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The case of Daniel Paul Schreber was one of the most emblematic cases for Sigmund Freud, although the father of psychoanalysis never had a personal encounter with Schreber. Freud's analysis of the case was published in "Psychoanalytic Notes Upon an Autobiographical Account of a Case of Paranoia" in 1911, after reading Schreber's book: "Memoirs of My Nervous Illness (1903)". Through his work, Schreber became one of the most complex figures in the history of psychoanalysis, and his case became globally recognized once Freud analyzed it. Reading Freud is, as always, a journey of discovery in this endless ocean called the human being.
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Sigmund Freud
THE SCHREBER CASE
INTRODUCTION
THE SCHREBER CASE
I – Case History
II – A attempts at interpretation
III – On the Mechanism of Paranoia
Postscript (1912)
Sigmund Freud
1856-1936
Sigmund Freud (1856-1939) was an Austrian physician considered the founder of psychoanalysis. This method caused a great stir in its time and is based on attempting to explain human behavior to address mental problems. Its objective is to work with the unconscious to make problems and traumas conscious and begin to change them to help the patient. Sigmund Freud is one of the most influential figures in the field of psychology.
Freud was born in 1856 in Austria. Later, he graduated in medicine and specialized in the nervous system of fish, working as a researcher. Later, he began working at the General Hospital of Vienna and started to develop the theory of psychoanalysis.
He traveled to Paris thanks to a scholarship, and his work with the neurologist Jean-Martin Charcot was a true revelation for him. He began to learn about hypnosis and became interested in suggestion.
Upon returning to Vienna, he shared his theories with his colleagues, but was rejected by all except Josef Breuer, who financially supported him to open his own practice. They even worked together at one point, but their differences in the scientific field and the implementation of various techniques eventually led to their separation.
At the dawn of the 20th century, the Austrian neurologist Sigmund Freud began to lay the foundations of psychoanalysis, a novel approach to the human psyche that is both a theory of personality and a method of treatment for patients with disorders. Freud's main contribution to psychology would be his concept of the unconscious. Freud argued that a person's behavior is deeply determined by repressed thoughts, desires, and memories; according to his theory, painful childhood experiences are banished from consciousness and become part of the unconscious, from where they can strongly influence behavior. As a treatment method, psychoanalysis seeks to bring these memories to consciousness to free the individual from their negative influence.
About the work
PSYCHOANALYTICAL REMARKS ON AN AUTOBIOGRAPHICAL ACCOUNT OF A CASE OF PARANOIA (PARANOID DEMENTIA) (1911)
Schreber's Memoirs were published in 1903; however, although they had been widely discussed in psychiatric circles, they only seem to have caught Freud's attention in the summer of 1910. It is known that he discussed them and the entire subject of paranoia during his trip to Sicily with Ferenczi in September of that year. Upon returning to Vienna, he began writing the article, the completion of which was announced to Abraham and Ferenczi in letters dated December 16. It does not appear to have been published until the summer of 1911. The 'Postscript' was read at the Third International Psychoanalytic Congress (held in Weimar) on September 22, 1911, and published early the following year.
Freud tackled the problem of paranoia at a very early stage in his research on psychopathology. On January 24, 1895, a few months before the publication of the Studies on Hysteria, he sent a long memorandum on the subject to Fliess (Freud, 1950a, Draft H). This included a brief clinical history and a theoretical examination aimed at establishing two main points: that paranoia is a neurosis of defense and that its main mechanism is projection. Almost a year later (on January 1, 1896), he sent Fliess another, much briefer note on paranoia, part of a general account of 'defense neuroses' (ibid., Draft K), which he soon expanded into his second published work with that title (1896b). In this publication, Section II included another, more extensive clinical history entitled 'Analysis of a Case of Chronic Paranoia', a case for which Freud (in a footnote added almost 20 years later) preferred the corrected diagnosis of 'paranoid dementia'. With reference to theory, this 1896 work added little to his earlier suggestions: but in a letter to Fliess not long after (December 9, 1899, Freud, 1950a, Letter 125), there is a somewhat critical paragraph, which foreshadows Freud's later considerations, including the suggestion that paranoia entails a return to primitive auto-erotism. This paragraph is reproduced in full in the English Editor's Note to the article on 'The Disposition to Obsessional Neurosis', concerning the problem of 'neurosis choice'.
Between the date of this latter passage and the publication of Schreber's clinical history, over ten years passed with hardly any mention of paranoia in Freud's published writings. Ernest Jones informs us (1955, 281), however, that on November 21, 1906, he presented a case of female paranoia to the Vienna Psychoanalytic Society. Apparently, at that time, he had not yet arrived at what should have been his main generalization on the subject, namely, the existing connection between paranoia and repressed passive homosexuality. Nevertheless, a little over a year later, he presented this hypothesis in letters to Jung (January 27, 1908) and Ferenczi (February 11, 1908), seeking and receiving confirmation. More than three years passed before Schreber's memoirs offered him the opportunity to publish his theory for the first time and to support it with a detailed account of his analysis of the unconscious processes at work in paranoia.
