Reflections on Freud’s Dora Case After 48 Years

Sachs, D. M. (2005). Reflections on Freud’sDora case after 48 years. Psychoanalytic

Inquiry, 25 (1), 45-53.

David M. Sachs, MD, author, is Training and Supervisory Analyst, Psychoanalytic Center of
Philadelphia; Clinical Professor in Child and Adult Psychiatry, Drexel University Medical
School.; 255 South 17th Street Philadelphia, PA 19103

I revisit Freud's case of Dora from the vantage point of current literary and psychoanalytic
perspectives. Mahony (this issue) argues that Freud's understanding of Dora is unconvincing to
the modern reader because Dora is a victim of trauma rather than sexual repression. I extend
Mahony's ideas in terms of the development of psychoanalytic ideas, place Freud's view in the
context of my psychoanalytic education in the mid-20th century, and suggest that modern
contributions to trauma theory and memory further support the thesis that Dora was a victim of
trauma rather than of conflicted libidinal desires.

ON SEPTEMBER 23, 2000, I WAS ASKED TO DISCUSS MAHONY'S PAPER on Freud's

Dora case. Mahony's revised paper appears in this issue of Psychoanalytic Inquiry. My paper is
based on the original discussion.

When I first read the Dora case in 1956, I was a candidate in an analytic institute, and Freud's
star was shining. His authority loomed over the psychoanalytic landscape, and his disciples
were my teachers. For them, it is evidence of Freud's modesty that he admitted that the accuracy
and completeness of his explanations of psychological symptoms are limited and partial,
inviting belief in his conclusions rather than skepticism. Dynamic narratives are represented as
accurate steps on the way to a more complete explanation. As such, Freud's logically coherent
formulations have surprising authority. Mahony (this issue) describes Freud's narrative style as
one in which a brilliantly painted logical mask conceals inconsistencies and contradictions. In
this view, Dora's objections to Freud's interpretations of her are well taken, but his
interpretations of her motivation miss the mark. In short, Freud's inability to hear Dora requires
an explanation.

As a beginning, consider that Freud was neither modest nor tentative in the narrative he
constructed to explain Dora's symptoms. A truly modest narrative would have made Dora and a
reader into thoughtful questioners of his evidence and conclusions; a truly tentative formulation
would invite the reader to construct alternative narratives. Instead, Freud placed both the reader
and Dora in a similar dilemma: either accept his interpretations as evidence of an accurate
beginning toward a more complete explanation or recognize Freud's disclaimers as a literary
device that “spins” the reader's attention away from critically evaluating Freud's constructions
of Dora's history. If steps in the formulation prove to be as implausible to the reader as they
were to Dora, then the entire narrative might be brought into jeopardy. When Freud explained
the dynamics of her symptoms, Dora could either challenge the validity of Freud's narrative or
accept it as a truthful, if partial, beginning. Dora chose the former but failed in her attempts to
get Freud to pay attention to her objections. Had Dora been in therapy with a less confident
analyst, she would not have had to become an adversary to his authority and leave treatment.
The power struggle between the two actually defined this analysis as a form of suggestive
therapy rather than one in which hypothesis formation and testing were prerogatives shared by
analysand and analyst. As a result, Freud constructed a false narrative to explain Dora's
symptoms. Such a false narrative raises two questions. How can we now account for Freud's
failure to understand Dora in terms of her unique life history? How has his failure affected the
history of psychoanalysis?

Mahony (this issue) approaches the first question by deidealizing Freud's clinical technique and
the theories that support his interpretations. In this process, Mahony demonstrates the
assumptions behind Freud's idea of science—namely, that it requires an “objective” observer
who functions as an authority over both the accuracy of what is observed and the narrative
offered to explain the present in terms of the past. In this vision of science—often considered an
application of positivism—the voice of the observed is irrelevant to the observer. Although
understandable for observations of the inanimate that do not require a response from the
observed, it is entirely unsuitable for psychoanalysis, the observation of the participatory
subject. Because observing affects the observed in ways that are unknowable unless the
observed has a voice, inaccurate observations must lead to inaccurate explanations. Mahony
shows how Freud painted his personal theories and values onto the psychology of his analysand.
In turn, Mahony claims that Freud did not discover Dora's unconscious but discovered his own
ideas about what might have been in Dora's unconscious. Viewed in this way, Freud achieved
something different; he described a narrative that he thought explains Dora, but it only
illustrates how the unconscious might work. The price of constructing a coherent narrative is the
loss of Dora's voice, which offers a different narrative. For example, an argument can be made
that Dora left therapy to escape Freud's pressuring her to accept a false story and that she did not
act out an earlier relationship with a father figure.

