Freud at Work

On the History of Psychoanalytic Theory and Practice, with an Analysis of Freud's Patient Record Books

Ulrike May

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429759031
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Presenting a new frame of reference, the author argues that Freud's theories are not the result of his genius alone but were developed in exchange with colleagues and students, which is not always apparent at first glance. Replete with examples, the author reconstructs who the theories were addressed to and the discursive context they originally belonged to, thus presenting fresh and surprising readings of Freud's oeuvre. The book also offers a glimpse into Freud's practice. For the first time, Freud's patient record books which he kept for ten years, are being reviewed, offering readers the hard facts about the length and frequency of Freud's analyses.

Part I
Freud and his Students

Chapter One
How the concept of narcissism came into being: from Ellis and Näcke to Sadger and Freud

When Freud made his first statements about narcissism in 1909 and 1910 he was referring to studies and communications by Isidor Sadger (Min 2, p. 312; Freud, 1910c, p. 99, fn. 1). He also cited Sadger after 1910 when he gave his reasons for introducing the concept of narcissism (1911c, p. 60, fn. 1; 1914c, p. 73). The question thus arises as to what Sadger contributed to Freud’s understanding of narcissism.

Before continuing I should point out that Freud’s first remarks on narcissism concerned only one aspect of the concept, that is, love of one’s own person (or, to use Freud’s term, one’s own “ego”) and of love objects that are similar to it. This component was initially the “strongest of the reasons” for introducing narcissism (Freud, 1914c, p. 88). Later this aspect was no longer as prominent. Today we find it in a refined and expanded form in Kohut’s descriptions of the narcissistic transferences, especially in the alter ego or twinship transferences, in which the need for essential alikeness plays a central role (Kohut, 1984). Thus in this article I shall be attempting to lay bare the early roots of some contemporary ideas about narcissism.

Questions

Freud’s earliest statement about narcissism is to be found in the Minutes of the Vienna Psychoanalytic Society dated 10 November 1909 (Min 2, pp. 312–313). On this evening Sadger had presented a case report and according to the Minutes he had, among other things, expressed the opinion that “autoerotism in the form of narcissism” played an important role in homosexuality and that the love objects of male homosexuals had characteristics that were the same as their own (Min 2, p. 307).¹ In the discussion Freud picked up on this detail of Sadger’s presentation. His remarks are recorded in the Minutes as follows:

PROF. FREUD: […] Sadger’s comment with regard to narcissism seems new and valuable. This is not an isolated phenomenon but a necessary developmental stage in the transition from autoerotism to object love. Being enamoured of oneself (of one’s genitals) is an indispensable stage of development. From there one passes to similar objects. In general, man has two primary sexual objects, and his future existence depends on which of these objects he remains fixated on. These two sexual objects are for every man the woman (the mother, nurse, etc.) and his own person; and it follows from this that [the question] is to become free from both and not to linger on too long with either. Usually, one’s own person is replaced by the father—who, however, soon moves into a hostile position. It is at this point that homosexuality branches off. Man does not set himself free of himself so soon, as this case very beautifully demonstrates. (Min 2, pp. 312–313)

There can be no doubt that it was here, on 10 November 1909, that Freud introduced the concept of narcissism into the terminology of psychoanalysis and that he was referring to Sadger. In the two essays in which his ideas on narcissism were first published he also referred to “investigations” and “material” by Sadger (1905d/1910, p. 135, fn. 1; 1910c, p. 99, fn. 1).²

Two questions arise. First, what was Sadger’s contribution to the concept of narcissism, and which ideas are attributable to him and which to Freud? And second, to what “investigations” and “communications” of Sadger’s was Freud referring?