There are several references to this illness in Freud's later writings. The most important were his article on 'A Case of Paranoia Contrary to the Psychoanalytic Theory of Illness' (1915), and Section B of 'Some Neurotic Mechanisms in Jealousy, Paranoidness, and Homosexuality' (1922b). Additionally, 'A Demonological Neurosis of the Seventeenth Century' (1923c/) includes an examination of the Schreber case, although the neurosis, which is the subject of the work, is nowhere described by Freud as paranoia. In none of these later writings is there any essential modification of the views on paranoia expressed in the present work.
The importance of Schreber's analysis, however, is by no means limited to the light it sheds on the problem of paranoia. The third part, especially, was, in many respects, as well as the brief article simultaneously published on the two principles of mental functioning, a precursor of the metapsychological articles to which Freud devoted himself three or four years later. Several themes were set forth that were subsequently to be examined in more detail. Thus, the observations on narcissism preceded the article devoted to this theme (1914c), the description of the course of a few years (1915c), and the examination of instincts laid the groundwork for a more elaborate study in 'Instincts and Their Vicissitudes' (1915c). The paragraph on projection , although promising, would find no sequel. Each of the two topics examined in the last part of the work, however - the various causes of the onset of neurosis (including the concept of 'frustration') and the role played by successive 'fixation points' - should be addressed before too long, in separate articles (1912c and 1913 - Finally, in the postscript, we find Freud's first quick excursion into the field of mythology and the first mention of totems, which were beginning to occupy his thoughts and were to provide the title for one of his major works (1912-13).
As Freud tells us, his clinical history makes use of only one fact (Schreber's age at the time he fell ill) that was not contained in the Memoirs. We now possess, thanks to a paper written by Dr. Franz Baumeyer (1956), a certain amount of additional information. Dr. Baumeyer was in charge of a hospital near Dresden for a few years (1946-9), where he found some of the original clinical records of Schreber's successive illnesses. He summarized these records and quoted many of them in full. In addition, he collected a large number of facts related to the family history and background of Schreber. Whenever this material is important for Freud's work, it will be mentioned in the footnotes. At this point, it is only necessary to report the sequence of the story narrated in the Memoirs. After his discharge in late 1902, Schreber seems to have led an outwardly normal existence for a few years. Then, in November 1907, his wife had a paralysis crisis (although she lived until 1912), which seems to have precipitated a new onset of his illness. He was again admitted - now to an asylum in the Dõsen district of Leipzig - two weeks later. There he remained, in an extremely disturbed and very unmanageable state, until his death, after gradual physical deterioration, in the spring of 1911 - shortly before the publication of Freud's work.
The following chronological table, based on data derived from the Memoirs and from Baumeyer's material, may make the details of Freud's study easier to unravel.
MEDICAL HISTORICAL
1842 July 25th: Daniel Paul Schreber is born in Leipzig.
1861 November: His father dies at the age of 53.
1877: His older brother (3 years older) dies at the age of 38.
1878: Marriage.
First Illness
1884 Autumn: Runs for candidacy for the Reichstag.
1884 October: Spends a few weeks at the Sonnenstein Asylum.
December 8th: Admitted to the Leipzig Psychiatric Clinic.
1885 June 1st: Discharged.
1886 January 1st: Assumes office at the Leipzig Landgericht.
Second Illness
1893 June: Informed of upcoming appointment to the Court of Appeal.
October 1st: Assumes office as presiding judge.
November 21st: Admitted again to the Leipzig Clinic.
1894 June 14th: Transferred to Lindenhof Asylum.
June 29th: Transferred to Sonnenstein Asylum.
1900-1902: Writes the Memoirs and files a lawsuit for discharge.
1902 July 14th: Judicial decision for discharge.
1903: Publication of the Memoirs.
Third Illness
1907 May: His mother dies at the age of 92.
November 14th: Wife has a paralysis crisis.
Falls ill immediately after.
November 27th: Admitted to the Asylum in Leipzig-Dõsen.
1911 April 14th: Death.
1912 May: Wife dies at the age of 54.
The analytical investigation of paranoia presents difficulties for doctors who, like myself, are not affiliated with public institutions. We cannot accept patients suffering from this condition or, in any case, keep them for a long time, as we cannot offer treatment unless there is some prospect of therapeutic success. Only under exceptional circumstances, therefore, am I able to obtain anything more than a superficial view of the structure of paranoia - for example, when the diagnosis (which is not always a simple matter) is uncertain enough to justify an attempt to influence the patient, or when, despite a secure diagnosis, I yield to the pleas of the patient's relatives and undertake to treat them for some time. Regardless, of course, I encounter many cases of paranoia and early dementia and learn about them as much as other psychiatrists do about their cases; but generally, this is not sufficient to lead to any analytical conclusions.