Even for those of us who have long since abandoned an idealization of Freud but have preserved
a recognition of his genius, it is a shock to be reminded that once many of us accepted Freud's
view of Dora. My candidate colleagues did not express compassion for Dora when she tried to
offer alternative understandings of herself to Freud, because we accepted his conviction that her
objections were without merit. Of course, after leaving treatment, she could offer no opposition
to Freud's “assumption-proving” text. Clinical failures, like the Dora case, are easily explained
away by blaming the analysand for not hearing the interpretations.

Was there a larger issue at stake for Freud in the Dora case? I suggest that he wanted evidence
to prove that the libidinal conflicts he had found to explain some psychological symptoms also
explain the consequences of traumatic experiences. Toward that end, he diagnosed Dora as a
hysteric and ignored that she was a victim of trauma. Doing this enabled him to “explain” her
symptoms as being a result of sexual repression. Beginning from this premise, Freud ignored
Dora's protestations that she had been abused by Herr K, and he plunged into her unconscious,
where he brilliantly explored the possibilities inherent in this theory. In short, Freud wanted to
prove his a priori assumption that traumatic events were not the cause of Dora's symptoms. This
stance disconnected him from a need to consider Dora's complaints, and he failed to
acknowledge with her that Herr K's behavior, like his own, was boorish, inappropriate, and
aggressive.

To the modern eye, able to see blind spots caused by counter-transference, the behavior in need
of explanation is Freud's. Mahony speculates that this is because of Freud's unresolved,
unconscious libidinal conflicts, which cause him to exonerate Herr K and blame Dora. As I am
reluctant to analyze Freud in absentia, I am inclined to place more emphasis than Mahony does
on Freud's need to defend his libido theory from a belief in the traumatic origin of Dora's
symptoms. Although I agree with Mahony that we learn much about Freud's values and male
chauvinist assumptions, I believe that this must be linked with other dynamic determinants to
account more fully for Freud's technique. In retrospect, it seems clear that Freud overreached to
defend his discoveries about the role of repressed libidinal conflicts and obscured this purpose
beneath a remarkable argumentative literary style. Unfortunately, for decades he succeeded in
misdirecting his followers away from respecting their analysands' opinions.

Whatever Freud's motivation was, Mahony exposes the plain fact that Freud was unable to
recognize his aggression toward Dora and assaulted her with interpretations rather than with the
physical demands that Herr K had made. Mahony articulates the danger faced by the analysand
when the analyst becomes an authoritarian figure who usurps the analysand's right to identify
the symptom to be explained. Mahony makes the case that psychoanalysis is neither scientific
nor humane unless it is an engagement between equals. This view went against the grain of
Freud's belief that science is practiced by an objective observer. Dora's plea to be heard in her
suffering from systematic abuse cannot be heard if the listener cannot consider the experience of
the person as valid. In this way, Dora was transformed into an inanimate subject of an objective
observer. Even a genius like Freud was unable to realize that Dora did not provide a window to
her unconscious but rather that she presented a mirror reflecting an image that he did not
recognize as, in large part, his own.

Dora's case had an important effect on psychoanalytic theory because it denies the role of
trauma in psychopathology. Consider what the candidates of my generation found appealing in
Freud's case histories—what in essence allowed them, like Freud, to ignore Dora's victimhood.

