from hypnotic suggestion to free association: freud as a psychotherapist, circa 1892–1893

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From Hypnotic Suggestion

to Free Association: Freud

as a Psychotherapist, circa1892–1893Lewis Aron Ph.D.

Published online: 28 Oct 2013.

To cite this article: Lewis Aron Ph.D. (1996) From Hypnotic Suggestion to

Free Association: Freud as a Psychotherapist, circa 1892–1893, ContemporaryPsychoanalysis, 32:1, 99-114, DOI: 10.1080/00107530.1996.10746942

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99

L E W I S ARON, Ph.D.

F R O M

HYPNOTIC

SUGGESTION

TO

F R E E

ASSOCIATION: FREUD AS A PSYCHOTHERAPIST,

CIRCA 1 8 9 2 - 1 8 9 3 ^

I

N

THIS

ARTICLE,

I want to celebra te on e aspect of Freud's creative

genius, and in doing so , I want to make use of Freud as a mode l for

contemporary students of psychotherapy and psychoanalysis. My use of

Freud in this way will, ironically, have subversive implications for psycho

analytic practice. The facet of Freud's originality that I will focus on is his

unsurpas,sed ability and de terminat ion to develop a way of working as a

p,sychotherapist that was uniquely his own and that best expressed his

own character. Freud believed that he was discovering a scientific

method, an instrument that to a great extent eliminated or minimized

what he called the subject ive factor. Nevertheless, he recognized that to

work as a p,sychotherapist, different peopl e were likely to ne ed varying

procedures. In the third chapter of Studies on

Hysteria

(Bre uer & Freud,

1 8 9 3 - 1 8 9 5 ) ,

the case of Miss Lucy R., Freud wrote, perhaps a bit sar

castically, in regard to the practice of clinical hypnosis, that he was sure

that many other physicians who practice psychotherapy could deal with

certain technical difficulties with more skill

than

he could. If so, he

went on, they may

adopt

some procedure other

than

mine (p. 109 ).

This comment foreshadows his later remark, in the opening

paragraph

of

his

( 1 9 1 2 )

Recommendat ions to physicians practicing psycho-analysis :

I

must, however, expressly state that this technique has proved to be the

only method suited to my individuality; I do not venture to deny that a

physician quite differently constituted might feel impelled to

adopt

a dif

ferent

attitude

to his patients and to the task bef ore him (p. 111) . In

deed, Freud was relatively open-mi nded and even encouraging of experi

ments with psychoanalytic technique, as long as they did not direaly

challenge

his theoretical beliefs or risk endanger ing the reputat ion of the

An earlier version of this

article

was presented at New York University Postdoctoral Pro

gr am ,

Conference,

The

Psychoanalytic

Century. Psyche,

Soma,

Gender,

Word,

May

6 ,

1995.

0 0 1 0 - 7 5 3 ( V 9 6

» 2 . 0 0 -I- .05

Copyright © 1 9 9 6 W A. W. Institute

2 0

W 74th Street, New Y o r k , NY

1 0 0 2 3

All rights

of

reproduaion

in any

form reserved.

Contemporary- Psychoanalysis, Vol. 32. No. 1 ( 1 9 9 6 )

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FREUD AS A PSYCH OTHERAPIST 101

To anticipate my broadest conc lusi ons, I will say that I believe that

Freud's creation o f the psychoanalytic method was a unique, revolu

tionary,

and

personally expressive development,

and

that

by

1893

he

had evolved a distinctly psychoanalytic brand o f psychotherapy, but

also that the development o f this form o f psychotherapy was a product

o f its

time

and a

logical outgrowth

o f the Zeitgeist.

Looking

at

Freud's

discoveries in

historical context does

not

diminish

our

appreciation

o f

his achievements, but rather enhanc es our awareness o f his unique

contributions.

Other accounts

o f

Freud's abandonment

o f

hypnotism have tended

to

blame

Freud for the general decli ne in the us e o f hypnotism. That is, they

have suggested that hypnotism became less popular because psycho

analysis

became

the

dominant form

o f

treatment.^

I

will

be

suggesting

that the causal flow was mor e complicated, moving in both directions,

and that psychoanalysis itself came about because o f a more general

trend away from hypnotism

and

toward verbal psychotherapy conduct ed

in

the

awake state.

In 1923, Freud wrote, It is no t easy to overestimate the importance o f

the

part

played

by

hypnotism

in the

history

of the

origins

o f

psycho

analysis.

