The Topic of Cancer

Jonathan Burke

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367101466
• eBook ISBN: 9780429922466
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book focuses on our emotional responses to cancer by offering a range of perspectives: psychoanalytic, medical, spiritual and religious, as well as literary. Once suppressed, akin to a taboo, the topic of cancer is now very much in the public consciousness. The prevalence of the disease and well-publicised medical advances in its treatment demand it.

Topic of Cancer begins with Freud's cancer, widely known of but rarely understood in its historic and analytic context. Psychotherapeutic reflections are then offered on our understanding of the adult and adolescent with cancer, and the challenges of sustaining a thoughtful presence in the face of the trauma experienced when a child is diagnosed with cancer, and during treatment. The dilemmas and challenges faced by today's psychotherapist with cancer are explored next and, for the first time in cancer literature, an account of the emotional demands on nurses involved in sensitive, intimate care. With an increasing number of people living longer with cancer, "survivorship†and palliative care are the focus of the chapters that follow.

PART I

BEARING THE UNBEARABLE

CHAPTER ONE


Freud’s cancer

Martin Schmidt

Anyone turning biographer commits himself to lies, to concealment, to hypocrisy, to flattery, and even to hiding his own lack of understanding, for biographical truth is not to be had, and even if it were it couldn’t be used. Truth is unobtainable; humanity does not deserve it …

—Freud to Zweig, 31 May 1936, in Freud, E. L., 1961, p. 430.

Hardly words of encouragement. So it is with some trepidation that I attempt a biographical account of the influence of cancer on the pioneering father of psychoanalysis and his theories.

One of his closest friends and colleagues, Ernest Jones, identified two features which exemplify the last twenty years of Freud’s illustrious life. The first was “the truly astonishing fresh outburst of original ideas” which “effected a revolution in both the theory and the practice of psycho-analysis”. The second was the “dauntless fortitude with which he endured the political and financial dangers that threatened to engulf both him and his work, the loss of several of those dear to him, and above all the cruel tortures of the many years of suffering from the devouring cancer that ultimately killed him” (Jones, 1957, p. 1).

A heavy smoker, with a penchant for cigars, Freud’s addiction staved off recurrent depressive episodes. Without cigars, he couldn’t think. His twenty-a-day habit was one of his greatest pleasures. He tried to give up many times: “I have given up smoking completely, after it has served me for exactly fifty years as sword and buckler in the battle of life. Thus I am now better than I was, but not happier” (Freud to Salome, 8 May 1930, in Pfeiffer, 1963, p. 187). His abstinences were short-lived and he returned to his cigars. In his excellent biography of Freud, Peter Gay (2006) reminds us that in German, food (the stuff of life) is Lebensmittel and that Freud contrived a neologism for his own cigars—Arbeitsmittel (p. 384), the stuff of work. They became the stuff of death.

Freud the man

One of the greatest minds of modern times, he lived for his work: “I cannot face with comfort the idea of life without work; work and the free play of the imagination are for me the same thing, I take no pleasure in anything else” (Freud to Pfister, 6 March 1910, in Freud, E. L. & Meng, 1963, p. 35).

On a typical day, he was up and dressed by seven, ready for breakfast. Patients arrived from eight to noon. At one o’clock, lunch was shared with whichever family members were available. His wife, Martha, sat at the opposite head of the table whilst the maid administered the soup tureen. Then he would take a walk before further consultations from three until nine. After the family supper, there would be either a game of cards, or another walk, before reading and writing until lights out at one.

Rather than a doctor “in the proper sense”, Freud preferred to see himself as a pioneering research scientist or conquistador. Indeed, he concluded that the wish to practice medicine is an attempt to compensate for unconscious sadism: “I have no knowledge of having had any craving in my early childhood to help suffering humanity. My innate sadistic disposition was not a very strong one, so that I had no need to develop this one of its derivatives” (1926a, p. 253).

Aware of his own genius, he expected the Nobel Prize (which didn’t come): “… modesty—I would be enough of a friend of the truth or, let us rather say: objectivity, to dismiss this virtue” (Freud to Ferenczi, 8 April 1915, in Falzeder & Brabant 1996, p. 55). Paradoxically, he was often scathing of his own work, dismissing it as worthless, childish, and feeble, but I get the sense that he didn’t really believe his own bad press, rather that this mock censure was a type of obsessive superstitious ritual to counter the danger of narcissistic inflation and to “get in first” on his own hypercritical superego.