Although obvious, it needs saying that Freud and analysts of my generation who were trained in
the United States were of a similar “zeitgeist.” As doctors, we were all trained to be
“scientifically objective” about human suffering so that we could bypass “surface” complaints
and treat “real” underlying causes. After all, our first patients were cadavers who hardly
complained as we probed and cut to understand anatomy. It is a long path from that training to
becoming therapists who begin with the suffering of patients and explore with them the causes
of that suffering. Compassion was considered dangerous if it distracted a physician from
discovering the true cause of the disease process. We were ready to accept Freud's expository
skills uncritically, because we wanted to believe that we could apply to psychology what we
learned in medicine. To our later regret, it was no stretch for us to displace our interest from
Dora to how Freud thought about the workings of the unconscious. After all, we sincerely
believed that we did so only to establish causal connections between the etiology of
psychopathology (one common medical model) and the sentient beings we were trying to help.
Similarly, we had not seen ourselves as cold-blooded or indifferent when we plunged needles
into sensitive flesh or pushed probing fingers into delicate openings. We were trained to believe
that we caused pain only in order to cure. It seemed as natural to us as breathing to disregard
such details as Freud's authoritarian chauvinism, his selective marshaling of evidence to prove
his assumptions, his mixture of personal values and the claim of objectivity, and so forth in
order to understand how the unconscious mind might influence consciousness and behavior.
Because we realized that Freud's clinical ability left much to be desired—even though we did
not realize how much—we wanted to use Freud's insights to become better clinicians. Thus
began for many of us a lifelong learning process that we hoped would enable us to begin with
the analysand and enter that person's unconscious. Initially, though, we felt fortunate to
accompany Freud in his bathysphere as it plunged beneath the roiling water at the surface, and
we shared with one another our astonishment at the wondrous sights along the way. We simply
did not appreciate the disconnection between mapping the unconscious (the task Freud set for
himself) and the need to take into account the experience of Dora. Freud's genius was on safer
ground when he analyzed novels (Gradiva), historical figures (Moses), myths (Oedipus), and so
forth. In these situations, the “patient” did not feel the pain of the constructions Freud used to
reach the territory of the unconscious.

Like many great explorers and scientists, Freud was in a strange land, and he was busy
describing what he found. Look at some of the early maps of the United States, and a graphic
picture will emerge of how different they are from modern maps. With old maps as guides, it
would be easy to become lost simply trying to go from Philadelphia to Washington. Consider
how much easier it would be to become lost if one thought one was in the Far East but was
actually in the Caribbean. So, too, the analysts of my generation were guided by maps that often
were not placed in connection with analysands' recollections of their own experiences—making
it as understandable as it was undesirable that we frequently became lost. The assumption that
all aspects of the unconscious have some important connection to the surface was simply wrong,
and we, like Columbus, searched in vain for India in the Atlantic Ocean.

It took my generation many years to escape from identifying with Freud and his disciple-
teachers who disguised suggestion with the illusion of their objectivity. We know that many
never took the steps necessary to emancipate themselves from this training. Those of us
interested in a second step are grateful to Mahony, who has joined many others in decoding the
ways in which Freud's blind spots become our own and in offering support to all those analysts
engaged in deidealization.

Deidealization, however, has dangers of its own. It can lead to a reforming zeal that replaces
objectivity with complete subjectivity. Such swings to extremes may be inevitable but cannot be
seen as desirable, because the necessary tension between these extremes is essential for the kind
of science that psychoanalysis is.

There is no need, then, to diminish Freud's achievements in order to acknowledge that he

sometimes lost sight of his analysands as he rushed into the unconscious. Perhaps our training
can be compared to that of an imaginary modern playwright who tries to learn his trade from the
disciples of only one playwright, William Shakespeare. How could one hear the voices of other
playwrights so that one is not obligated to become an imitator? Or, consider how similar Freud's
work with Dora is to Sherlock Holmes's deductions. Both Freud and Holmes seem to find
hidden targets with unerring accuracy. Freud deduced the unconscious meaning of Dora's
symptoms from a few surface clues; Holmes deduced that Watson had been in Afghanistan
from the ashes of his cigarette! That Watson could have been somewhere else, Turkestan, say,
was not mentioned by Sir Arthur Conan Doyle. If we do not suspend disbelief, we would know
that Holmes could have been wrong many times, just as Freud could have misinterpreted Dora's
symptoms. Our need to accept authorial omniscience in order to believe in the infallibility of the
conclusions of both Freud and Holmes allows us to accept them. Instead of finding the answer
to the cause of Dora's symptoms, Freud found what he had in mind in the first place.
Suspending disbelief in reading detective fiction leads to a satisfactory experience; suspending
disbelief when treating human beings is not safe.

