In some quarters it is considered a given that Sigmund Freud’s treatment of women was aberrant and indicative of a patriarchal approach, in which women were demeaned and mistreated. Of course, from the perspective of today, we can observe many flaws in Freud’s technique. However, we must remember Freud’s revolutionary innovation of a century ago—Freud learned that in order to understand and effectively treat a patient a doctor had to listen to his patients, many of whom were women. This contribution represented a quantum leap in psychological treatment and far outweighs the impact of his technical errors. Freud’s treatment of “Dora,” exactly 100 years ago, is an example of the dramatic change in the history of mental health treatment for women. A dramatic contrast, for example, to the usual treatment, such as that of Charcot, of women with hysteria, who were treated as if they were simply anatomical specimens.
On October 14, 1900, Sigmund Freud wrote to his correspondent (the only person with whom he shared his psychoanalytic ideas at the time), Wilhelm Fliess, in Berlin, that he recently began to work with an 18-year-old girl, whom he came to call Dora. She suffered from physical symptoms of psychological origin, which would appear and disappear over the years: she had coughs, headaches, and would lose her voice, feel weak, and complain of abdominal pains. A note threatening suicide, discovered by her parents, brought her to Freud.
In short, the treatment came to an abrupt end on December 31, 1901. Freud wrote his paper in January 1901, but withheld publishing it for reasons of discretion until 1905. On reading the case history today, we observe that, despite the obviously culture-bound details in the story, the descriptions offer a great deal in helping us understand how to listen to patients, particularly adolescents, and how to help them with their emotional states.
Freud listened to Dora, something she had never experienced before, particularly from a man. How many doctors at the time listened carefully to their patients, particularly their women patients, and especially adolescent girls?
As an 18-year-old girl living in a comfortable upper middle class family in Vienna, we cannot compare Dora to an 18-year-old girl at the beginning of our century. On the one hand, girls at the turn of the last century were likely, physiologically and psychologically, to be less mature than girls during our own turn of the century. On the other hand, many women in Dora’s and Freud’s circle, in middle class Jewish Vienna, married young, to men almost a decade older and who were already established; many of these young women were treated in an infantilized way by their husbands.
Dora’s father was a successful manufacturer, described by Freud as intelligent and dominant in his social circle. He experienced a number of severe illnesses from the time Dora was 6 on: tuberculosis when she was 6, a detached retina when she was 10, and a confusional attack followed by symptoms of paralysis and slight mental disturbances beginning when she was 12. Several of these symptoms were associated with the father's syphilis, which he had contracted before his marriage. We have known that syphilis was relatively common in that community at the time. Men did not marry until the end of their twenties, once they were established in their professions. Prior to marriage, their sexual outlets were only via prostitutes, many of whom were carriers of the disease.
Freud, as a neurologist, often treated patients with neurological complications from syphilis. Among these patients was Dora’s father who sought Freud’s treatment when Dora was 12. Interestingly enough, Dora’s father was introduced to Freud by a Herr K (who came to play an important role in Dora’s life). Freud treated the father successfully. When Dora was 16, her father brought her to Freud for a consultation because of her physical problems. When Dora was 18, Freud recorded that: “he (Dora’s father) handed her over to me for psychotherapeutic treatment.”
From the perspective of adolescence, the phrase (“he handed her over to me for psychotherapeutic treatment”) communicates the father’s relationship to his daughter and his expectations from Freud. (Or, to be more precise, the way Freud clearly understood the father’s motives.) In order to understand the problematic significance of that statement, I have to first highlight the two most important tasks of adolescence, which they need to accomplish:
We learn from Freud that Dora’s father was having an affair with Frau K, Herr K’s wife. We also learn that Herr K had made seductive passes at the young girl, but the father tells Freud that Dora just imagined that Herr K tried to seduce her and stresses that his relationship with Frau K was honorable. Dora’s father maintained that Dora got her strange sexual ideas from reading Mantegazza’s Physiology of Love, a medical hygiene book of the time popular with young people, for the usual reasons.
Freud, however, reports that after listening to the father’s account, he “had resolved from the first to suspend judgement of the true state of affairs till I had heard the other side as well.”
How many turn-of-the-last-century men would have made such a comment? How many would have thought to take into consideration the young woman’s side of the story, and not just simply believe the father, the master of the house, after all? Freud’s message from a century ago is a central one for all of us who are parents of teenagers or who work with teenagers—regardless of their attempts to provoke, it is crucial that we LISTEN to what they have to say. The communication may be with direct words, with actions, or in some other disguised manner whose code may be very difficult to decipher.
