Research invitation

My recently completed PhD explored the illness experience of Freud’s patient Anna von Lieben, using a qualitative research methodology – Interpretative Phenomenological Analysis – to analyse her previously undiscovered autopathographical poetry. The analysis, supplemented by a reading of her husband’s diaries and other family documentation, indicated that the patient’s pathology was due primarily to a longstanding gynaecological condition, possibly endometriosis. The overall findings led to the identification of several new avenues of research which I would like to offer for the consideration of researchers in the field of Medical Humanities/Narrative Medicine. My proposals also draw on the work of Nezhat, Nezhat and Nezhat (2012)* who suggest that, throughout history, many of the women diagnosed with hysteria were in fact suffering from endometriosis, or something similar.
On this basis, I have formulated the following ideas:

• a study of ‘hysterical’ patients of the 19th century to identify and further explore those with gynaecological co-morbidities 
• a qualitative analysis comparing the lived experiences of 19th-century ‘hysterical’ patients manifesting gynaecological symptoms and those of present-day endometriosis sufferers  
• a historical investigation over several millennia designed to find evidence in support of the Nezhat theories.

A project based on any of the above might serve as a topic for doctoral or postdoctoral research. It might equally be possible to investigate all three suggestions for an interdisciplinary team-based project. It could also be of interest to language scholars, both modern and classical.
The amount of new primary material which I obtained from the von Lieben family archive would in itself be sufficient for a number of researchers. Added to this is the substantial bank of archival information which I have built up in the course of my own research. I would like therefore to offer the above ideas as a ‘provocation’ to stimulate further investigation. I will not be undertaking any more substantial academic activity myself, but I would be happy to act as a facilitator for others, putting my knowledge and resources at their disposal, and passing the baton on to the next generation of researchers.
My methods and findings are summarised in the Abstract of my doctoral thesis, In her own words: Exploring the subjectivity of Freud’s ‘teacher’ Anna von Lieben (see below). The thesis itself can be accessed at https://theses.gla.ac.uk/82795/
If you would like further information, or to engage in some exploratory discussion, please contact me at hilda.reilly@glasgow.ac.uk
*Nezhat, C., Nezhat, F., & Nezhat, C. (2012). Endometriosis: Ancient disease, ancient treatments. Fertility and Sterility, 98(6), 1-62.
 
ABSTRACT
This project is inspired by the work of Roy Porter (1985), who draws attention to the patient-shaped gap in medical history, and Rita Charon (2006), who emphasises the need to bring the patient’s narrative to the fore in the practice of medicine. The principal aim of the project was to devise a means of accessing the lived experience of a patient who is no longer alive in order to gain an understanding of her narrative.
Anna von Lieben was identified as a suitable subject as she wrote a substantial quantity of autopathographical poetry suitable for analysis and her status as Freud’s patient makes her a person of significant interest to the history of medicine.
The poems were analysed using Interpretative Phenomenological Analysis (IPA), an idiographic and inductive method of qualitative research, based on Heideggerian hermeneutic phenomenology, which explores the lived experience of individuals and is committed to understanding the first-person perspective from the third-person position.
The main findings from the IPA study reveal that Anna experienced a prolonged period of malaise, starting in late adolescence which she believed to result, at least partly, from a traumatic experience which occurred at that time. The analysis also indicates that Anna suffered from deep and lasting feelings of guilt and shame.
The discovery of a significant quantity of additional family documentation enabled me to contextualise and give added substance to the findings of the IPA study. The diaries which Anna’s husband kept throughout their marriage reveal that:

• she had a severe and longstanding gynaecological disorder
• she suffered from severe morphinism
• she did not benefit from Freud’s treatment which seemed neither to ease her symptoms nor identify any cause
• she was treated in Paris, not by Charcot as previously supposed, but by a French hydrotherapist, Theodore Keller, who appears to have become a person of considerable significance in her life.

The above findings led me to investigate Anna’s comorbidities (gynaecological disease and morphinism) and to show how those could be responsible for much of the symptomatology identified by Freud as ‘hysteria’. I then explore the possibility that her psychotic-like experiences could have been iatrogenically induced by her treatment first by Keller and then by Freud. Finally, I propose a fourfold set of hypotheses as an alternative to Freud’s diagnosis of hysteria.
The study overall presents a three-stranded account of the illness and treatment of one of Freud’s patients, combining the narratives of the patient herself, her husband, and Freud. As such, this study is likely to be the first of its kind.