From

a

theoretical

as

well

as

from

a

therapeutic point

o f

view,

psychoanalysis

has at its command a legacy which it has inher ited from

hypnotism

( 1 9 2 3 ,

p. 192) .

To

go

back

in

time, between I860

and

1882 hypnotism

had

fallen into

disrepute. This was a period o f heavily organ ic p.sychiatry, which placed a

strong emphasis on neuroanatomy and neurophysiology, on heredity and

on theories

o f

degeneration,

and in

which there

was

little room

for

men

tal events

and for

psychology. Remember, after all, that

it is no t as if

these

psychiatrists held

any

real keys

in

their hands; attitudes

of

pessimism

and

dierapeutic nihilism dominated

the

p.sychiatric teaching hospitals

o f the

time. But

then, during

the 1860s and

1870s,

the

Danish hypnotist Carl

Hansen stirred up a great deal o f popular and scientific interest in hypno

tism by traveling from city to city, performing public demonstrations. In

his autobiographical study, Freud ( 1 9 2 5 ) remembers that

as a

student

he

See,

for example, the highly

polemical Freud and

Hypnosis by

Kline ( 1 9 5 8 ) .

But even the

most

authoritative reviews of the history of hypnotism have taken this stand.

For

example,

Wolberg ( 1 9 4 8 ) ,

in

his comprehensive KxlbooV. Medical Hypnosis, asserts that the

growth

o f

the psychoanalytic

movement

and the

development

of

other

forms of psychotherapy

reduced hypnosis to a place of

relatively

minor

importance

(p. 12). M o r e recently, in

their

introduaion

to

the Handbook of Clinical Hypnosis, EUiue, Lynn, and Kirsch ( 1 9 9 3 )

similarly

suggest

that After

the

abandonment

of hypnosis by Freud, its

clinical

use

vir

tually vanished

for decades (pp.

6 - 7 ) .

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102 L E W I S ARON, Ph.D.

had seen on e of Hansen 's performances and was conv inced of the genu

ineness of die phe nomena (p. 16). Freud is referring to demonstrations

o f

hypnotism given by Hansen in 'Vienna in

1880.*^

Up to and around 1880, clinical hypnotism had still not become wide

spread. Two unrelated events occ ur red in 1882 that were to quickly raise

hypnotism into something of a fad in European medica l

circles.

First,

Jean

Martin Charcot, who had an international reputation as the greatest

neurologist o f his time, had begun to exper iment with hypnotism in

1 8 7 8 , and on February 13, 1882, he read a paper to the Academy of

Sciences

that was to establish hypnot ism as a legitimate subject of scien

tific study. Freud 1 8 8 6 ) was to write regarding Charcot that he had made

a

scientific study of hypnot ism— a region of neuropathology which had

to be

wrung

on the one side from skepticism and on the other from

fraud (p. 11) . Se cond, it was in 1882 that Hippolyte Bernheim, a pro

fessor with an excel lent reputation in the faculty of medicine at Nancy,

visited the country doc tor and hypnotist A. A. Liebault and be ca me a dis

ciple and proselytizer of clinical hypnotism and the founder of the so-

called Nancy school of hypnotism. Freud was soon to be directly influ

enced

by both o f these leading pioneers.^

In Vienna, Benedikt, a neuropathologist , had experi mented with hyp

notism from the late

1 8 6 0 s .

Bre uer, who was at that time his assistant,

warned Benedikt to discontinue these experiments because he was prac

ticing a form of animal magneti sm (Ch en ok & De Saussure, 1979, p.

1 1 5 ) .

Benedikt vacillated in his opinions regarding hypnotism. After

meeting Charcot, he spoke in favor of hypnotism, but at other times he

opposed the prac tice of hypnotism and even its investigation. I will re

turn

to Benedikt later, because in his own opposi tion to hypnotism, he

was moving in a direct ion that anticipates wher e Freud would ultimately

go.

With the help of so me intervention by his teacher s Brücke and

Meynert , Freud was to be awarded a travel grant from the University of

Vienna

to go and study with Charcot in Paris, which he did from late 1885

to early 1886. It was Benedik t who wrote a letter o f introduct ion for

Freud to Charcot.

Freud had seen hypnotism being practiced in Obersteiner's private

See

Freud s

letter to Eduard Silberstein,

February

3, 1880.

Space does not permit me to discuss the differences between the views of the so-called

Paris and Nancy schools or to reflea on

Freud s

position on these differences. However,

Freud clearly summarizes his understanding of the differences in his 1 8 9 0 ) review of

Forell s

h>ook (p. 97) as well as in

other

places.

