patients. The challenge he faced in
balancing these two duties did not always yield the most ethical result; at times his determination
to prove his theories in a scientific manner blinded him to the welfare and humanity of his
patients, as in the case of Dora. At times, perhaps, Freud became the mad scientist. The
question I would ask, though, is whether Freuds experimental treatments ever left his subjects in
a worse condition than when they started. Despite the traumatic, frustrating experience with
Freud, Dora in the end was forced to achieve her own cure by confronting Frau K. about the
affair with her father, exacting an admission of guilt from Herr K. regarding his attempted
seduction, and separating herself from the K. family. This was not the cure that Freud had in
mind, but perhaps it was no less effective than what he had to offer her.