In the remark made by Sadger quoted above and in the places where Freud’s first published statements on narcissism appeared, narcissism seems to be a phenomenon that is tied to homosexuality. As we can see from the above quotation Freud already detached it from this specific context in his first statement (1909) and put forward the hypothesis that love of oneself is not tied to homosexuality, but a necessary stage in normal development. Freud presented this idea with great assurance. In fact, all of his first statements about narcissism give the impression of being so well rounded and definitive that we must assume that they were the product of an extended process of exploration and reflection. But if we look for explicit references in Freud’s publications we do not find anything about his “half-way stations”. Perhaps there were precursors of the concept of narcissism, perhaps Freud observed and described manifestations of narcissism before 1909, but under a different name?

In this article I look for answers to these questions in Freud’s work published in the years between 1905 and 1910, that is, in the period between the first and second editions of the Three Essays on the Theory of Sexuality. In the first edition (1905) we do not yet find any mention of narcissism, while the second edition (1910) contains the abovementioned footnote on narcissism. Apart from Freud and Sadger’s publications, my main source is the Minutes of the Vienna Psychoanalytic Society (Nunberg & Federn, 1962–1975).³ To date these sources have only infrequently been drawn upon and they were not yet systematically taken into account by the English and German editors of Freud’s works and letters.⁴

Isidor Sadger

Isidor Sadger (1867–1942) was admitted to the Psychological Wednesday Evening Society on 21 November 1906. The members of this group (which from 1908 onwards called itself the Vienna Psychoanalytical Society) in the period between 1905 and 1910 who are well known today were Alfred Adler, Paul Federn, Wilhelm Stekel, Otto Rank, Eduard Hitschmann, Fritz Wittels, and Max Graf, the father of “Little Hans”. Freud was present every Wednesday evening to take part in the discussions of the lectures given by the members of the group and guests. Sometimes he would present drafts of his own publications. Sadger also participated regularly and actively in the weekly meetings during that period. Between November 1906 and December 1910 he gave twelve lectures to the group and thus spoke on more evenings than any of the other members. Ten of the twelve lectures were published. They account for only a small proportion of Sadger’s total publications during that time.⁵

Today Sadger’s papers and books are little known. They do not rank anywhere near those of Abraham, Ferenczi, Adler, and Jung. Their intellectual level is inferior to that of Rank’s writings, and there is no comparison to the work of Stekel in regard to the art of interpretation. Today we associate Sadger’s name with the early days of research on homosexuality and perversion. He is considered to be a pioneer in that field. The first insights into the aetiology of homosexuality and the first publications on the subject are generally ascribed to him and Freud.⁶ In the “Bericht über die Fortschritte der Psychoanalyse in den Jahren 1909 bis 1913 [Report on the Progress of Psychoanalysis in the years 1909 to 1913]”, which contains fourteen reviews, it was Sadger who provided an overview of research on perversion (1914a). The term “urethral eroticism” that he introduced became broadly accepted, while others such as “Gesässerotik [buttock eroticism]”, “Haut-, Schleimhaut- und Muskelerotik [skin, mucosa and muscle eroticism]” as well as “Assoziationswiderwille [unwillingness to associate]” did not.

To date no biographies of Sadger or collections of his work have been published. Very little is known about his life. He was born in Galicia in 1867, studied medicine in Vienna, graduated in 1891, and became interested in Freud’s work at the end of the 1890s. He was known to Freud at the latest by 1899 and reported that he began to carry out psychoanalyses in 1898.⁷ He started to publish even before graduating; according to Graf-Nold these were “popular articles on subjects in the areas of overlap between medicine, psychology, and literary science” (1988, p. 35).

From 1906 onwards he was a member of the group that had gathered around Freud and left it in 1933 for unknown reasons (Handlbauer, 1990, p. 47). The editors of the Minutes state that he had increasingly isolated himself as the years passed (Min 1, p. XXXVI). Angela Graf-Nold (1988) writes that he was the analyst and close friend of Hermine Hug-Hellmuth.⁸ Karl Fallend (1988, pp. 29, 50, 42) reports that he taught at the Vienna training institute in the 1920s, gave courses in the “Seminar for Sexuology”, and was the first analyst of Wilhelm Reich. At that time Sadger belonged to the group of older analysts whom the younger analysts called “libido hunters”—a label that suits him well (Sterba, 1982, p. 34). His tragic death is all that is known about his life during the time after he left the Vienna Psychoanalytic Society. He was deported to the concentration camp Theresienstadt in 1942 and died there.

