In the case studies of Elisabeth Von R. and Anna O., Freud seems to emphasize the individual nature of his patient’s psychological conflicts. In the case of Elisabeth Von R., he argues that her “hysterical” leg pain is caused by her internal conflict between personal desires for romance (in particular, her desire to be with her sister’s husband) and sense of duty to her sick family members. Freud explains that “the contrast between the blissful feelings she had allowed herself to enjoy… and the worsening of her father’s state… constituted a conflict, a situation of incompatibility.” (146) Similarly, Anna O. is also driven to hysteria by an emotional internal conflict. In her case, Freud argues that “her monotonous family life and the absence of adequate intellectual occupation left her with an unemployed surplus of mental liveliness and energy,” which eventually manifested itself as hallucinations and disassociation (41). While it would be very easy to make these case studies about the suppression of bright young women into caretaker roles and the consequences of heavy societal expectations, Freud is very careful not to politicize these specific cases. He frames the conflicts as entirely internal, between the women’s desires for a social life and their love for their families.
However, Freud is unclear about whether the nature of his treatments are more individualistic or social in nature. When first describing his technique for Elisabeth Von R., he emphasizes the importance of the patients themselves being aware of the internal conflict causing the hysteria, saying that the aim of his process is to allow the patient to “reproduce the story of her illness,” (138) and therefore to come to terms with it. The psychoanalyst’s job is to allow and encourage the patient’s understanding. Freud believes that once a patient recognizes and understands the connections between a traumatic memory or thought and their neuroses, the symptoms will disappear.
However, Freud’s method for guiding the patient to this understanding relies heavily on intervention by others, rather than private self-reflection. Speaking of Elisabeth’s psychoanalysis, he likens it to an archeological excavation, saying that he was “clearing away the pathogenic psychical material layer by layer.” (139) In general, he describes the therapeutic process in the two case studies as a series of actions he performs on his patients, saying he “penetrated,” (139) “elicited,” (35) and “extracted” (145) his patients’ thoughts and memories. He uses first person perspective in the majority of his case studies, describing his actions on his patients rather than their own experiences of coming to terms with their unconscious.
While this may seems like an indication of Freud’s personality rather than insight into the individual or collective nature of psychoanalysis in general, this focus on the doctor’s actions points to the inherently social process of abreaction. In his many case studies, Freud claims that the patient could not be cured until they voiced aloud their internal conflicts, and vocally made the connection between their physical state and some repressed desire or memory. He describes times during Elisabeth’s treatments when certain memories would trigger her hysterical pain, which would persist until she finished explaining the memory to him. Freud describes this process as the pain being “talked away.” (148) He uses similar language describing Anna’s treatment, saying that many of her strange behaviors disappeared “after she had described the experiences which had given rise to them,” again saying that these neuroses were being “talked away.” (35) Freud does think that the patient themselves need to make the connection between the repression and their neurotic symptoms, and cites some instances of the patient coming to that conclusion without his help. But Freud emphasizes this “talking cure” as the most reliable treatment. He seems to believe that the internal problem can only be brought into the patient’s consciousness if they express it out loud to another person, as if the process to internal understanding is external vocalization. This is an extremely social approach to what Freud himself seems to describe as an individual problem. The process of vocal communication alone is an extremely socialized and collectivized process, existing solely for the purpose of interacting with other members of ones species.
While it may seem contradictory for Freud to prescribe such a social cure for what he views as an internal problem, humanity has always struggled with the conflict between the individual and the collective. As a species, we are not as socially driven as ants or bees, but not as individualistic as wolves or tigers. As conscious organisms, we rely on our sense of self and mental autonomy. At the same time, we form civilizations and societies that require us to be heavily influenced by the demands and perceptions of others. While Freud may not directly address the conflict between an internalized struggle with an externalized solution, the individual/collective dichotomy is certainly not new to humanity.