Chapter I

Several of the contributors to this series of “Autobiographical Studies”[2] have begun by expressing their misgivings at the unusual difficulties of the task they have undertaken. The difficulties in my case are, I think, even greater; for I have already more than once published papers upon the same lines as the present one, papers which, from the nature of the subject, have dealt more with personal considerations than is usual or than would otherwise have been necessary.

I gave my first account of the development and subject-matter of psychoanalysis in five lectures which I delivered in 1909 before Clark University at Worcester, Mass., where I had been invited to attend the celebration of the twentieth anniversary of the foundation of that body.[3] Only recently I gave way to the temptation of making a contribution of a similar kind to an American collective publication dealing with the opening years of the twentieth century, since its editors had shown their recognition of the importance of psychoanalysis by allotting a special chapter to it.[4] Between these two dates appeared a paper, “On the History of the Psycho-Analytic Movement,”[5] which, in fact, contains the essence of all that I can say on the present occasion. Since I must not contradict myself and since I have no wish to repeat myself exactly, I must endeavor to construct a narrative in which subjective and objective attitudes, biographical and historical interests, are combined in a new proportion.

I was born on May 6th, 1856, at Freiberg in Moravia, a small town in what is now Czecho-Slovakia. My parents were Jews, and I have remained a Jew myself. I have reason to believe that my father’s family were settled for a long time on the Rhine (at Cologne), that, as a result of a persecution of the Jews during the fourteenth or fifteenth century, they fled eastwards, and that, in the course of the nineteenth century, they migrated back from Lithuania through Galicia into German Austria. When I was a child of four I came to Vienna, and I went through the whole of my education there. At the Gymnasium I was at the top of my class for seven years; I enjoyed special privileges there, and was scarcely obliged to pass any examinations. Although we lived in very limited circumstances, my father insisted that, in my choice of a profession, I should follow my own inclinations. Neither at that time, nor indeed in my later life, did I feel any particular predilection for the career of a physician. I was moved, rather, by a sort of curiosity, which was, however, directed more towards human concerns than towards natural objects; nor had I recognized the importance of observation as one of the best means of gratifying it. At the same time, the theories of Darwin, which were then of topical interest, strongly attracted me, for they held out hopes of an extraordinary advance in our understanding of the world; and it was hearing Goethe’s beautiful essay on Nature read aloud at a popular lecture just before I left school that decided me to become a medical student.

When, in 1873, I first joined the University, I was met by some appreciable disappointments. Above all, I found that I was expected to feel myself inferior and an alien, because I was a Jew. I refused absolutely to do the first of these things. I have never been able to see why I should feel ashamed of my descent or, as people were beginning to say, of my race. I put up, without much regret, with my nonadmission to the community; for it seemed to me that in spite of this exclusion an active fellow-worker could not fail to find some nook or cranny in the frame-work of humanity. These first impressions at the University, however, had one consequence which was afterwards to prove important; for at an early age I was made familiar with the fate of being in the Opposition and of being put under the ban of the “compact majority.” The foundations were thus laid for a certain degree of independence of judgment.

I was compelled, moreover, during my first years at the University, to make the discovery that the peculiarities and limitations of my gifts denied me all success in many of the departments of science into which my youthful eagerness had plunged me. Thus I learned the truth of Mephistopheles’ warning:

“Vergebens, dass ihr ringsum wissenschaftlich schweift,
Ein jeder lernt nur, was er lernen kann.”[6]

At length, in Ernst Brücke’s physiological laboratory, I found rest and satisfaction—and men, too, whom I could respect and take as my models. Brücke gave me a problem to work out in the histology of the nervous system; I succeeded in solving it to his satisfaction and in carrying the work further on my own account. I worked at this Institute, with short interruptions, from 1876 to 1882, and it was generally thought that I was marked out to fill the next post of Assistant that might fall vacant there. The various branches of medicine proper, apart from psychiatry, had no attraction for me. I was decidedly negligent in pursuing my medical studies, and it was not until 1881 that I took my somewhat belated degree as a Doctor of Medicine.

The turning point came in 1882, when my teacher, for whom I felt the highest possible esteem, corrected my father’s generous improvidence by strongly advising me, in view of my bad financial position, to abandon my theoretical career. I followed his advice, left the physiological laboratory and entered the General Hospital[7] as an “Aspirant.” I was soon afterwards promoted to being a junior physician, and worked in various departments of the hospital, amongst others for more than six months under Meynert, by whose work and personality I had been greatly struck while I was still a student.