In the biographies of Freud by Jones, Clark, Gay, and Sulloway, Freud’s correspondence with Abraham, Jung, and Pfister and the smaller autobiographies and memoirs of Wittels, Sterba, Sachs, Stekel, Reik, Jones, Helene Deutsch, and Andreas-Salomé, Sadger is either not mentioned at all or only in passing, and almost always in an unfavourable light. The picture painted of him in the Minutes is similarly uncongenial. The editors remark that he “made himself disliked” (Min 1, p. 258, fn. 3).⁹ Freud also does not seem to have liked him.

Apart from his awkward and tactless behaviour the main reason for the rejection that Sadger provoked lay in his obsession with sexuality. That this should have shocked a group of analysts may be surprising, but it becomes understandable if we consider that in Sadger’s case the interest in sexuality had nothing to do with a tolerance and acceptance of drive impulses (“Triebfreundlichkeit”), but with a covert and unadmitted moral indignation. Sadger questioned his patients in a penetrating, inquisitorial way about the details of their sexual experiences and practices and publicised the results of these extended sexual histories in over-long case reports, describing unsavoury particulars in minute detail. Freud drew his attention to the fact that this led to “aversion” and that Sadger did not take into account his audience’s and readers’ normal defences (Min 2, p. 379). At another point Freud reproached him with a “lack of tolerance” which “manifests itself in a moralistic pathos” (ibid., pp. 224–225). This was referring to the fact that Sadger’s detailed descriptions of his patients’ sexual lives were permeated by a tone of moral judgement. His patients had to “admit” sexual wishes for which they were then condemned. Sadger thus failed to respect both his patients’ defences and those of his audience. He may have denied feelings of shame and disgust of his own. At one point Freud remarked that Sadger neglected the “whole superstructure” of the mind (Min 4, p. 16).¹⁰ He went on to say that Sadger neglected to describe his patients’ resistances, which led to the impression that the “psychosexual factors which are at the deepest roots were the solutions that offered themselves at the start” (ibid.). Moreover, Freud felt that Sadger did not make any effort to develop a theoretical understanding of the material he had gleaned from his patients.

One can see Sadger as a representative of a mode of psychoanalytic conduct and thinking that is tied neither to that time, nor to personal idiosyncrasies or to his person. This mode is characterised by an overriding interest in primitive drive impulses, a tendency to condemn those very impulses, a lack of interest in psychoanalytic theory, a relatively rigid, dogmatic way of perceiving clinical material, a tendency to get lost in patients’ histories, little appreciation of complexity or over-determination, and a technique in which patience plays a minor role, while confrontation is central.

The questions we have asked focus our interest on the years between 1905 and 1910. During this period Sadger published no fewer than forty-two essays.¹¹ Twenty-two of these dealt with the application of hydriatics (treatment by means of water) in various organic and mental diseases. Five articles were written for German daily and weekly newspapers and are, for example, about the German poet Christian Friedrich Daniel Schubart (1905a), Ibsen (1905b), the psychology of taste (1905c), disturbances of child development (1910f), and transvestism (1910c). The remaining fifteen papers, all of which were published after 1907, can be considered psychoanalytic in the narrower sense, that is, pathographies on C. F. Meyer (1908c), Lenau (1909a), and Kleist (1910e), three clinical papers (1908a, 1909b, 1910d), and nine papers of a more general nature on psychoanalysis (1907, 1908b, 1908d, 1909c, 1909d, 1910a, 1910b, 1910g, 1910h). The following are of particular importance for our investigation: “Psychiatrisch-Neurologisches in psychoanalitischer Beleuchtung [A Psychoanalytic View of Some Psychiatric and Neurological Disorders]” (1908d), “Fragment der Psychoanalyse eines Homo-sexuellen [A Fragment of the Psychoanalysis of a Homosexual]” (1908a), “Ist die konträre Sexualempfindung heilbar? [Is Contrary Sexual Feeling Curable?]” (1908b), “Zur Ätiologie der konträren Sexualempfindung [On the Aetiology of Contrary Sexual Feeling]” (1909c), and “Ein Fall von multipler Perversion mit hysterischen Absenzen [A Case of Multiple Perversion with Hysterical Absences]” 1910d).¹²

