|
|
| |
Commentary on Freud's "Analysis of a Phobia in a Five-Year-Old Boy"
Johanna Krout Tabin, PhD, ABPP
In the heady early days of psychoanalysis, new ideas constantly stretched the thinking of its adherents. Nonetheless, the publication of "Little Hans" was a turning point because it opened a whole new field of application. The possibility that one could work with a child, helping the child to overcome symptomatic behavior and hopefully prevent later neurosis, was a breathtaking concept. The treatment of Little Hans was the first time on record where psychoanalytic insight was applied to the unconscious concerns of a child.
Nearly one hundred years later, papers are still being written about it from the standpoint of object relationists, neo-Kleinians, self psychologists, family therapists, ego psychologists, classical psychoanalysts. A recent book on psychoanalysis (Rudnytsky, 2002) devoted two chapters to it.
Part of the allure of this remarkable case is the temptation for later theorists to put their own stamp on ways of understanding it. The general tone is critical about what Freud did and did not do. One might as well question why Lewis and Clark did not use a good Rand McNally map to find their way to the Pacific Ocean. History can be unkind to trailblazers.
The urge of each new generation to justify itself becomes a temptation as well to denigrate its forebears. What is ironic is that in an eagerness to prove that we have gone past Feud in our understanding, the critics above all mostly ignore the success of the treatment. Or raise doubts about the treatment's "completeness" on the grounds that various issues were not analyzed. (Hinshelwood, 1988).
Some commentators simply reinterpret the material in terms of their own predilections, for example Bowlby (1975) in emphasizing the ample evidence that Hans expressed separation anxiety. In fact, Freud mentions as the first matter in his summary of the case Hans's first symptom: awakening from an anxiety dream that his mother had gone away (p.118). He also underscored the mother's role in the child's early care in relation to the ego and eroticization of early experience (p. 108). Freud also makes a strong point of the child's ambivalence toward both parents (just two examples: pp. 112, 138). Fromm and Narvaez (1968) reinterpret a dream that Freud believed reflected Hans's castration fears as instead of reflecting the boy's fears of growing up—as if these were unrelated matters. Silverman (1980) accused Freud of overlooking Hans' impregnation fantasies in regard to the father, even though Freud actually states the probable ubiquity of the negative Oedipus at Hans's age (p.110).
The many who complain that Freud did not analyze the case completely overlook Freud's own comments that he recognized unanalyzed material but (it may be interpreted) felt that Hans's overcoming his symptoms was a sufficient basis for being optimistic about the results of the treatment (pp. 135, 145).
Slap's (1961) effort in this crowded field of scholarly attempts to update (and perhaps to upstage) Freud is the idea that Hans' reason for fearing a white horse was memory of the surgeon who removed his tonsils a couple of months after the phobia appeared. This sounds plausible except that at the turn of the century, surgeons still operated in their street clothes, even though they had learned to sterilize the patient (Margotta, 1968, pp. 268-269).
The case of Little Hans is not often enough studied for what we may learn from it. The most important fact might seem to be that the treatment of Little Hans was successful. Not only did this boy who was phobic at age four turn up in Freud's study as a healthy nineteen year old who was curious about the history he had come upon in a book (pp.148-149). He became an internationally recognized leader in his field, whose ease in the larger world was as evident as his charm and intelligence in a four part interview he gave as an adult (Graf, 1972). He traveled widely in Europe and back and forth to New York's Metropolitan Opera Company. He controlled the productions of performances of such big stallions in the music world as Toscannini on a collegial basis.
Holland (1986) offers a truly likely new insight. He takes into account that Hans, as the son of an important musicologist himself became a renowned stage director of opera and concerts. In the interview with him, he called himself an invisible man. Holland suggests that while the identification with his father is obvious, directing what happens from behind the scenes was perhaps an identification also with Professor
Freud. We meet him as Little Hans, son of Max Graf—unnamed in the account—an acquaintance of Freud's who for a time was a member of the regular meetings of Freud's inner circle. Before that, Hans's eventual mother was a patient of Freud's in her girlhood. Freud was even instrumental in encouraging Graf to marry her. (Rudnytsky, 2002). What we can appreciate from this is the smallness of the psychoanalytic circle in the early days in Vienna. By necessity, there was constant intermixing of social and professional roles.
Hans's father applied to Freud for help because the boy was suddenly afraid to go outside of his home for fear of being bitten by a horse. In 1906, this phobia became incapacitating, for the streets were as full of horses then as ours are of automobiles now. His father, unnamed in the article, was actually Max Graf, a friend of Freud's. Graf appealed to the Professor for guidance as to how to help his little son. Freud took the
opportunity to learn whether the theories he was developing about childhood sexuality might be observable in a child (as opposed to reconstructed from the analyses of adults). Freud actually met with the child only once during the treatment. The work with Hans was conducted by his father, who sent running notes to Freud. Freud responded to these to the father and wrote a running commentary on them for the rest of us.