In a certain sense I nevertheless remained faithful to the line of work upon which I had originally started. The subject which Brücke had proposed for my investigations had been the spinal cord of one of the lowest of the fishes (Ammocoetes Petromyzon); and I now passed on to the human central nervous system. Just at this time Flechsig’s discoveries of the non-simultaneity of the formation of the medullary sheaths were throwing a revealing light upon the intricate course of its tracts. The fact that I began by choosing the medulla oblongata as the one and only subject of my work was another sign of the continuity of my development. In complete contrast to the diffuse character of my studies during my earlier years at the University, I was now developing an inclination to concentrate my work exclusively upon a single subject or problem. This inclination has persisted and has since led to my being accused of one-sidedness.

I now became as active a worker in the Institute of Cerebral Anatomy as I had previously been in the physiological one. Some short papers upon the course of the tracts and the nuclear origins in the medulla oblongata date from these hospital years, and my results were regularly noted down by Edinger. One day Meynert, who had given me access to the laboratory even during the times when I was not actually working under him, proposed that I should definitely devote myself to the anatomy of the brain, and promised to hand over his lecturing work to me, as he felt he was too old to manage the newer methods. This I declined, in alarm at the magnitude of the task; it is possible, too, that I had guessed already that this great man was by no means kindly disposed towards me.

From the practical point of view, brain anatomy was certainly no better than physiology, and, with an eye to material considerations, I began to study nervous diseases. There were, at that time, few specialists in that branch of medicine in Vienna, the material for its study was distributed over a number of different departments of the hospital, there was no satisfactory opportunity of learning the subject, and one was forced to be one’s own teacher. Even Nothnagel, who had been appointed a short time before, on account of his book upon cerebral localization, did not single out neuropathology from among the other subdivisions of medicine. In the distance glimmered the great name of Charcot; so I formed a plan of first obtaining an appointment as Lecturer on Nervous Diseases in Vienna and of then going to Paris to continue my studies.

In the course of the following years, while I continued to work as a junior physician, I published a number of clinical observations upon organic diseases of the nervous system. I gradually became familiar with the ground; I was able to localize the site of a lesion in the medulla oblongata so accurately that the pathological anatomist had no further information to add; I was the first person in Vienna to send a case for autopsy with a diagnosis of polyneuritis acuta. The fame of my diagnoses and their _post mortem_ confirmation brought me an influx of American physicians, to whom I lectured upon the patients in my department in a sort of pidgin-English. I understood nothing about the neuroses. On one occasion I introduced to my audience a neurotic suffering from a persistent headache as a case of chronic localized meningitis; they quite rightly rose in revolt against me, and my premature activities as a teacher came to an end. By way of excuse I may add that this happened at a time when greater authorities than myself in Vienna were in the habit of diagnosing neurasthenia as cerebral tumor.

In the spring of 1885 I was appointed Lecturer on Neuropathology on the ground of my histological and clinical publications. Soon afterwards, as the result of a warm testimonial from Brücke, I was awarded a Traveling Fellowship of considerable value. In the autumn of the same year I made the journey to Paris.

I became a student at the Salpêtrière, but as one of the crowd of foreign visitors, I had little attention paid me to begin with. One day in my hearing Charcot expressed his regret that since the war he had heard nothing from the German translator of his lectures; he went on to say that he would be glad if someone would undertake to translate the new volume of his lectures into German. I wrote to him and offered to do so; I can still remember a phrase in the letter, to the effect that I suffered only from _l’aphasie motrice_ and not from _l’aphasie sensorielle du français_. Charcot accepted the offer, I was admitted to the circle of his personal acquaintances, and from that time forward I took a full part in all that went on at the Clinic.

As I write these lines, a number of papers and newspaper-articles have reached me from France, which gave evidence of a violent objection to the acceptance of psychoanalysis, and which often make the most inaccurate assertions in regard to my relations with the French school. I read, for instance, that I made use of my visit to Paris to familiarize myself with the theories of Pierre Janet and then made off with my booty. I should therefore like to say explicitly that during the whole of my visit to the Salpêtrière, Janet’s name was never so much as mentioned.

