Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides)
"PSYCHO-ANALYTIC NOTES ON AN AUTOBIOGRAPHICAL ACCOUNT OF A CASE OF PARANOIA (DEMENTIA PARANOIDES )"
This paper is one of Freud's great theoretical-clinical studies. It deals with the autobiography, published in 1903, of Daniel Paul Schreber, a mental patient whom Freud never met personally.
Schreber was the son of a physician who was a great believer in rigid educational methods. The young man studied and later practiced law. After a political setback, however, he fell victim to a depression accompanied by hypochondriacal ideas and spent six months (1884-1885) in a Leipzig psychiatric clinic run by Paul Emil Flechsig. In 1893 he was offered a significant promotion, but six months later he was admitted once again to Flechsig's clinic, then transferred to an asylum, directed by Doctor Guido Weber, where he would remain for the next eight years after being diagnosed as suffering from "paranoid dementia."
During this eight-year period, he first went through a phase of intense hallucinatory delusion characterized by an extremely disorganizing anxiety; he then organized his delusions somewhat, eventually achieving a degree of stability that allowed him (at his own request) to argue for his freedom (with great legal talent) and to regain it by a judgment of the Royal Appeal Court of Dresden dated July 14, 1902.
Over the years Schreber had taken occasional notes, and toward the end of his internment he made these the basis of a book, which he succeeded in having published in 1903 under the title Denkwürdigkeiten eines Nervenkranken (Memoirs of a neuropath). Many passages were excised at the behest of the publisher—and, one may suspect, at the behest of Schreber's family to conceal the family's great sexual crudity. It is essential to read Schreber's book, translated as Memoirs of My Nervous Illness (1955), in order fully to appreciate the commentary Freud offered on it a few years later. It provides a very eloquent description of the sensory hallucinations to which Schreber fell prey, along with his own explanation of them. According to this explanation, these sensations were imposed on him by God, by means of "divine rays" connected directly to his body, and specifically to his nerves. Schreber strove mightily to satisfy God by procuring the "voluptuous sensations" that God demanded, yet at the same time he waged a ferocious, superhuman struggle to free himself from the rays.
Schreber's God was a strange, capable of this terrifying kind of possession, yet at the same time pitiful, inasmuch as God understood nothing about humans and ardently sought to become acquainted with their sensations. In Schreber, God found a unique being who gave God an ardently wished-for connection. This God, who had a dual nature (Schreber evoked the dualism of Ahriman and Ormuzd found in Zoroastrianism), had created a replica of himself in Flechsig (who was also divided into two, but who was liable to shatter into many pieces at certain moments), and Flechsig had been God's agent with regard to Schreber. The incoherence of this account is immediately apparent, yet it is a poignant testimony to a sick man's desperate struggle to establish a level of meaning that he could accept and that would free him from his incoherent anxiety about disintegration.
Little by little, Schreber's explanation organized itself into a vast theological cosmogony: The world was coming to an end, and for a whole stretch of time Schreber was the sole survivor, surrounded by shadows, semblances of men, mere apparitions. A new humanity would supposedly be born from Schreber himself, provided that he is transformed into a woman and offered God the voluptuous feelings of women's pleasures.
Schreber published his book to enlighten psychiatrists. Granted, he was mentally ill (as indicated in the title of his autobiography), but the causes of his illness were quite different from what the psychiatrists attributed it to. Schreber, above all, wanted to convey his message to people at large in order to enlighten humanity about essential truths.
It is instructive to read the clinical reports of Dr. Weber appended to Schreber's narrative (1955, pp. 267ff.), for they offer a remarkable description of how a calming delusional system can cure anxiety. Also of great interest is the wise judgment passed by the appeals court in Dresden (Schreber, 1955, pp. 329-356), which discharged Schreber in 1902. The court forcefully declared, in effect, that Dr. Schreber was completely mad, but that his worldview was interesting, and that he no longer represented any danger to himself or others. Indeed, after his release Schreber passed several uneventful years before being recommitted and dying in an asylum in 1911, the very year in which Freud published his study of the case.
When he worked on this text, Freud had been engaged for two or three years in a sustained discussion of the psychoses with Carl Jung. From these discussions Freud he expected much of value to emerge, though the first signs of Jung's coming break with Freud were already beginning to appear. Freud made no attempt here to account for all the psychopathological phenomena and processes characterizing Schreber's illness. Rather, as in all of Freud's great clinical writings, his purpose was to prove something. In this case he set out to demonstrate that the motor of the paranoiac's persecution anxiety and delusional world-view is related to issues attending homosexuality, as was strikingly revealed by Schreber's delusions.
The first part of Freud's discussion, "Case History," though it hews close to Schreber's Memoirs, nevertheless presents the material that will serve to illustrate the thesis set out in the second part, "Attempts at Interpretation." In Freud's view, Flechsig, as a doctor admired by Schreber, is the privileged object of Schreber's homosexual desire, a desire justified and indeed sanctified by his delusional system. Yet the roots of Schreber's homosexual desire must be sought in his relationship with his father, Daniel Gottlieb ("God's love") Moritz Schreber, a relentless educator who promoted absolute submission to God's will. In this case the father, it would seem, was the bane of his children's lives (an elder brother of Daniel Paul killed himself, while a younger sister was a confirmed mental patient).
In the third and last section of his study, "The Mechanism of Paranoia," Freud analyses the process of projection that constitutes the paranoiac's chief defense and organizes the paranoiac's delusions of persecution: the basic homosexual desire, "I (a man) love him (a man)," is negated into "I do not love him—I hate him," which then, as a result of projection, becomes "He hates (persecutes) me," and from this the paranoiac derives the justification "I do not love him—I hate him—because he persecutes me" (1911c , p. 63). What we have is a system of transformations to defend against homosexuality. Freud presents two more variants of such systems, one being the mechanism at work in erotomania and the other the mechanism mobilized in delusions of jealousy. (A fourth possible mode of defense against homosexual desires embraces the formula "I do not love at all—Idonotloveanyone.")
This work of Freud's spawned a large number of discussions and commentaries, the most notable of which are cited in the bibliography below.
See also: Castration complex; Delusion; Dementia; Ego instincts/ego drive; Fixation; Friendship; Hypochondria; Megalomania; Narcissism; Paranoia; Paraphrenia; Persecution; Projection; Rationalization; Schizophrenia; Schreber, Daniel Paul; Sublimation.
Freud, Sigmund. (1911c ). Psychoanalytische Bemerkungen über einen autobiographisch beschriebenen Fall von Paranoia (Dementia paranoides) [Schreber]. Jb. psychoanal. psychopathol. Forsch., III, p. 9-69; GW, Vol. 8, p. 239-316; Psycho-analytic notes on an autobiographical account of a case of paranoia (dementia paranoides ). SE,12:1-82.
Israëls, Han. (1989). Schreber: father and son. Madison, CT: International Universities Press. (Original work published 1981)
Kanzer, Mark, and Glenn, Jules (Eds.). (1980). Freud and his patients. New York: Jason Aronson.
Lothane, Zvi. (1992). In defense of Schreber: Soul murder and psychiatry. Hillsdale, NJ: Analytic Press.
Prado de Oliveira, and Luis Eduardo (Ed.). (1979). Le cas Schreber: Contributions psychanalytiques de langue anglaise. Paris: Presses Universitaires de France.
——. (1997). Freud et Schreber: Les sources écrites du délire, entre psychose et culture. Paris:Érès.
Schreber, Daniel Paul. (1955). Memoirs of my nervous illness (Ida Macalpine and Richard A. Hunter, Trans.). London: Dawson. (Original work published 1903)