The psychoanalytic investigation of paranoia would be completely impossible if the patients themselves did not possess the peculiarity of revealing (albeit distortedly) exactly those things that other neurotics keep hidden as a secret. Since paranoids cannot be compelled to overcome their internal resistances and since, anyway, they only say what they resolve to say, it follows that paranoia is a disorder in which a written report or a printed clinical history can take the place of personal knowledge of the patient. For this reason, I believe it is legitimate to base analytical interpretations on the clinical history of a patient who suffered from paranoia (or precisely, paranoid dementia) and whom I never saw, but who wrote his own clinical history and published it.
I refer to the Doctor of Law Daniel Paul Schreber, formerly Senatspräsident in Dresden, whose book, "Denkwürdigkeiten eines Nervenkranken" [Memoirs of a Nervous Patient], was published in 1903, and, if I am correctly informed, aroused considerable interest among psychiatrists. It is possible that Dr. Schreber is still alive today and that he has distanced himself so much from the delusional system he presented in 1903 that he may feel hurt by these notes about his book. However, to the extent that he still identifies with his former personality, I can rely on the arguments with which he himself - 'a man of superior mental gifts and endowed with extraordinary acuteness, both of intellect and observation' - contradicted the efforts made to prevent him from publishing his memoirs: "I had no trouble," he writes, "closing my eyes to the difficulties that seemed to lie in the way of publication, and particularly to the concern of giving due consideration to the susceptibilities of some persons still alive. On the other hand, I am of the opinion that it could be advantageous both for science and for the recognition of religious truths if, during my lifetime, qualified authorities could undertake to examine my body and conduct research on my personal experiences. All feelings of a personal nature must submit to this consideration. He declares, in another passage, that he had decided to adhere to his intention to publish the book, even if, as a consequence, his physician, Geheimrat Dr. Flechsig, of Leipzig, took action against him. However, he attributes to Dr. Flechsig the same considerations that I now attribute to him. 'I trust,' he says, 'that even in the case of Geheimrat Prof. Dr. Flechsig, any personal susceptibilities will be overcome by a scientific interest in the general context of my memoirs.' (446.) Although all the passages from Denkwürkdigkeiten on which my interpretations are based are quoted verbatim on the following pages, I would request my readers to become familiar with the book by reading it at least once beforehand.
‘I have suffered twice from nervous disorders', writes Dr. Schreber, ‘and each time as a result of menial overstrain. This was due on the first occasion to my standing as a candidate for election to the Reichstag while I was Landgerichtsdirektor at Chemnitz and on the second occasion to the very heavy burden of work that fell upon my shoulders when I entered on my new duties as Senatsprasident in the Oberlandesgericht in Dresden.’
Dr. Schrebers first illness began in the autumn of 1884. and by the end of 1885 he had completely recovered. During this period he spent six months in Flechsig s clinic and the latter, in a formal report which he drew up at a later date, described the disorder as an attack of severe hypochondria. Dr. Schreber assures us that this illness ran its course ‘without the occurrence of any incidents bordering upon the sphere of the supernatural’.
Neither the patient s own account, nor the reports of the physicians which are reprinted at the end of his book, tell us enough about his previous history or his personal circumstances. I am not even in a position to give the patient's age at the time of his illness, though the high judicial position which he had attained before his second illness establishes some sort of lower limit. We learn that Dr. Schreber had been married long before the time of his ‘hypochondria'. The gratitude of my wife', he writes, ‘was perhaps even more heartfelt; for she revered Professor Flechsig as the man who had restored her husband to her. and hence it was that for years she kept his portrait standing upon her writing-table.’ And in the same place: ‘After my recovery from my first illness I spent eight years with my wife - years, upon the whole, of great happiness, rich in outward honors and only clouded from time to time by the oft repeated disappointment of our hope that we might be blessed with children.’
In June. 1893, he was notified of his prospective appointment as Senatsprasident and he took up his duties on the first of October of the same year. Between these two dates{i} he had some dreams, though it was not until later that he came to attach any importance to them. He dreamt two or three times that his old nervous disorder had come back; and this made him as miserable in the dream as the discovery that it was only a dream made him happy when he woke up. Once, in the early hours of the morning, moreover, while he was in a state between sleeping and waking, the idea occurred to him that after all it really must be very nice to be a woman submitting to the act of copulation’. This idea was one which he would have rejected with the greatest indignation if he had been fully conscious.
The second illness set in at the end of October 1893 with a torturing bout of sleeplessness. This forced him to return to the Flechsig clinic, where, however, his condition grew rapidly worse. The further course of the illness is described in a Report drawn up subsequently by the director of the Sonnenstein Asylum: At the commencement of his residence there{ii}