Freud on Neurosis and Psychotherapy as Illustrated in the Little Hans Case

The aim of psychotherapy, according to Sigmund Freud, is to make the unconscious conscious by uncovering repressed ideation, that is, ideas associated with the emotion of a triggering or traumatic event, and verbalizing the repressed ideas while also reexperiencing or reliving the emotions that were displaced to a symptom or symptoms. The process is called abreaction in the English translation.*
 
Psychological problems—neurosis—often result from repressed childhood injury, Freud discovered, but may also occur later in life. And not all such problems result from sexual trauma as a child, a view called “pan-sexualism,” which Freud’s critics accuse him of saying. (See Freud’s denial in Three Essays on the Theory of Sexuality, preface to fourth edition and elsewhere).
 
Freud wrote several case histories to exhibit his method of therapy, as well as his theory of the causes and cures of neurotic symptoms. Let me illustrate this with a summary of his “Little Hans” case about a five-year-old boy with a phobia of horses. The case was published in 1909.
 
Though Freud only met with the boy once, when he was not quite five, the case is an excellent example of why he thought psychoanalysts do not need to have an MD degree to practice psychoanalysis, which many of his medical critics thought, including especially American physicians.**
 
The parents in this case were not medical doctors, though they knew Freud. The father of Hans attended Freud’s Wednesday night group (which in 1910 became the Vienna Psychoanalytic Society) and Hans’s mother had been Freud’s patient. They were both encouraged by Freud to use minimal coercion in their parenting and neither laugh at nor bully Hans about his phobia. The father conducted most of the analysis by asking non-judgmental questions, taking Hans’s answers seriously, and sending letters with the answers to Freud. This occurred over the first five months of 1908 before and after Hans turned five.
 
Hans’s main symptom was the phobia of horses, which began as an anxiety of unknown origin while walking in the street with his father. At the time he wanted to go home to “coax” (cuddle) with his mother. On another occasion while walking with his mother, he became afraid that a white horse would bite him.  Upon questioning by his father, Hans recalled an event  some time earlier when he witnessed a large work horse fall and “make a row” with its feet. This frightened Hans considerably as he thought the horse might be dead. Subsequently, in early 1908, Hans was hesitant to go out into the busy street in front of his home where many horse-drawn carts and coaches would be seen. His anxiety had transformed into a mature phobia of horses.
 
The emotions of anxiety and fright that became the phobia are displacements from the repressed cause, according to Freud. Let us explore the possibilities. There were several.
 
From the age of three, Hans, like most boys his age, became interested in his “widdler” (penis, or wiwimacher in the German) and “widdling.” He also naturally became fascinated by the widdlers of others, including those of animals, and curious about whether his baby sister and mother had widdlers. He was especially fascinated by the largeness of the widdlers of giraffes and horses. He liked touching his.
 
At about three-and-a-half, his mother (apparently reverting to older methods of parenting) saw him in this activity and told him that if he keeps touching it she will call the doctor to have it cut off. Because it was implied by his mother that this “activity” was naughty and dirty, Hans acquired what Freud calls a castration complex with the fears becoming repressed. This was also about the time his sister Hanna was born, of whom he soon became jealous.
 
Other issues were relevant. His parents, unfortunately, told him that his baby sister was delivered by stork, which led to speculation of how that happens. More particularly, when it became obvious that babies somehow come from the mother, Hans wondered how. From the mom’s rear end, for example?
 
Freud was critical of the parents for not informing Hans about the differences in sex organs of boys and girls and for not enlightening him about sexual intercourse between his mother and father. This last is important for Freud because he found that children who witness or hear their parents having sex usually conclude that it is an act of violence with the dad harming the mother. Freud concluded that if the parents had been more open about these two issues, the phobia of Hans could have been resolved more quickly. According to the father, Hans never witnessed his parents having sex—although he did sleep in their bed until he was four.
 
The central issue for Hans revolves around what Freud calls the Oedipal complex, which does not mean that five-year old boys want to have sexual intercourse with their mothers. It is metaphor summing up common issues that arise between children and their parents, especially when there is an attachment to the mother and lesser feeling toward, and in some cases alienation from, the father. The Oedipal myth is about self-discovery, which is what psychoanalytic therapy is about.
 
Hans did show more attachment to his mother than to his father, but Hans’s dad was unusual—for dads then and now—by being so lovingly interested in and patient to help Hans with his phobia, or “nonsense,” as Hans referred to it, talking to him about widdlers, babies (his sister), large and small animals (and their widdlers), and often encouraging him to go out to the street where horses could be seen to test his “nonsense.” That Hans was aware of his nonsense as an issue indicates his eagerness to seek a remedy.
 
