Freud: Civilization and its Discontents Essay
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Freud: Civilization and its Discontents, and the case of Elisabeth von R
Neurotic repression of instinct and guilt accompany the endeavor of humankind to live harmoniously in a family and a community. According to Freud, Strachey, Strachey, Richards and Breuer (1974), states of the mind are clearly outlined and delimited. However, the mind state of being in love obscures this clear demarcation. Indeed, the gratification of instincts like love generated happiness. However, starvation from such gratification may become a cause of great suffering. The duality love and pain, and love and loneliness are tensions that emanate from the perpetual endeavor to conform and instinctually repress the demands of civilization. The innate fear to break laws and incur the associated punishment may diminish the search for instinctual individual freedom. At the worst case, such tensions may result into many kinds of psychosis. This is manifested in the discrepancy exhibited between human opinion and their behavior (Freud, Strachey, Strachey, Richards and Breuer, 1974). One such situation is the development of hysteria as depicted in the case of Ilona Weiss, alias Fraulein Elisabeth von R. Such cases require a psychoanalytic approach for their resolution.
This discussion describes the use of psychoanalysis by a neuro-pathologist who was trained to apply electro-prognosis and local diagnoses to treat his patients. In the application of psychoanalysis approaches in the treatment of Fraulein Elisabeth von R’s condition, the physician realized that his trained skills would not be effective in the treatment of hysteria. The physician could not trace any hereditary predispositions to explain his patient’s ailment. In other words, the patients close relations had no reported cases of severe neuro-psychosis and they all appeared well balanced emotionally.
However, many cases of hysteria may be rooted to incidences of nursing the sick for a prolonged time. In particular, sick-nursing results to ill physical health due to sleep interruptions, causes perpetual anxiety over the sick person’s vegetative functions, leads to the neglect of one’s own person and most importantly, accumulates unresolved impressions through suppression of one’s emotions. The recovery of the sick appears to dissolve these adverse effects, but the death of the person who was being nursed is what onsets hysteria to the caregiver. It is also commonplace to find hysterical tendencies in people who exhibit postponed abreaction.
This discussion delves into the application of the theory of duality in the resolution of the case of Fraulein Elisabeth von R. the discussion shall describe the specific symptoms that demonstrated duality and their dissonance to the unified clinical definition of health. In addition, the diagnosis of this case is discussed in light of how Freud pathologizes duality. Finally, the discussion dwells on the clinical treatment approach as guided by the desire for love, a unification of sexuality and emotion.
Fraulein Elisabeth von R. was a young twenty-four year old Hungarian woman who exhibited various symptoms of neurosis. The most apparent symptom that Elisabeth exhibited was of difficulties in walking, perhaps due to the painful abasia she was experiencing in her legs. This condition had persisted for more than two years. On further interrogation, the condition of Elisabeth may probably be attributed to her family’s misfortunes that had resulted in much unhappiness for her. These misfortunes included the father, Herr von R’s death due to pulmonary oedema, her mother undergoing a serious eye surgery and her sister dying from a condition of the heart after prolonged confinement in pregnancy (Freud, Strachey, Strachey, Richards and Breuer, 1974).
Although no hysteria or pathology was apparent in her symptoms, Elisabeth walked in a gait with her upper body bended forward, yet without any support. Specifically, the woman complained about great pain in her legs, especially located on the anterior surface of her right thigh. Elisabeth described this pain as particularly sensitive to pressure on the skin and muscles of this area. In addition, this pain produced a pinching sensation to suggest a condition of hyperalgelsia that manifested in her both legs. Essentially, the presence of any serious organic infection was ruled out as the Elisabeth’s reflexes demonstrated medium strength while her legs’ motor power was greatly impaired. Noteworthy, the onset of this pains are traced back to the moment Elisabeth was nursing her father through his condition of pulmonary oedema and is especially the last six months before his death. However, Elisabeth only became conscious of her leg pains after two years of her father’s death.
