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The origin and development of psychoanaysis

however, that in one type of cases with just as unfavorable symptoms, another, far more
favorable, opinion is justified. When one finds such a series of symptoms in the case of a young
girl, whose vital organs (heart, kidneys), are shown by objective tests to be normal, but who has
suffered from strong emotional disturbances, and when the symptoms differ in certain finer
characteristics from what one might logically expect, in a case like this the doctors are not too
much disturbed. They consider that there is present no organic lesion of the brain, but that
enigmatical state, known since the time of the Greek physicians as hysteria, which can simulate a
whole series of symptoms of various diseases. They consider in such a case that the life of the
patient is not in danger and that a restoration to health will probably come about of itself. The
differentiation of such an hysteria from a severe organic lesion is not always very easy. But we
do not need to know how a differential diagnosis of this kind is made; you may be sure that the
case of Breuer's patient was such that no skillful physician could fail to diagnose an hysteria. We
may also add a word here from the history of the case. The illness first appeared while the patient
was caring for her father, whom she tenderly loved, during the severe illness which led to his
death, a task which she was compelled to abandon because she herself fell ill.
So far it has seemed I best to go with the doctors, but we shall soon part company with them.
You must not think that the outlook of a patient with regard to medical aid is essentially bettered
when the diagnosis points to hysteria rather than to organic disease of the brain. Against the
serious brain diseases medical skill is in most cases powerless, but also in the case of hysterical
affections the doctor can do nothing. He must leave it to benign nature, when and how his
hopeful prognosis will be realized.[4] Accordingly, with the recognition of the disease as
hysteria, little is changed in the situation of the patient, but there is a great change in the attitude
of the doctor. We can observe that he acts quite differently toward hystericals than toward
patients suffering from organic diseases. He will not bring the same interest to the former as to
the latter, since their suffering is much less serious and yet seems to set up the claim to be valued
just as seriously.
But there is another motive in this action. The physician, who through his studies has learned so
much that is hidden from the laity, can realize in his thought the causes and alterations of the
brain disorders in patients suffering from apoplexy or dementia, a representation which must be
right up to a certain point, for by it he is enabled to understand the nature of each symptom. But
before the details of hysterical symptoms, all his knowledge, his anatomical-physiological and
pathological education, desert him. He cannot understand hysteria. He is in the same position
before it as the layman. And that is not agreeable to any one, who is in the habit of setting such a
high valuation upon his knowledge. Hystericals, accordingly, tend to lose his sympathy; he
considers them persons who overstep the laws of his science, as the orthodox regard heretics; he
ascribes to them all possible evils, blames them for exaggeration and intentional deceit,
"simulation," and be punishes them by withdrawing his interest.
Now Dr. Breuer did not deserve this reproach in this case; he gave his patient sympathy and
interest, although at first be did not understand how to help her. Probably this was easier for him
on account of those superior qualities of the patient's mind and character, to which he bears
witness in his account of the case.
His sympathetic observation soon found the means which made the first help possible. It had
been noticed that the patient, in her states of "absence," of psychic alteration, usually mumbled
over several words to herself. These seemed to spring from associations with which her thoughts
were busy. The doctor, who was able to get these words, put her in a sort of hypnosis and
repeated them to her over and over, in order to bring up any associations that they might have.
The patient yielded to his suggestion and reproduced for him those psychic creations which
controlled her thoughts during her "absences," and which betrayed themselves in these single
spoken words. These were fancies, deeply sad, often poetically beautiful, day dreams, we might
call them, which commonly took as their starting point the situation of a girl beside the sick-bed
of her father. Whenever she had related a number of such fancies, she was, as it were, freed and
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