So we can extend some compassion to the candidates of my generation and the next who
learned psychoanalysis from idealized figures. We wanted Freud to be right, just as we want
Holmes to defeat Moriarty every time, and we were easily persuaded that Freud's connections
from the surface to the depths were correct. We read Freud's texts like the literature of the great
writer he longed to be, and we were caught in our need and his wish for us to suspend disbelief.
Although Freud was as much a genius at encouraging this process as he was at mapping the
unconscious, we need to admit that we were willing coconspirators in finding an unconscious
ever more engaging than the person whose unconscious we examined.

A challenge for all analysts is to find a way to accept the extraordinary contributions of Freud
and emancipate ourselves from the misleading suggestions created through his literary gifts and
genius. Each of us has a personal odyssey of discovery to tell, but a common thread in the story
is a recognition of the work of so many analysts who built on and enriched our work. In the
context of this paper, it would be tangential to list those who most influenced my own ideas, but
it would be of interest to the profession if analysts described how their work has changed in the
decades after being exposed to Freud. For the purposes of my discussion of Dora, several
important issues influenced me aside from the contributions of psychoanalysts. One involved
the cultural changes that occurred with Vietnam and the women's movement—changes that
showed the limits to blind acceptance of authority figures. I learned to pay attention to the
voices I had been trained to ignore. Another issue involved the history of science and
philosophy, which alerted me to the limits to positivism as the underlying basis of
psychoanalysis. These extra-analytic concepts encouraged analysts to separate earned authority
from authoritarian assumptions. Although Freud's view of science gave him permission to
believe that his view of Dora was objective truth, such a conclusion is not possible when the
assumptions that justify it are no longer available to the analyst.

Another theme that entered my analytic work more than 15 years ago is crucial to my approach
to Dora. Beginning with my neglect of Ferenczi in my education, I became increasingly aware
of the turn Freud made away from trauma as a cause of symptoms that seemed neurotic but that
could not be analyzed without accepting trauma as a reality. My clinical experience reinforced
the need to differentiate the consequences of childhoodtrauma from sexual conflict in order to
resolve presenting symptoms. Then, exposed to the writings of literary theoreticians who had
developed a special interest in trauma theory and memory, I discovered concepts having
important implications for psychoanalytic theory and practice. A very short list of these writers
includes Herman (1992), Caruth (1995, 1996), Zwarg (1995), and Leys (2000). In addition, the
work of La Planche (1976) made a powerful impression on me. Particularly helpful were the
trauma and memory problems addressed by researchers like Damasio (1994, 1999), LeDoux
(1996), and Ramachandran and Blakeslee (1998) and philosophers like Hacking (1995). The
psychoanalyst who takes this new knowledge into account cannot explain current suffering as
the returned of repressed libidinal conflicts, as Freud did with Dora.

I again express my appreciation to Mahony for providing the stimulus to organize the ideas
presented here and for his long-standing courage in taking on the idealized figure of Freud and
its organizational apparatus in a search for a more complete view of the man. Mahony's
approach offers a path out of a field unnecessarily restricted by allegiance to its founding
genius. He helps us to recognize how Freud's idealized figure created and traumatized our
field—so that we might experience a decent mourning over the loss of a powerful father and get
on with our work.

References

1
Caruth C. (1995), Trauma: Explorations in Memory. Baltimore, MD: Johns Hopkins
University Press .

2
Caruth C. (1996), Unclaimed Experience: Trauma, Narrative, and History. Baltimore, MD:
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3
Damasio A. (1994), Descartes' Error. New York: Avon Books .

4
Damasio A. (1999), The Feeling of What Happens. Orlando, FL: Harcourt .

5
Hacking I. (1995), Rewriting the Soul. Princeton, NJ: Princeton University Press .

6
Herman J. (1992), Trauma and Recovery. New York: Basic Books .

7
La Planche J. (1976), Life and Death in Psychoanalysis, trans. J. Mahlman. Baltimore, MD:
Johns Hopkins University Press .

8
LeDoux J. (1996), The Emotional Brain. New York: Simon & Schuster .

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Leys R. (2000), Trauma: A Geneology. Chicago: University of Chicago Press .

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Ramachandran , V. & Blakeslee , S. (1998), Phantoms in the Brain. New York: Morrow .

11
Zwarg , C. (1995), Feminist Conversations. Ithaca, NY: Cornell University Press .