Sometimes, when the family was on summer vacation away from Vienna, the dad would have to return to the city for business. Hans once said, “When you’re away, I’m afraid you’re not coming home,” which was then followed by a benevolent emphasis by his father that he always comes home.
 
The attachment to his mother is shown as follows. The “seduction” scene, as Freud refers to it, using the word broadly, not literally, occurred when Hans’s mother was giving him a bath and he said to her, “Why don’t you put your finger there?” (on his widdler). His mother responded that that would be piggish and improper. On another occasion, which Freud describes as a second seduction, Hans said to his mother that his aunt recently said that he has a “dear little thin­­-gummy.” And once after an anxiety dream, Hans awoke crying, “I thought you were gone and I had no Mummy to coax with.” In addition to these issues of attachment to his mother, Hans was not able to see her during her confinement (last several weeks) of pregnancy. Much of this came out during the Q&A sessions with his father.
 
In early April, 1908, Hans and his father paid a brief visit to Freud. Observing the two sitting opposite him and listening to Hans describe how he disliked the black thing around the horses’ mouths (the bridle strap above the nose that usually holds a metal bit for control), Freud made a connection between the bridle and the father’s black mustache. Freud said that because Hans is so fond of his mother, he must think his father is angry with him. The father responded by asking why Hans would think such a thing, since he, the father, had never scolded or hit him. But yes, Hans intervened, you did hit me once, which happened as a reflex hit after Hans had head butted him in the stomach!
 
After this short visit to Freud, the father reported that Hans’s phobia began to retreat, as Hans was more open to talking about his repressed wishes. Many additional concrete details that cannot be summarized here, including associations between his feelings toward horses and his feelings toward his parents, followed in Hans’s life, but more intimate Q&A sessions occurred between Hans and his father, such as: Do you wish your sister had not been born? And on a different occasion, do you wish she would fall into the bath water and die? Both answers were yes, the psychological meaning being that his sister was robbing him of his parents’ love. And such an occurrence (her death) would leave more time for him to spend with his mother.
 
These verbalizations about his sister, father and mother, and his widdler (the castration complex) constitute the ideation Freud talks about that led to a gradual melting of his symptoms of anxiety and fright of horses.
 
Near the end of this period, Hans experienced and talked about a number of fantasies with his father, including his wish to marry his mummy and, sometimes, his wish that his father would go away. One day, Hans’s father saw him playing with imaginary children and said to him that boys cannot have children to which Hans responded, “I know. I was their Mummy before, now I’m their Daddy.” Who’s their Mummy? the father asked. “Mummy, and you’re their Grandaddy” (Freud’s italics).
 
To this, Freud concluded, “The little Oedipus had found a happier solution than that prescribed by destiny” (for Oedipus the King). Hans’s father wrote to Freud shortly afterwards, “A trace of his disorder still persists, though it is no longer in the shape of fear.”
 
It was the content of the Q&A sessions with the father, as well as the comments made by Freud during the visit with him, that constitute the ideation associated with Hans’s emotions, the emotions that troubled him sufficiently to transform them into a fear of horses. And it was this ideation that Freud asserts is necessary to be made explicit and conscious (which in an adult would likely have long since been deeply repressed). The various expressions in Hans’s words of his fears and anxieties were the “abreactions” Freud refers to as being essential for successful therapy. The job performed by Hans’s father got Hans to bring out or “work off and get rid of” the ideas and emotions of the triggering events, which then encouraged the displaced emotions in the symptoms to melt away.
 
Hans’s father was Max Graf (1873–1958), a Viennese musicologist. Hans was Herbert Graf (1903–73), a highly successful opera producer and director, including twenty-four years between 1936 and 1960 at the Metropolitan Opera in New York City (read interview in Opera News, 1972). At age nineteen, Herbert visited Freud, who described him as a “strapping youth” who seemed to have survived “puberty without any damage” and, though his parents had divorced and remarried, kept his emotional life intact by going through “one of the severest of ordeals” (the divorce).
 
In this post, I have deliberately used a minimum of Freud’s technical terms, including especially the many questionable English translations. Next month, I will address the challenge of reading Freud in general and in specific the English translations.
 
 
* Freud’s word in German is abreagieren, which means to work off or get rid of. As mentioned in the first post in this series, I prefer the word subconscious to Freud’s “un-,” but when quoting or citing Freud will use unconscious. I consider them similar, though not synonymous. Abreaction in modern terms seems close to derepression.
 
** From 1926–32, American psychoanalysts succeeded in getting a law passed making it illegal for anyone to practice psychoanalysis without the MD degree (Bettelheim, 33–34). Today, a master’s degree is the minimum, but a degree with “doctor” in it is still preferred. In 1926 Freud wrote The Question of Lay Analysis to argue why laypersons (non-doctors) should be allowed to practice his method and theory.