What impressed me most of all while I was with Charcot were his latest investigations upon hysteria, some of which were carried out under my own eyes. He had proved, for instance, the genuineness of hysterical phenomena and their conformity to laws (“_introite et hic dii sunt_”), the frequent occurrence of hysteria in men, the production of hysterical paralyses and contractures by hypnotic suggestion and the fact that such artificial products showed, down to their smallest details, the same features as spontaneous attacks, which were often brought on traumatically. Many of Charcot’s demonstrations began by provoking in me and in other visitors a sense of astonishment and an inclination to scepticism, which we tried to justify by an appeal to one of the theories of the day. He was always friendly and patient in dealing with such doubts, but he was also most decided; it was in one of these discussions that (speaking of theory) he remarked, “_Ça n’empêche pas d’exister_,” a _mot_ which left an indelible mark upon my mind.

No doubt the whole of what Charcot taught us at that time does not hold good today: some of it has become doubtful, some has definitely failed to withstand the test of time. But enough is left over, and has found a permanent place in the storehouse of science. Before leaving Paris I discussed with the great man a plan for a comparative study of hysterical and organic paralyses. I wished to establish the thesis that in hysteria paralyses and anæsthesias of the various parts of the body are demarcated according to the popular idea of their limits and not according to anatomical facts. He agreed with this view, but it was easy to see that in reality he took no special interest in penetrating more deeply into the psychology of the neuroses. When all is said and done, it was from pathological anatomy that his work had started.

Before I returned to Vienna I stopped for a few weeks in Berlin, in order to gain a little knowledge of the general disorders of childhood. Kassowitz, who was at the head of a public institute in Vienna for the treatment of children’s diseases, had promised to put me in charge of a department for the nervous diseases of children. In Berlin I was given assistance and a friendly reception by Baginsky. In the course of the next few years I published, from the Kassowitz Institute, several monographs of considerable size on unilateral and bilateral cerebral palsies in children. And for that reason, at a later date (in 1897), Nothnagel made me responsible for dealing with the same subject in his great _Handbuch der allgemeinen und speziellen Therapie_.

In the autumn of 1886 I settled down in Vienna as a physician, and married the girl who had been waiting for me in a distant city for more than four years. I may here go back a little and explain how it was the fault of my _fiancée_ that I was not already famous at that early age. A side interest, though it was a deep one, had led me in 1884 to obtain from Merck some of what was then the little-known alkaloid cocaine and to study its physiological action. While I was in the middle of this work, an opportunity arose for making a journey to visit my _fiancée_, from whom I had been parted for two years. I hastily wound up my investigation of cocaine and contented myself in my book on the subject with prophesying that further uses for it would soon be found. I suggested, however, to my friend, L. Königstein, the ophthalmologist, that he should investigate the question of how far the anæsthetizing properties of cocaine were applicable in diseases of the eye. When I returned from my holiday I found that not he, but another of my friends, Carl Koller (now in New York), to whom I had also spoken about cocaine, had made the decisive experiments upon animals’ eyes and had demonstrated them at the Ophthalmological Congress at Heidelberg. Koller is therefore rightly regarded as the discoverer of local anæsthesia by cocaine, which has become so important in minor surgery; but I bore my _fiancée_ no grudge for my neglected opportunity.

I will now return to the year of 1886, the time of my settling down in Vienna as a specialist in nervous diseases. The duty devolved upon me of giving a report before the “Gesellschaft der Aerzte” [Society of Medicine] upon what I had seen and learnt with Charcot. But I met with a bad reception. Persons of authority, such as the chairman (Bamberger, the physician), declared that what I said was incredible. Meynert urged me to find some cases in Vienna similar to those which I had described and to present them before the Society. I tried to do so; but the senior physicians in whose departments I found any such cases, refused to allow me to observe them or to work at them. One of them, an old surgeon, actually broke out with the exclamation: “But, my dear sir, how can you talk such nonsense? _Hysteron_ (sic) means the uterus. So how can a man be hysterical?” I objected in vain that what I wanted was, not to have my diagnosis approved, but to have the case put at my disposal. At length, outside the hospital, I came upon a case of classical hysterical hemi-anæsthesia in a man, and demonstrated it before the “Gesellschaft der Aerzte.” This time I was applauded, but no further interest was taken in me. The impression that the great authorities had rejected my innovations remained unshaken; and, with my hysteria in men and my production of hysterical paralyses by suggestion, I found myself forced into the Opposition. As I was soon afterwards excluded from the laboratory of cerebral anatomy and for a whole term had nowhere to deliver my lectures, I withdrew from academic life and ceased to attend the learned societies. It is a whole generation since I have visited the “Gesellschaft der Aerzte.”

