Mathilde, Case of
MATHILDE, CASE OF
The Mathilde case involves a patient of Freud's whose death, from a medical overdose, is discussed in his commentary on the "dream of Irma's injection." Mathilde S., a twenty-seven-year-old woman, came to see Freud at the beginning of 1889 for treatment. She presented the signs of inhibition, self-reproach, and delusional melancholia. The trigger turned out to be a broken promise of marriage that had been made to her. After a significant improvement with hypnotic treatment, the patient decompensated while Freud was away, with polymorphous symptoms, and had to be hospitalized in October 1889 in a private psychiatric clinic in Vienna.
At the clinic it became obvious that the patient was developing erotomania, whose object was initially Freud, then a physician at the institution. The circumstances supported the diagnosis of a transference psychosis. It appears that the patient's eroticized transference reinforced the ideas that Freud's former teacher, the psychiatrist Theodor Meynert, was defending at the time, specifically with respect to hypnosis.
While the patient was hospitalized, use was made of the entire range of medications available at the time: morphine, chloral hydrate, valerian, bromide, digitalin, opium, scopolamine, and sulfonal, a sedative that had recently been discovered. Unwanted and extremely severe side-effects resulting from the chloral hydrate endangered the patient's life. But she recovered and left the clinic in May 1890, still suffering from melancholia.
Freud resumed treatment, prescribing alternating high doses of chloral hydrate and sulfonal, but apparently dit not hypnotize her further. In the autumn she displayed a heightened pattern of vomiting, abdominal pains, and retention of urine, which was red in color. At the end of September the patient died. Shortly afterwards, a warning was issued against this kind of medication, and Mathilde's clinical symptoms were recognized as the expression of the presence of a severe hepatic porphyria resulting from the medication. In a report that was succinct and clear, Freud assumed responsibility for the fatal consequences of his treatment.
Five years later, as part of his associations with the dream of Irma's injection, Freud recalled this case, and his feelings of guilt were plainly apparent when he made the connection between his fear for the life of his daughter Mathilde, who was suffering from diphtheria—Behring had just introduced the serum therapy that was to save so many lives—and this case with its dramatic outcome: "This Mathilde for the other Mathilde, an eye for an eye, a tooth for a tooth." In the dream and its interpretations, feelings of guilt reappear concerning the failure to take medical precautions, and the secondary effects of the medication and the hypnosis; but along with these there is also present the fantasy of becoming a kind of "Behring of neuroses."
See also: Irma's injection, dream of.
Freud, Sigmund. (1891e). Mitteilung über eine Sulfonalvergiftung [Wiedergabe aus zweiter Hand]. In Adolf F. Jolles, Über das chemische Verhalten der Harne nach SulfonalIntoxikation—Internat. klin. Rdsch., Bd. 5 (1891), Sp. 1913-1916, 1953-1959.
——. (1900a). The interpretation of dreams. SE, 4-5.
Hirschmüller, Albrecht. (1989). Freuds "Mathilde," Ein weiterer Tagesrest zum Irma-Traum. Jahrbuch für Psychoanalyse, 24, 128-159.