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 Anna:
- had a severe and longstanding gynaecological disorder
- suffered from severe morphinism
- did not benefit from Freud’s treatment which seemed neither to ease her symptoms nor identify any cause
- was treated in Paris, not by Jean-Martin 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.