Elisabeth von R., Case of
ELISABETH VON R., CASE OF
"Fräulein Elisabeth von R." is the pseudonym Freud gave to Ilona Weiss, a young woman of Hungarian origin, whose case is described in the Studies on Hysteria (1895d) and whom he treated in the fall of 1892 and July 1893. The third daughter in a well-to-do Hungarian family, Elisabeth von R. was twenty-four years old when Freud treated her in the autumn of 1892 for pains in her legs and difficulties walking, problems she had been experiencing for two years. He confirmed the diagnosis of hysteria that had been made and noted that "if one pressed or pinched the hyperalgesic skin and muscles of her legs, her face assumed a peculiar expression, which was one of pleasure rather than pain. She cried out—and I could not help thinking that it was as though she was having a voluptuous tickling sensation—her face flushed, she threw back her head and shut her eyes and her body bent backwards" (1895d, p. 137).
After an initial period of four weeks during which he prescribed electrical treatments, he suggested to her the use of a cathartic cure that "turned out, however, to be one of the hardest that I had ever undertaken" (1895d, p. 138). Resistant to hypnosis, the patient stretched out with her eyes closed but was able to move, open her eyes, and sit up. Freud then applied his "concentration technique," the same one he was using on another patient of his at the time, Miss Lucy R.
It was this that persuaded Freud that she was hiding a secret, but her initial remarks had no effect in spite of their dramatic nature. Her family history was characterized by heart disease and the death of her father, whom she deeply loved, for whom she "took the place of a son and a friend with whom he could exchange thoughts" (1895d, p. 140). Freud understood that her illness had begun with pains in her legs, which first occurred while she was caring for her sick father, even though she was not aware of them until two years after his death. The sickness and death of her sister, who was also afflicted with heart disease aggravated by pregnancy, followed by a quarrel between her brothers-in-law, had coincided with the two years of the development of her illness.
During this period of the treatment, she repeated to Freud that she was not doing better in spite of her confession and Freud remarked that "when she looked at me as she said this with a sly look of satisfaction at my discomfiture, I could not help being reminded of old Herr von R.'s judgment about his favorite daughter—that she was often 'cheeky' and 'ill-behaved"' (1895d, p. 141).
An improvement occurred when she herself provided the source of her hysterical conversion: Her pains began at the spot on her thigh where, every morning, her father placed his inflamed leg so she could change his bandages. From then on "her painful legs began to 'join in the conversation' during our analyses" (1895d, p. 141), a period of abreaction when, Freud writes, "I sometimes followed the spontaneous fluctuations in her condition; and I sometimes followed my own estimate of the situation when I considered that I had not completely exhausted some portion of the story of her illness" (1895d, p. 149). He then experimented with the phenomenon that would soon modify his conception of psychotherapy: "In the course of this difficult work I began to attach a deeper significance to the resistance offered by the patient in the reproduction of her memories and to make a careful collection of the occasions on which it was particularly marked" (1895d, p. 154). It was on her account that he used publicly for the first time (this information is found six months later in Draft H, dated January 24, 1895, in 1950a) a key theoretical concept: "it can be shown with likelihood that complete conversion also occurs, and that in it the incompatible idea has in fact been 'repressed' [verdrängt ], as only an idea of very slight intensity can be."
In the spring of 1893 a sharp pain reoccurred when she heard, in a room adjacent to Freud's office, her brother-in-law who had come to pick her up. This enabled Freud to track down her "secret"—she had fallen in love with her brother-in-law. She had grown closer to him as a result of her sister's illness, and upon her death was unable to repress the thought that he was now free. In spite of his patient's denials, Freud insists on, and goes so far as to solicit the testimony of the young woman's mother, who confirmed that she had suspected as much. The treatment concluded in July 1893 with the appeal to the mother for assistance. This was to have repercussions later on, since the daughter rebelled and refused to see Freud again because he had betrayed her secret.
Freud, confident in his treatment, notes with pleasure: "In the spring of 1894 I heard that she was going to a private ball for which I was able to get an invitation, and I did not allow the opportunity to escape me of seeing my former patient whirl past in a lively dance" (1895d, p. 160). When he prepared the case study for the Studies on Hysteria, he learned from Wilhelm Fliess (to whom he had given it to read) on July 14, 1894, that she had just gotten engaged.
Elisabeth von R., if we are to believe her daughter's revelations, told the story somewhat differently. "She described Freud as 'just a young, bearded nerve specialist they sent me to. He had tried "to persuade me that I was in love with my brother-in-law, but that wasn't really so." Yet, her daughter adds, Freud's account of her mother's family history was substantially correct, and her mother's marriage was happy." (Gay, p. 72).
It was in this context that Freud wrote, "This was my first complete analysis of a hysteria. It allowed me for the first time, with the help of a method that I would later use as a technique, to eliminate psychic material in layers, which I like to compare to the technique of unearthing a buried city" (1895d, p. 139). Yet the treatment is less important historically for the spectacular discovery of the "love secret" that is revealed than because it demonstrates to Freud the mechanism of conversion, his link to a father with whom he identifies without yet drawing the relevant conclusions, and the resistance he must overcome through belief in his method, in order to eliminate, beyond the relative freedom of association he allows his patient, through speech, layer by layer, the psychic material that blocks the return of repressed memories.
Alain de Mijolla
See also: Cathartic method; Erotogeneity; Phlyogenesis; Resistance; Studies on Hysteria .
Ellenberger, Henri F. (1970). The discovery of the unconscious: The history and evolution of dynamic psychiatry. New York: Basic Books.
Freud, Sigmund. (1950a [1887-1902]). Extracts from the Fliess papers. SE, 1: 173-280.
Freud, Sigmund, and Breuer, Josef. (1895d). Studies on hysteria. SE, 2: 48-106.
Gay, Peter. (1988). Freud: A life for our time. London-Melbourne: Dent.