Whilst rigorous and intolerant of forays into wild analysis by his disciples, he was less severe on his own breaching of boundaries. On occasion, patients were fed, fees waived, and analyses conducted during evening strolls in the park. Some patients were allowed to be privy to intimate information about his personal life and one, Horace Frink, who was also a psychoanalyst, was encouraged by Freud to divorce his wife in order to marry one of his patients. We know that he analysed his daughter and befriended a number of his favourite patients including Princess Marie Bonaparte. It was Marie who, perhaps as an expression of the inevitable ambivalence that this evoked, enabled him to escape the Nazis but also kept him supplied with his precious cigars. Freud was not the supreme practitioner of his art, Ferenczi complained bitterly about his own analysis with the master, and others, such as Alix Strachey and Melanie Klein, found Karl Abraham a much sounder analyst (Gay, 2006, p. 461).

In the words of Max Schur, his physician for over twenty years, Freud “… was always a deeply human and noble man … I saw him face dying and death as nobly as he had faced living … I saw him suffer pain and sorrow. I saw him show scorn and contempt for brutality and stupidity as well as tender love and concern for those close to him” (Schur, 1972, p. 2).

Gay suggests that he was prone to explosive outbursts: “His life, it appears over and over, was a struggle for self-discipline, for control over his speculative impulses and his rage—rage at his enemies and, even harder to manage, at those among his adherents he found wanting or disloyal” (2006, p. 316). However, this fury was not evident at home. Contrary to the sometimes wretched portrayal of himself that he furnishes us with in his correspondence, with his family he was: “even tempered, optimistic, and even gay” (Anna Freud to Jones, 16 June 1954, (in Jones, 1954)). Although he suffered at times from a cheerless Weltanschauung, he considered himself neither depressed nor pessimistic but a realist, subscribing to the view that a pessimist is nothing more than a well-informed optimist.

Generous by nature, he enjoyed providing financial support (when he had the money) not only to his extended family but also to colleagues and patients. He felt that he had to keep working to make enough to maintain his standard of living but was far from avaricious. The Chicago Tribune tempted him with 25,000 dollars to go to the United States to psychoanalyse two killers in a high profile murder case, and Samuel Goldwyn offered him 100,000 dollars to participate in the making of a series of films about the great love stories of history (beginning with Anthony and Cleopatra). Freud declined all such offers.

He was a loving, but not demonstrative father, rarely kissing his children, but more likely to be physically affectionate towards his daughters. The demands of his work meant that most of the domestic and childrearing duties were left to Martha. She was a model Hausfrau, diligent, meticulous, and devoted, but did not share his passion for psychoanalysis. In fact, Minna, his sister-in-law, was more of a confidante in this regard. Sigmund and Minna sometimes visited Swiss resorts or Italian cities alone. Jung suspected that they were lovers, and claimed that Freud had indeed confessed this to him (Billinsky, 1969). In later life, as his passion for both Martha and Minna dimmed, it was his daughter, Anna, who became the object of his deepest affection and his closest companion.

Although he did love his wife, children, and grandchildren, he preferred the company of men, cultivating a series of very close passionate friendships: “In my life, as you know, woman has never replaced the comrade, the friend” (Freud to Fliess, 7 August 1901, in Masson, 1985, p. 447). With predictable candour, he alluded to this being a feminine quality, a sublimation of “androphile” tendencies or, simply put, his latent homosexuality.

Todesangst and hypochondria

Throughout his life, Freud had been obsessed with death and plagued by attacks of todesangst (dread of dying). Though beset by bouts of hypochondria, his health was generally good. He did intermittently suffer from attacks of tachycardia, arrhythmia, dyspnoea, chest pain, fainting fits, migraines, gastro-intestinal complaints, and abdominal problems, but they didn’t prevent him from working.

Nevertheless, long before his cancer was diagnosed, he was convinced that he would die prematurely. Surprisingly, for a man renowned for his antagonism to unscientific magical thinking, he subscribed to a peculiar superstitious preoccupation with prospective dates of his own demise. He was impressed by his beloved friend Fliess’ (1897) theory of “vital periodicity” which predicted critical periods and dates in an individual’s life. Indeed, Freud idealised Fliess and was so influenced by his tenuous hypotheses, including reflex nasal neuroses, that he even referred some of his patients to him for treatment of their neurosis by nasal surgery.

He also applied Fliess’ permutations to himself and accordingly expected to die at the ages of forty, then forty-two, forty-three, fifty-one, sixty-two, and eighty-one and a half. After an “absurd dream”, Freud became persuaded that the age of fifty-one had special significance: “fifty-one is the age which seems to be a particularly dangerous one to men: I have known colleagues who have died suddenly at that age” (1900a, p. 438). Here, he is referring to the death of the physicist Kundt who actually died at the age of fifty-four not fifty-one.