In “A Psychoanalytic View of Some Psychiatric and Neurological Phenomena”, published in April 1908, Sadger announced the discussion of two problems that “have not yet or hardly been clarified to date, that is, narcissism and the phenomenon of the Doppelgänger” (1908d, p. 53).¹³ In view of the date on which Freud made his first statements on narcissism it seems surprising that Sadger should speak of narcissism quite matter-of-factly—one year before Freud did. Thus it needs to be clarified when the term “narcissism” was first used in everyday parlance and in medical terminology, and what was understood by it.

Ellis and Näcke: The concept of narcissism in sexology

It is well known that Havelock Ellis (1859–1939) drew attention to a “Narcissus-like tendency” in his essay “Auto-erotism: a Psychological Study” (1898a, p. 280). Paul Näcke, a German physician and sexologist, translated “Narcissus-like tendency” as “Narzißmus” (1899b, p. 375), thus coining the term that Freud was later to adopt.¹⁴ As regards the term “autoerotism” it is known that Freud adopted it from Ellis, but gave it a different meaning: according to Freud a sexual activity is autoerotic when it “is not directed towards other people, but obtains satisfaction from the subject’s own body” (1905d, p. 181). Neither “narcissism” nor “autoerotism” had been part of English or German vocabulary before 1899, just as many other terms for what was considered to be deviant sexual behaviour have only been used since about 1880, that is, only surprisingly recently.¹⁵

When Näcke translated Ellis’ “narcissus-like tendency” as “Narziß-mus”, he not only created a new word, but also interpreted it differently from Ellis. It is worth looking more closely at this process, since ultimately it sheds new light on the relationship between psychoanalysis and sexology.¹⁶

Ellis’s paper entitled “Auto-erotism” is thirty-nine pages long and focuses on masturbation. Ellis went through the reports, observations, and surveys available at the time and presented the various masturbation practices and their frequencies in relation to age, sex, cultural affiliation, and so on. He classified the sexual arousal induced by masturbation in a group of sexual phenomena that he called “autoerotic”. He understood autoerotism to mean, “the phenomena of spontaneous sexual emotion generated in the absence of an external stimulus proceeding, directly or indirectly, from another person” (1898a, p. 260). For instance, sexual arousal is autoerotic when it occurs during sleep or as a result of daydreams, masturbation, religious fervour, or ecstasy, or alternatively of self-love. Ellis saw it as his mission in life to describe normal sexuality, or sexuality as it occurs, in all its manifestations and to exercise reserve in regard to moral judgement. He always pleaded in favour of tolerance vis à vis different expressions of sexuality, including, for example, homosexuality. He took the same attitude towards autoerotism. It was important to him to remove the fear that masturbation and other autoerotic phenomena would lead to mental illness or do some other harm. In his view, all autoerotic phenomena are normal, which does not exclude the possibility that they can be practised to a pathological degree. Ellis considered a self-love pervaded by sexual arousal to be a rare phenomenon, a “curiosity”, and wrote only a few lines about it, including the remark that love of the ego or self-admiration is “narcissus-like”:

To complete this summary of the main phenomena of autoerotism, I may briefly mention that tendency which is sometimes found, more especially perhaps in women, for the sexual emotions to be absorbed, and often entirely lost in self-admiration. This Narcissus-like tendency, of which the normal germ in women is symbolized by t...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• ABBREVIATIONS
• SERIES EDITOR’S FOREWORD
• INTRODUCTION
• PART I: FREUD AND HIS STUDENTS
• PART II: FREUD AND HIS PATIENTS
• SOURCES
• REFERENCES
• INDEX