There are many bonuses in reading this account. Foremost is the shape of a treatment of a phobic child. We see the formation of layers of primary process, as well as the interplay that occurs between primary process and secondary process, and its unfolding as treatment progresses. Then there are clinical insights that Freud mentions along the way as he confides in the reader. The account is certainly interesting in terms of Freud's personality. Very important is the manifest influence of living in the
cultural milieu of the earliest 1900's. Every now and then someone remarks on the effects that had on Freud's thinking; but seeing how that cultural milieu contributed to Hans's concerns startles us in the 21st Century. It is a significant sidelight to realize how much Freud's influence fostered the contrast from then to how we think today.
The quaint truth was that books for children (of which Hans owned a cherished example) explained that children were delivered to families by the stork. It passed as acceptable for a parent to threaten to cut off a boy's penis if he were caught again masturbating. Children were not supposed to notice and react to the thunderously noisy equipment for flushing toilets. If a child was recalcitrant in any way, even in benign, enlightened households, it was expected that a sound thrashing would cure the situation. In that period, as Freud put it, the aim in bringing up children was to be left in peace and have no difficulties. (p. 143) Giving children correct information instead of the mixture of fantasy and denial that they were characteristically given then seemed to Freud as a way out of the cultural confusions that led to his patients' distresses. One can see how this hope led to the custom of prophylactic child analyses which became fashionable in psychoanalytic circles, with disappointing results.
I remember rueful discussion about this among Hampstead faculty members who were from the original group in Vienna. The emphasis at the time of this experiment, however, was upon revelation and proof of the unconscious—the preoccupation of all psychoanalysis at the time, plus educating children about the mysteries of life that lend themselves to distorted thinking. The equal importance of tracing the relationship with the therapist, that we take for granted today, might have made a difference to prophylactic success, in the way that we believe everyone who becomes an analyst profits from personal analysis first. The prevailing view of why prophylactic analyses of children were a mistake was this: With children who presented no symptoms, analyses were plausibly an untimely focus on emotional issues, an interference with the
children's natural development, reminiscent of the folk saying, "If it ain't broke, don't fix it."
The impact of the case of Little Hans was to inspire direct work with children, not guidance of parents. Our present day notions of prevention of emotional problems in children emphasize the interpersonal, which Freud was slow to recognize to the degree that we do. He is content to leave Little Hans with only intuitive understanding of a father's role in creating children because Freud respected the limitations of Mr. Graf in dealing with such material with his son. Understanding that there were
unconscious messages from the father that affected Little Hans, and vice versa, would be automatic today. Nonetheless, Freud did take into account some of the affective behavior on the part of both parents.
For us now, the more valuable aspect of this case might be refreshing our respect for how much even a child brings to the interpersonal from the child's own bodily-based thoughts, emotions and puzzlements. The bodily involvement of Little Hans becomes clear at once with his questioning as to who also, like him, has a "Wiwimacher." (p. 6) The translator does a disservice to the English language reader by translating the name of this organ as a "Widdler." It is important to translate Hans's word correctly in order to understand some of his communications about his "Weeweemaker." (E.g., Hans's mother threatened to cut off his organ if he masturbated, asking him what he would do then. He responded that he would use his bottom. This makes no sense unless he referred to an organ of elimination. pp.6-7)
When Hans was not quite three years old, he already was fascinated with the size of horses' penises. By the time he was four years old, the interpersonal significance of his desires, fears, angers and bodily puzzlements culminated in a full blown phobia of horses. Helpfully, Max Graf, like many in Freud's circle, was in the habit of making notes on his child's behavior that might interest the Professor. Thus, one of the benefits of this study is that one can see from Freud's preservation of those notes how the layering of concerns of Hans's was, as Freud mentions, condensed in the actual symptoms the boy developed.
When Freud received a letter from Graf asking for guidance, he could use the previous notes for useful background. The unfolding of the case is presented in the most lively way because the father wrote down his dialogues with Hans (who sometimes helped in the phrasing) and most of the text is in their dialogue. Freud confides his thinking as the case developed. His reflections are peppered with generalizations that apply to any analysis and are relevant thoughts for our work today.
On the lighter side, we can appreciate the moments when Hans corrects his father's doctrinaire (and defensive) interpretations. For example, Hans is talking about a white horse that bites. The father tells him, "I say, it strikes me that it isn't a horse you mean but a weeweemaker, that one mustn't put one's hand to." Hans: "But a weeweemaker doesn't bite."(p. 29) It is a side amusement that both father and son often sound like
British actors portraying upper class characters, in keeping with the structure, too, of the German language. Freud is accustomed to this form of speech, however, and focuses on the meanings.
My favorite moment is when the father tries to face Hans's sibling rivalry after a fantasy of drowning the little sister: "I: And then you'd be alone with Mummy. A good boy doesn't wish that sort of thing, though. Hans: But he may THINK it. I: But that isn't good. Hans: If he thinks it, it IS good, because you can write it to the Professor." (p.72) Freud comments that he wished for no better understanding of psychoanalysis from any grownup.