Fliess provoked his fears by arguing that all vital processes are developed in a cycle lasting twenty-three days in men and twenty-eight days in women. He predicted that the age of fifty-one years (twenty-eight plus twenty-three) would either be the year of Freud’s death or at least a critical period for him. As luck would have it (or perhaps synchronicity), the year in question was 1907 in which he was first to meet Jung, Abraham, and Ferenczi. He survived his fifty-first year, but then anticipated the next promised date of his own death, in February 1918, with both terror and yearning: “I have worked hard, am worn out, and am beginning to find the world repulsively disgusting. The superstition that has limited my life to around February 1918 seems downright friendly to me” (Freud to Ferenczi, 20 November 1917, in Masson, 1985, p. 249).

Even reaching this milestone offered Freud little relief: “So I have really reached sixty two … My prevailing mood is powerless embitterment, or embitterment at my powerlessness” (Freud to Abraham, 29 May 1918, in Falzeder, 2002, p. 378).

This was most peculiar, as nineteen years earlier he had already predicted his own retirement to be at the age of sixty-seven. In the writing of The Interpretation of Dreams (1900a), he refers to “2,467 mistakes—which I shall leave in it” (Freud to Fliess, 27 August 1899, in Masson, 1985, p. 368). Two years later, in the Psychopathology of Everyday Life (1901b), Freud tried to explain why he picked this seemingly random number from the ether. He remembered that in 1899, at the age of forty-three, he had been wondering about when he would retire. Perhaps this wish to know evoked his unconscious to provide him with the answer of another twenty-four years’ work which would take him to the venerable age of sixty-seven (2467)? Curiously, it was in 1923, at the age of sixty-seven, that he became ill but did not retire! To add to this uncanny coincidence, it was also in 1899 that Freud first referred to himself as a cancer: “… I have turned completely into a carcinoma. The neoplasm in its most recent stages of development likes to drink wine. Today I am supposed to go to the theatre; but this is ridiculous—like an attempt to graft onto the carcinoma. Nothing can adhere to it, so from now on the duration of my life span is that of the neoplasm [a tumour]” (Freud to Fliess, 19 February 1899, in Masson, 1985, p. 345).

Georg Groddeck, one of the founders of psychosomatic medicine, heard about this story and became convinced that Freud’s own unconscious had produced the malignancy. He held that unconscious thoughts evoked somatic processes including cancers and invited Freud to his private hospital for treatment. Freud refused but nevertheless admired and encouraged Groddeck (1923) who coined the term “id” which Freud later adopted in his structural model of the psyche.

So why was such an advocate of rational science so superstitious and preoccupied with his own death? Could we consider his fatalistic and morbid musings the expression of an unconscious death wish?

Superstition

Freud proposed that superstition derives from repressed hostile and murderous impulses which can be most clearly recognised in obsessional neurotics, people of often high intelligence: “Superstition is in large part the expectation of trouble; and a person who has harboured frequent evil wishes against others, but has been brought up to be good and has therefore repressed such wishes into the unconscious, will be especially ready to expect punishment for his unconscious wickedness in the form of trouble threatening him from without” (1901b, p. 260).

However, at first, he was reluctant to apply this reasoning to himself. Instead, his self-analysis revealed that his own superstition “… has its roots in suppressed ambition (immortality) and in my case takes the place of that anxiety about death which springs from the normal uncertainty of life …” (1901b, p. 260, n. 3). Here he accepts that his superstitious preoccupation with death is abnormal, but felt that those, like himself, who had experienced the death of loved ones at an early age were predestined to such a fixation. We must remember that Freud lived through the First World War, with death as a constant companion, and lived in fear of his sons being killed (his eldest, Martin, was captured by the Italian Army).

Guilt

Freud considered his addiction to nicotine as a derivative of the primary addiction of masturbation which he described as the original sin. Did he imagine that he was being punished for this sin? As Max Schur (1972, p. 194) opined, he did not develop cancer as a result of guilt, but did punish himself by persisting in smoking. He was aware that smoking was potentially dangerous, but would only abstain during his most severe cardiac episodes.

At the tender age of eighteen months, Sigmund was displaced from the breast by the birth of his brother Julius. This led to prototypical guilt when Julius seemed to surrender to Sigmund’s hatred by dying within a year. He said that he had welcomed this brother with “adverse wishes and genuine childhood jealousy … and his death left the germ of (self-) reproaches in me” (Freud to Fliess, 3 October 1897, Masson, 1985, p. 268). Freud believed that his guilt and preoccupation with death could be traced back to the death of this baby brother.

He also suffered from remorse in relation to the death of Ernst Fleischl, a brilliant physiologist and beloved friend, who lent him money when he was destitute. Sigmund treated him for morphine addiction by administering cocaine orally. The results were at first miraculous but he then deteriorated drastically with symptoms worse than before. This resulted in harrowing nightly vigils comforting his friend until his death in 1891. His contrition was amplified by the memory of envious death wishes he entertained towards Fleischl who had a career which Freud, m...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• About the Editor and Contributors
• Foreword
• Preface
• Introduction
• Part I: Bearing the Unbearable
• Part II: Containment and Creativity
• Index