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F R E U D AS A P S Y C H O T H E R A P I S T 103

sanitorium for three weeks prior to his visit to Paris, and Jones (cited in

Chertok & De Saussure,

1 9 7 9 ,

p. 1 16) bel ieves that he may have first tried

it

at that time. Nevertheless, when Freud left Vienna to go to study with

Charcot,

his intention was to study neuroanatomy; but by the time he left

Paris

a few months later, his mind was filled with thoughts regarding

hypnosis, hysteria, and the neuroses. Undoubtedly, Freud's meeting with

Charcot

had a profound effect on him, in spite of the

fact

that, as Ellen-

berger has demonstrated, he only actually studied with Charcot for a few

weeks.

The meeting, in Ellenberger's

1 9 7 0 )

account, took the form of an

existential encount er (p. 436 ) and Charcot remained so important in

Freud's estimation that in December of

1 8 8 9 ,

when Freud's first son was

born, Freud named him Jean Martin after his teacher.

Upon his

return

to Vienna, Freud was singing the praises of Charcot, so

much so that this idealization of Charcot contr ibuted to getting him into

some

t rouble with his col leagues . I am referring to üie infamous epi sode

o f

Freud's reading his paper on male hysteria to the

Society

of Physicians

in Octo be r 1886. Freud's coll eagues were offended by the credit that

Freud attributed to Charcot and to the way in which he consequently

devalued their own contributions and understandings (Ellenberger,

1 9 7 0 ) .

Freud opened his own private practice as a nerve specialist on Easter,

1 8 8 6 ,

and was married that September. In that same year, he translated a

vol ume of Charcot 's lectures. Hysteria and hypnosis dominated Freud's

imagination, yet in his practice he relied on the then traditional tech

niques of elect rotherapy, hydrotherapy, massage, rest-cures, and perhaps

most importantly, suggestion and manipulation. In a letter to Fliess of

December 28 , 1887, Freud writes that During the last few weeks, 1 have

taken up hypnosis and have had all sorts of small but remarkable suc

cesses

(quoted in the editor's introduction to Breuer and Freud's

Studies

on Hysteria . Given Freud's enthusi asm about hypnoti sm. Why did he

wait almost a year and a h a l f after opening his practice before beginning

to use the method?

It needs to be remembered that Freud was just beginning his praaice,

had just got ten marr ied, and would have be en reluctant to do anything

overly

controversial , particularly because he had already be en involved

in two cont roversies, on e about his use of coca ine and the other regard

ing his 1886 paper on male hysteria, which had offended some of his

colleagues. Remember , too, that the clinical use o f hypnot ism still had

very strong opponen ts in Vienna, including Freud' s teacher Meynert as

D o w n


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1 0 4 L E W I S ARON, Ph.D.

well

as Benedikt . Fur thermore, it must be understood that even Charcot

had

not

been enthusiastically advocating hypnotism as a treatment pro

cedure; he had only cautiously endorsed hypnotism for therapeutic

pur

poses.

For Charcot, hypnosis was mostly important as a means of demon

stration and experimentation, because by using hypnotism with hysterical

patients he could stimulate through suggestion the same somatic symp

toms typical of traumatic hysteria. In our efforts to understand Freud's

fledgling efforts at utilizing hypnosis, it should not be forgotten that at

this time therapeutic practice for nervous and mental disorders was still

dominated by degenerationist thinking, and even Charcot 's views on hys

teria were quite st ria ly neurological. As

Micale ( 1 9 9 5 )

writes, concerning

die

clinics

o f Charcot and Bernhe im during this period, they were above

a ll sites for medical observation and experimentation. Generally speak

ing, the second

h a l f

of the nineteenth century, while a major period of

advancement in the etiological

understanding

of disease, was not a great

a g e of healing (p. 26 8) . So, Freud's therapeudc u.se of hypnotism could

not have come about

under

the influence of Charcot. As both

Hirschmuller

( 1 9 7 8 )

and Swales

( 1 9 8 8 )

concluded, in spite of the

fact

that he was lecturing on hypnosis by 1886, having been influenced by his

trip

to Paris, it seems evident that his clinical use of hypnotism did not

occur for another eighteen months, and as we are about to see, it was

more the result of the influence of Bernhe im.