As Freud listened, Dora told him about an episode at 16, when Dora and the father visited the K’s at their lake house. Dora was to spend a few weeks alone with the K's and their children, as a mother’s helper. She suddenly said that she was leaving. Only after several days, after returning home, did she tell her mother about Herr K’s attempt to seduce her. The mother told the father who then confronted Herr K, who, of course, denied the episode. We learn that there was an even earlier episode, at 14, when Herr K made an advance to Dora, when he “suddenly clasped the girl to him and pressed a kiss upon her lips.” Dora wanted a relationship with her family’s friends; she wanted her mother and father to protect her when she was exposed to these inappropriate sexual overtures.
We also learn that Dora, when she was a governess to the K’s children, heard the K’s talking about divorce. This is a situation to which we are not unaccustomed during our own time, when children know more about the complicated and complicating issues in the adults’ lives than they might wish for. It became clear to Freud that Dora’s father wanted to protect his relationship with Frau K and in addition to wanting to help his daughter with her problems, brought Dora to Freud so Freud would eliminate Dora’s “imaginary” thoughts about Herr K.
If we think about the different people in Dora’s life (her father, Herr K, as well as others) we see that they all betrayed her. Although Freud also eventually came to betray her, he actually listened to her, believed her, and despite many, many statements to her, which by today’s standards of treatment, would be considered anti-therapeutic, he spoke to her in a way so she could sense that her feelings were her own. However, he did betray her in two ways. He was interested in her case for the sake of the science of psychoanalysis as he was trying to confirm his hypotheses of his dream theory and he betrayed her 15 months after she left him. She returned to see him and really wanted to return to treatment but he refused to treat her. At that session Dora said that she had returned in order to tell him that they had confessed to her. Frau K confessed that in fact she did have an affair with her father and Herr K admitted the truth about the seduction episode at the lake.
What can we learn from all of these complicated family interactions? Dora constantly was disappointment, not just because of frustrated inner wishes, but also because she became so aware of her father’s affair. When she turned to Herr K, the way young girls may turn to teachers, to family friends, to clergy, she yearned for a relationship with a substitute man, a father figure, in which she felt accepted as a person, and not as a sexual plaything. She wished to be loved, admired, paid attention to. She did not get it with her father, nor with Herr K and eventually neither with Freud, because his technique at that time, 100 years ago, resulted in a treatment in which he spoke much too openly about sexual wishes and fantasies to this young adolescent girl. He was not cognizant of what we have come to learn about the important aspects of a relationship between an adolescent girl and her father and the other men in her life.
What can we learn about fathers and daughters from Freud’s oversight? We certainly know that emotional upheavals can be created in girls who have been neglected or ignored by their fathers. Certain adolescent girls whose family lives have been unstable and whose fathers have been inconsistent may have problems with their own sense of identity and later in life may shift quickly from one man to another, alternately rebelling against and searching for a father-protector. That fathers play a critical role in an adolescent girl’s development is a fact that we cannot underestimate. Fathers may not realize their important role, particularly in the midst of a screaming battle—but they are important protectors for their teen-aged daughters—including protectors of their daughter’s self-esteem during a vulnerable period of life.
Why is adolescence such a vulnerable period during which a young girl’s self-esteem is easily deflated and her sense of herself as a person, as a woman is easily doubted? How might we imagine Dora felt about herself as a person and as a woman, given that her father exposed her to the inappropriate sexual intentions of Herr K? How may she have felt about herself given that her father was more concerned with the preservation of his own sexual liaison with Frau K than with his daughter’s sense of well being?
During adolescence, there is an intensification of the child’s passionate desires as a result of hormonal changes that result in their distancing themselves from their parents. The adolescent still needs the parental support and encouragement but often cannot ask for it in a direct way. The adolescent may overtly reject any offered support even though he/he still covertly longs for the parental support, despite verbal protestations to the contrary. The moodiness and negativism, manifestations of their own conflicts, including poor self-esteem, may lead parents to say, “I better leave him/her totally alone.” Adolescents still need attachments. And DORA taught us that adolescent girls need attachments to fathers and to other men and they need to be heard. Fathers need to listen in order to remain available to support and protect their daughters.