Emmy von N., Case of
EMMY VON N., CASE OF
Frau Emmy von N. was the pseudonym given by Sigmund Freud in the Studies on Hysteria to his patient Fanny Moser, who was born Fanny Sulzer-Wart in 1848 and died in 1925. In her autobiography her daughter Mentona speaks of "the famous professor that [her] mother went to see in Vienna" (referring to either Josef Breuer or Rudolf Chrobak), who soon referred the patient to "his first assistant," Doctor Sigmund Freud. "He was small and thin, his hair was blue-black, large black eyes, he looked timid and very young. He made a profound impression on me." (in Ellenberger, Henri F., 1977).
On May 1, 1889, during her first visit, Freud described his meeting with this forty-year old woman, which would have made her seven years younger than Freud: "This lady, when I first saw her, was lying on a sofa with her head resting on a leather cushion. She still looked young and had finely-cut features, full of character. Her face bore a strained and painful expression, her eyelids were drawn together and her eyes cast down; there was a heavy frown on her forehead and the naso-labial folds were deep. She spoke in a low voice as though with difficulty and her speech was from time to time subject to spastic interruption amounting to a stammer." He also noted the clicking sound she made with her tongue when upset.
This intelligent but very anxious patient provided him, without his awareness, with a premonitory indication of the future therapeutic framework when she cried out: "Keep still!—Don't say anything!—Don't touch me!" She made use of this incantatory remark on several occasions, whenever she was frightened by some particularly terrifying memory, but Freud, after ten days of therapy, decided to eliminate it through the use of suggestion, which he succeeded in doing.
His treatment was consistent with customary practice, which consisted in her case of a stay at a clinic, separated from her two daughters, with whom she did not get along. Freud prescribed warm baths and massages twice a day. The patient was completely accessible to hypnosis and, in this state, recounted the origin of the delusional fears and visual hallucinations (rats, frogs) from which she suffered, retracing them to her childhood. "My therapy consists in wiping away these pictures, so that she is no longer able to see them before her. To give support to my suggestion I stroked her several times over the eyes."
The systematic pursuit of her memories enabled Freud to state that the case of Emmy von N. was the first in which he had employed the "cathartic method." One day, when she was irritated, the patient also made a remark whose practical consequences Freud did not fail to draw. She asked him to stop interrupting her with questions and to allow her to speak freely. At the time Freud still played the role of the grand magician, the antithesis of the future psychoanalytic attitude, and his authority was necessary to erase the patient's pathogenic memories through the process of suggestion.
It is interesting to note that there exists an 1894 note Freud added to the case history—this still a year before the dream of the injection given to Irma—in which he indicates that he wrote down his own dreams and traced them back to two factors: "(1) to the necessity for working out any ideas which I had only dwelt upon cursorily during the day—which had only been touched upon and not finally dealt with; and (2) to the compulsion to link together any ideas that might be present in the same state of consciousness. The senseless and contradictory character of the dreams could be traced back to the uncontrolled ascendancy of this latter factor." Although here is evident a clear glimpse of clinical intuitions that, in retrospect, appear anticipatory, at this point Freud's therapy continues to be a blend of such "purgative retellings" and electrotherapy.
Freud's notes stop on June 20 and Emmy von N. apparently left, quite improved, for her château in Switzerland. Freud visited her on July 18, traveling along the road to Nancy, where he was to meet Hippolyte Bernheim.
In January 1890 Emmy had a relapse. She went to see Breuer, complaining of nervous disturbances from which her daughter was suffering and blaming Freud and Chrobak. She was so agitated that they had her admitted to a sanatorium, from which she ended up escaping with the help of a woman friend. No doubt she came to represent one of the cases Freud referred to later to explain why he abandoned hypnosis: "On one occasion a severe condition in a woman, which I had entirely got rid of by a short hypnotic treatment, returned unchanged after the patient had, through no action on my part, got annoyed with me; after a reconciliation, I removed the trouble again and far more thoroughly; yet it returned once more after she had fallen foul of me a second time." (1916-17a [1915-17])
In May 1890, the anniversary of his first therapy, she came back to see Freud for additional therapy, which lasted eight weeks—until July. She felt better but suffered from mental confusion, "storms in her head," and insomnia, and the clicking tic and stammering had reappeared. Freud analyzed the origin of the return of these symptoms and again succeeded in eliminating them.
In the spring of 1891 Freud saw Emmy von N. at her home, where he stayed for several days to help resolve the problems she was having with her older daughter. She was feeling better but Freud resumed the therapy to eliminate her phobia of train travel. Because she claimed to be less docile than before, that is less attached to him, he reestablished his authority and his position through his little drama of being a hypnotist, which he exposed with such candor that it is obvious he was entirely unaware of his unconscious motives.
In an addendum that dates from 1924, Freud reports that, several years after this last visit, he met a doctor with whom she had behaved as she had with him: easy to hypnotize in the beginning then irritable and subject to relapses: "It was a genuine instance of the 'compulsion to repeat."' He added that around 1920 her elder daughter had written him to request a report, because she wanted to initiate a lawsuit against this "cruel tyrant" who had chased away her two children.
It has become fashionable to question Freud's diagnoses, and the case of Emmy von N. is no exception: melancholia, schizophrenia, nervous tics, the neurosis of a rich and idle woman, according to the various reports. Although Anna O. alone was successfully treated and managed to create an exemplary life for herself, Henri F. Ellenberger has remarked that it was Emmy's daughter, Mentona Moser, who benefited from the intellectual and social emancipation her mother never achieved.
Alain de Mijolla
See also: Andersson, Ola; Cathartic method; Ellenberger, Henri Frédéric; Free association; Moser-von Sultzer-Wart, Fanny Louise; Psychoanalytic treatment; Studies on Hysteria .
Andersson, Ola. (1962). Studies in the prehistory of psychoanalysis. Stockholm: Svenska Bokförlaget.
Ellenberger, Henri F. (1970). The discovery of the unconscious: The history and evolution of dynamic psychiatry. New York: Basic Books.
——. (1977). The story of "Emmy von N.": A critical study with new documents. Princeton: Princeton University Press, 1993.
Freud, Sigmund. (1916-17a [1915-17]). Introductory lectures on psycho-analysis. Parts I & II, SE, 15-16.
Micale, Mark S. (Ed.). (1993). Beyond the unconscious. Essays of Henri F. Ellenberger in the History of Psychiatry. Princeton, NJ: Princeton University Press.