One of the interesting things in the setup is the glimpsing of Freud's personality in his interactions with Hans and the father. Critics seem to struggle with Freud's not being a perfect person. He was, after all, merely a mortal man who happened to initiate a new way of thinking about human personality. Here he pokes fun at himself, but it seems
disingenuous to some (Rudnytsky, 2002). One example occurs of Freud's wish to be always right, when Freud admits that some advice of his backfired, pleased to come to understand why. He does not, however, take blame for giving the advice.
It is interesting to see Freud's respect for how children think, in terms of the unchanging qualities of children's mentation. He did not press Hans's father beyond a point to recognize what Hans was dealing with, for Hans came to an appropriately constructive resolution for his conflicted feelings on the basis of the work that was done. Nonetheless, the material is ample to support Freud's guesses about oedipal strivings, identity needs, sibling rivalry, and bodily concerns. Recognizing these
things was so inimical to the cultural norms of that day, Freud had to justify his recommendations in the treatment as not taking away a child's innocence (p. 144).
From the standpoint of current views, it can be unsettling to encounter Freud's references to perversion, especially in relation to homosexuality. A reader must bear in mind that in Freud's day, homosexuality was considered to be a crime. His willingness to consider the developmental circumstances of overt homosexuality represented quite advanced thinking at that time. The theory he suggests in these pages has relevance to some aspects of behavior we find today.
In spite of revelations that do occur of Freud's frailties, not so much in this case, the most important thing for clinicians is probably Freud's caution about interpretations. He shows satisfaction when he believes his theories of child development are being substantiated, but he warns often in telling about Little Hans, as on page 120, against imposing interpretation where the patient does not accept it.
Among instructive points about the technique of treatment, over and again, there is emphasis in Little Hans about following the patient's material. Where the patient does not take the lead in the analysis, when the analyst seems too knowing, the patient can be expected to retreat into not knowing. Freud underscores that the unconscious significance of a communication is often found in the associations that follow—not in
the preceding material where we often look for it. He also points out that a feeling of monotony with repeated material is only the therapist's problem. How repetition provides steps in progress is apparent with Hans, whose seeming repetitions hold different meanings at different times, for himself. A fundamental respect for the patient is encouraged throughout. Asking whether Hans exhibited foolish fears, Freud answers himself strongly in the negative. No, he says, a neurosis never says foolish things.
There is one more bonus for the reader of this case. In addition to the immediacy of recognizing the cultural milieu in which Freud worked, there are intriguing bits of the history of psychoanalysis. For example, one finds his first use of the term "transference." In its first meaning, it meant the metaphoric elaboration appropriate to unconscious selection of an object for a phobia, according to some features that made the phobic object useful for expression. Also, Freud wrote up this case around the
time of Adler's split from him, so he tossed in his view of the difference in their thinking. In another historical note, Freud refers to a time, twenty years earlier, when the idea was hooted at of a psychological effect from suggestion by an authority figure. By 1906, he was accused of being too influential over his patients because of the power of suggestion.
The case of Little Hans is a window on the pioneering creation of psychoanalysis. It is most particularly an early turning point paper that deserves attention now because of its lasting value.
References
Bowlby, J. (1975). Attachment and Loss, Vol. 2: Separation, Anxiety and Anger. London: Penguin.
Freud, S. (1906). Analysis of a Phobia in a Five-Year-Old Boy. S.E., X, pp. 5-149.
Fromm, E., & Narvaez, F. (1968). The Oedipus Complex: Comments on the Case of Little Hans. Contemporary Psychoanalysis, 4, 178-188.
Graf, Herbert. (1972). Memoirs of an Invisible Man: A Dialogue with Francis Rizzo. Opera News. February 5, pp. 25-28; February 12, pp. 26-29; February 19, pp. 26-29; February 26, pp. 26-29.
Graf, Max. (1942). Reminisces of Professor Sigmund Freud. Psychoanalytic Quarterly, 11: 465-476.
Hinshelwood, R.D. (1988). Little Hans's Transference. Journal of Child Psychotherapy, 15: 63-78.
Holland, N. (1986). Not So Little Hans: Identity and Ageing. In K. Woodward & M. Schwartz (eds.). Memory and Desire. Bloomington, Indiana: Indiana University Press.
Margotta, R. (1968). The Story of Medicine. New York: The Golden Press.
Rudnytsky, P.L. (2002). Reading Psychoanalysis. Ithaca, NY: Cornell University Press.
Silverman, M. (1980). A Fresh Look at Little Hans. In J. Glenn & M. Kanzer (eds.). Freud and His Patients. New York, Aronson.
Slap, J.W. (1961). Little Hans' Tonsillectomy. Psychoanalytic Quarterly, 30, 259-261.
We have joined up with Amazon.com to provide you with the convenience of ordering books online. In the pages to come you can order specific books that we cite in our courses, or you may browse Amazon.com.
|
|
|