Anyone who wanted to make a living from the treatment of nerve-patients must clearly be able to do something to help them. My therapeutic arsenal contained only two weapons, electrotherapy and hypnosis, for prescribing a visit to a hydropathic establishment after a single consultation was an inadequate source of income. My knowledge of electrotherapy was derived from W. Erb’s text-book, which provided detailed instructions for the treatment of all the symptoms of nervous diseases. Unluckily I was soon driven to see that following these instructions was of no help whatever and that what I had taken for an epitome of exact observations was merely the construction of phantasy. The realization that the work of the greatest name in German neuropathology had no more relation to reality than some “Egyptian” dream-book, such as are sold in cheap book-shops, was painful, but it helped to rid me of yet another piece of the innocent faith in authority by which I was still obsessed. So I put my electrical apparatus aside, even before Möbius had solved the problem by explaining that the successes of electric treatment in nervous disorders (in so far as there were any) were the effect of suggestion on the part of the physician.

With hypnosis the case was better. While I was still a student I had attended a public exhibition given by the “magnetist” Hansen and had noticed that one of the persons experimented upon had became deathly pale at the onset of cataleptic rigidity and had remained so as long as that condition lasted. This firmly convinced me of the genuineness of the phenomena of hypnosis. Scientific support was soon afterwards given to this view by Heidenhain; but that did not restrain the professors of psychiatry from declaring for a long time to come that hypnosis was not only fraudulent but dangerous and from regarding hypnotists with contempt. In Paris I had seen hypnosis used freely as a method for producing symptoms in patients and then removing them again. And now the news reached us that a school had arisen at Nancy which made an extensive and remarkably successful use of suggestion, with or without hypnosis, for therapeutic purposes. It thus came about, as a matter of course, that in the first years of my activity as a physician my principal instrument of work, apart from haphazard and unsystematic psycho-therapeutic methods, was hypnotic suggestion.

This implied, of course, that I abandoned the treatment of organic nervous diseases; but that was of little importance. For on the one hand the prospects in the treatment of such disorders were in any case never promising, while on the other hand, in the private practice of a physician working in a large town, the quality of such patients was nothing compared to the crowds of neurotics, whose number seemed further multiplied by the manner in which they hurried, with their troubles unsolved, from one physician to another. And apart from this, there was something positively seductive in working with hypnosis. For the first time there was a sense of having overcome one’s impotence; and it was highly flattering to enjoy the reputation of being a miracle-worker. It was not until later that I was to discover the drawbacks of the procedure. At the moment there were only two points to complain of: first, that I could not succeed in hypnotizing every patient, and secondly, that I was unable to put individual patients into as deep a state of hypnosis as I should have wished. With the idea of perfecting my hypnotic technique, I made a journey to Nancy in the summer of 1889 and spent several weeks there. I witnessed the moving spectacle of old Liébault working among the poor women and children of the laboring classes, I was a spectator of Bernheim’s astonishing experiments upon his hospital patients, and I received the profoundest impression of the possibility that there could be powerful mental processes which nevertheless remained hidden from the consciousness of men. Thinking it would be instructive, I had persuaded one of my patients to follow me to Nancy. She was a very highly gifted hysteric, a woman of good birth, who had been handed over to me because no one knew what to do with her. By hypnotic influence I had made it possible for her to lead a tolerable existence and I was always able to take her out of the misery of her condition. But she always relapsed again after a short time, and in my ignorance I attributed this to the fact that her hypnosis had never reached the stage of somnambulism with amnesia. Bernheim now attempted several times to bring this about, but he too failed. He frankly admitted to me that his great therapeutic successes by means of suggestion were only achieved in his hospital practice and not with his private patients. I had many stimulating conversations with him, and undertook to translate into German his two works upon suggestion and its therapeutic effects.

During the period from 1886 to 1891 I did little scientific work, and published scarcely anything. I was occupied with establishing myself in my new profession and with assuring my own material existence as well as that of a rapidly increasing family. In 1891 there appeared the first of my studies upon the cerebral palsies of children, which was written in collaboration with my friend and assistant, Dr. Oskar Rie. An invitation which I received in the same year to contribute to an encyclopædia of medicine led me to investigate the theory of aphasia, which was at that time dominated by the views of Wernicke and Lichtheim, which laid stress exclusively upon localization. The fruit of this inquiry was a small critical and speculative book, _Zur Auffassung der Aphasie_. But I must now show how it happened that scientific research once more became the chief interest of my life.