The arrival to a diagnosis was difficult but it bore extensive opinion from colleagues in the field. This difficulty of the differential diagnosis employed is exhibited in the variety of causes proposed to have caused the painful condition of Fraulein Elisabeth von R. The ailment of this woman may be diagnosed as an organic disorder of rheumatic origin, which was aggravated by psychical traumas. These traumas manifested themselves in hysteria. Specifically, Elisabeth’s emotional traumas were transformed to physical pain in her legs. This occurred through a mechanism of conversion from psychical excitation to physical pain, a typical occurrence of the condition of astasia-abasia. The woman apparently had two sets of pain, one on the right leg and another on the left leg. The pain on the right leg may be traced back to the events of her first pathogenic experiences. These include the duration when she was nursing her sick father and the moments during her relation with her boyfriend during her youth. In particular, her symptoms were characteristic of hysteria, which emanated from the conflict between the ideas surrounding the patient’s nursing her sick father and the contents of her erotic desires at the time. During the nursing period, Fraulein Elisabeth von R. may have lacked exercise and fed poorly, characteristic of such a situation. The patient’s focus of the pains in this leg formed an artificial hysterogenic zone from which other pains radiated. The pain on the left leg may be traced back to the memory of her relations with her two brother-in-laws and her demised sister.
Indeed, Freud and Strachey (2010), attribute such symptoms to the endeavor of an individual to master the three causes of displeasure. The first cause is the mortal and painful existence of humankind. The second is the natural world and its cruel and destructive aspect. Finally, the social requirement of humans living together which in reality may be a source of suffering. In addition, the inability of people to adapt and tolerate societal expectations may be a cause of neurosis as depicted in this case. Specifically, the inability of the patient to express and gratify her love for her brother in law may have been the cause for the hysterical pains.
The treatment regime was psychoanalytic in nature. The treatment administered to Fraulein Elisabeth von R. employed the hypnotic analysis effected by pressure to her skull. This required that the patient describe her memory and visions whenever at the moment of pressure application. The process of abreaction followed accompanied this approach. This methodology had the effect of invoking pertinent descriptions that had an incisive insight on the probable causes of her physical leg pains.
The treatment regime consisted of three distinct phases:
- The first phase of treatment was physiological. Faradizations and systematic kneading of the leg muscles essentially characterized the treatment regime. In addition, the use of high-tension electric currents appeared to relegate her pains to the periphery.
- The second phase of the treatment approach was psychoanalytic. However, this approach did not use hypnosis to have the patient relate her experiences especially those related to her illness. It is during this phase of treatment that duality in Elisabeth’s personality became apparent. This was illustrated as the connection between her painful mental impressions and her bodily pains. The painful mental impressions emanated from especially love feeling whose gratification had been ended abruptly by the death of loved ones.
- The third phase of the treatment was marked with increased improvement of the patient because she was mentally relieved. However, Fraulein Elisabeth von R’s physical pains remained as they periodically recurred. This period of the treatment was tasked with identifying the exact moment of the onset of the patient’s pain and the mechanism by which these pains had originated. Indeed, the treatment identified the moment when the conversion from psychical excitations into physical pains had occurred precisely. The treatment regime brought to fore the concept of ‘fending off’. Essentially, the psychoanalyst was able to build a connection between the incompatibility of an idea to the origin of hysterical symptoms, the conversion of psychical excitations into physical pains and the effect of conscious effort which formed a separate psychical group causing the ‘fending off’ reaction.
This treatment regime was premised on the conflict that emanates from a love-pain accompanied by a love-loneliness duality (Freud and Strachey, 2010). The treatment, at its third phase essentially applied the process of abreaction. In fact, the treatment made a breakthrough when the physical pains of the patient were finally attributed to the love for her brother-in-law and the surrounding circumstances. Once the psychoanalyst helped the patient recognize her desire for love and how her condition was endeavoring to unify her sexuality with the underlying emotions, the patient healed. Hypnosis was the tool that facilitated this clinical treatment (Dayal, 2009).
The case discussed elucidated the mechanism of the onset of hysteria. The conversion theory of hysteria was pertinent in explaining how the repression of erotic ideas from consciousness may be transformed in part into physical pain sensations. In addition, the theory also explained how erotic ideas might conflict with morality and manifest itself in unexplained physical pain. Indeed, by this theory, an escalation of erotic thoughts results to increase in physical pain as illustrated by the case of Fraulein Elisabeth von R. The mechanism of the development of hysteria is characterized by simultaneous formation of psychical groups and the development of hysterical pains. In turn, the motive of the development of hysteria is to reconcile the different psychical groups with the other contents of consciousness, which results in strong mental resistance. In essence, the condition of the patient illustrated how the ego and the object may be at conflict. Such a conflict may transform mental pains to physical pains through the mechanism of conversion.
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