Hirschfeld, Elfriede (1873-?)

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Born in 1873 and raised in Frankfurt-am-Main, Elfriede Hirschfeld was a patient of Sigmund Freud. She was treated between 1908 and 1914, and appears anonymously in several articles and in his correspondence. The work of Ernst Falzeder (1994) has enabled us to identify the person behind these references.

Freud was reticent about treating Hirschfeld after she had already undergone ten years of psychiatric treatment. She continued to receive treatment from several other psychoanalysts and psychiatrists but the results were inconclusive. She appears for the last time in the correspondence between Freud and Ludwig Binswanger on May 10, 1923, while she was being treated in Binswanger's clinic.

Hirschfeld appears as "Frau A." in the Freud-Abraham correspondence, "Frau H." in the Freud-Pfister correspondence, "Frau C." in the Freud-Binswanger correspondence, and finally as the "thirty-seven year old patient" in the Freud-Ferenczi correspondence. She was the subject of six articles and the origin of three articles from 1913: "An Evidential Dream" (1913a), "Two Lies Told by Children" (1913g), and "The Disposition to Obsessional Neurosis" (1913i). She is also directly implicated in the following articles: "Psycho-Analysis and Telepathy" (1941d [1921]), "Some Additional Notes on Dream-Interpretation as a Whole" (1925i), and finally in the chapter "Dreams and the Occult" in New Introductory Lectures on Psycho-Analysis (1933a [1932]). The list is long enough to establish the importance of Falzeder's discovery, but we can also confirm that her case serves as the background for the technical articles "Remembering, Repeating and Working-Through" (1914g) and "Observations on Transference Love" (1915a [1914]).

Hirschfeld's case was described in the three articles from 1913 and, in greater detail, in the article on obsessional neurosis. In it Freud introduced the erotic-anal phase, following the phases of autoeroticism and narcissism, which was not present in the first edition of the Three Essays on the Theory of Sexuality (1905d). He also introduces the idea of "symptom mobility," which he does not describe in detail.

After six years of analysis, three articles, references in his correspondence, and in spite of the fact that Freud claimed to have "reached the hard kernel of the illness," the patient had not made much progress. She was passed from doctor to doctor, seeing Carl Gustav Jung, Oskar Pfister, and finally Ludwig Binswanger, who treated her in his clinic. Freud made a comment to Binswanger that was to have considerable technical significance: "Analytic treatment should be accompanied by institutionalized control" (letter of April 27, 1922). This comment, along with others on then "current" methods of treatment that preceded analysis, appears in Freud's correspondence with Karl Abraham. It demonstrates Freud's pragmatism when faced with clinical difficulties.

Based on the evidence, Hirschfeld pushed Freud toward his final position on transference and counter-transference. We can now accept that Freud formulated his first ideas about counter-transference with reference to Hirschfeld. Everyone understood the notion of healing through love, as formulated by Carl Jung and Max Eitingon (and which is also found in the Minutes of the Vienna Psychoanalytic Society [Nunberg, Hermann; and Federn, Ernst, 1962]), in their own way. It is important to remember that it was during this time that Jung was deeply involved with Sabina Spielrein and Sándor Ferenczi with Elma Palos (Haynal, André, and Falzeder, Ernst, 1991). Freud was dealing with a patient who would not now be termed neurotic, as he wrote, nor schizophrenic, as Eugen Bleuler claimed, but very likely borderline or suffering from "pseudoneurotic schizophrenia." In these pathologies the symptoms do not mark the return of the repressed but serve as a defense against psychotic collapse.

Of the hundreds of patients that Freud treated in his practice, few were the subject of a monograph (Dora, for example) or an article (the young homosexual of 1919). Some are mentioned in an article and others appear only as signs or abbreviations in the correspondence. It is clear that psychoanalysis is not a purely empirical science and that its theory is firmly based on clinical practice (Lipton, Samuel D., 1977). Additionally, contemporary witnesses and belated analyses of Freud's treatments have contributed greatly to our understanding of Freudian practice, as well as how its theorization developed over time (Cremerius, Johannes, 1980).

The case of Elfriede Hirschfeld can be read as a female pendant to the Wolfman, to the extent that their treatments took place almost simultaneously. It is worthwhile rereading the introduction of pregenitality based on this case and the use of the primal scene in Freud's theorization of the Wolfman's symptoms. It is certain that Freud made progress as a researcher who experimented within this atmosphere of psychiatric nihilism that consisted in providing a diagnosis, then waiting for the illness to run its course. It is likely that his patients recognized this and, depending on their capabilities, benefited from it.

Nicolas Gougoulis

See also: Case histories.


Cremerius, Johannes. (1980). Freud bei der Arbeit über die Schulter geschaut. Beiheft zum Jahrbuch der Psychoanalyse. 123-158.

Falzeder, Ernst. (1994). My grand-patient, my chief tormentor: A hitherto unnoticed case of Freud's and the consequences. Psychoanalytic Quarterly, 63, 297-331.

Freud, Sigmund. (1905d). Three essays on the theory of sexuality. SE : 7, 123-243.

. (1913a). An evidential dream. SE : 12, 267-277.

. (1913g). Two lies told by children. SE : 12, 303-309.

. (1913i). The disposition to obsessional neurosis: a contribution to the problem of choice of neurosis. SE : 12, 311-326.

. (1914g). Remembering, repeating and working-through (Further recommendations on the technique of psycho-analysis II). SE : 12, 145-156.

. (1915a [1914]). Observations on transference love (Further recommendations on the technique of psychoanalysis III). SE : 12, 157-171.

. (1925i). Some additional notes on dream-interpretation as a whole. SE : 19, 123-138.

. (1933a [1932]). New introductory lectures on psycho-analysis. SE : 22, 1-182.

. (1941d [1921]). Psycho-analysis and telepathy. SE : 18, 173-193.

Hanyal, André, and Falzeder, Ernst. (1991). Healing through love? a unique dialogue in the history of psychoanalysis. Free Associations, 21 (2), 1-20.

Lipton, Samuel D. (1977). The advantages of Freud's technique as shown in the analysis of the ratman. International Journal of Psycho-Analysis, 58, 255-274.

Nunberg, Hermann, and Federn, Ernst. (1962-1975). Minutes of the Vienna Psychoanalytic Society. New York: International Universities Press.