In any event, Freud began to experiment with clinical hypnotism in

December

1887, and he later wrote

(Breuer

& Freud,

1 8 9 3 - 1 8 9 5 )

that he

began to use Breuer's cathartic method combined with direct hypnotic

suggestion in May 1889, in the case of Emmy von N. Again we must ask,

now that Freud was using hypnotism with his patients. Why the long

delay of another year and a

h a l f

before he would shift from

pure

hyp

notic suggestion to catharsis with suggestion? Contradiaing his earlier

remark, Freud later wrote in his Autobiographical Study that from the

very first I made use of hypnosis in another manner, apart from hypnotic

suggestion

( 1 9 2 5 ,

p. 19) . This would imply that he had been using the

cathartic method from the time he began using hypnotism. Swales con

cluded that Freud probably had been using Breuer's cathartic method

along with suggestion even before May 1889, and certainly by that sum

mer. But again the question arises. Why would Freud have waited so long

to use either hypnotism with suggestion alone or hypnotism with ca

tharsis, when Breuer had treated Anna O. during die years

1 8 8 1 - 1 8 8 2

and

had described the case to him as early as November 1882 and throughout

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1 8 8 3 ?

Presumably, by the time Freud opened his practice he had been

familiar with the idea of the cathanic method for a few years and would

have been eager to try it for

himself

I can not develop this line of

thought further here, except to say that a reading of HirschmuUer

( 1 9 7 8 )

leads one to question how much the story that we have come to know of

Anna O. was not the end result of much retroactive reconstruction by

Freud and Breuer that occurred years after the actual treatment of Bertha

Pappenheim.

But let's look even more carefully at the state of hypnotism at this time

and at the chronology of Freud' s use of hypnotism. In Germany, in 1888

and 1889, hypnotism gained momentum through the work of

Moll

and

Forel,

and in 1889 Krafft-Ebing emphasized the medical and therapeutic

aim of hypnotism. By

1 8 8 8 - 1 8 8 9 ,

the center of serious work in hypno

tism had shifted from France to German-speaking countries, and further

more it was now largely dominated by the influence of Bernheim.

In an article on Hysteria

( 1 8 8 8 b ) ,

Freud was already able to write that

in the direct method o f treating hysteria we look for the causes of hyste

ria in unconscious ideational

l i f e

(p. 56 ) , and he credits Breuer with the

method of leading patients

under

hypnosis back to the psychic origins of

their symptoms. He wrote that on ce Bernheim's ideas concerning the use

o f suggestion had more deeply penetrated medical circles, direct sugges

tion would

turn

out to be the best method for treating hysteria. It is

completely

unclear from reading Freud's paper

( 1 8 8 8 b )

how he recon

ciled

his

understanding

of Breuer's ideas and method with those of

Bern-

heim and the Nancy school.

Freud never regarded himself as particularly

adept

at hypnotism, and

he tells us that he went to Bernheim in Nancy to perfea his hypnotic

technique

( 1 9 2 5 ,

p. 17). During the years 1888 and 1889 he translated

Bernheim's

first book. He had contact with August

Forel,

a well-known

Swiss

psychiatrist, and in

July

and November of 1889 he wrote a review

o f Forel's work on hypnotism. It was

Forel

who introduced him to Bern-

heim. By 1889, in his review of Forel's

Hypnotism

about a year and a h a l f

after

beginning to experiment with the

clinical

use of hypnotism, Freud

would write quite authoritatively that he

himself

had reached an inde

pendent judgment in matters relating to hypnosis

( 1 8 9 0 ,

p. 93) , and he

asserts that his own patients improve through hypnosis.

If

Freud was just beginning to use catharsis at this time, then what else

had he been doing with his hypnotized patients? Using hypnotic sugges

tion, he would emphatically deny the patients' symptoms, give them as-

D o w n


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1 0 6 L E W I S ARON, Ph.D.

surances, commands, explanations, and posthypnotic suggestions. In an

1 8 9 1

article on hypnosis, Freud

adds

that he would question his patients

about the origins of their symptoms, but to do this they must be som

nambulistic,

otherwise they should not talk ( 1 8 9 1 , p. 112). This is a criti

c a l

point for us to

understand.

It was bel ieved that a hypnotized patient's

talking would be likely to lessen the

depth

of the trance, and therefore,

Freud could not use the cathartic method with patients unless they were

somnambulistic.** Freud correctly real ized that most patients were not

this hypnotizable. This would have meant that catharsis or any talking

therapy would only be useful with very few exceptionally hypnotizable

patients. So long as Freud was relying on direct suggestion, the

depth

of

the patient's trance did not matter very much, because the patient did not

have to talk; but with the cathartic method, the patient had to be verbally,

cognitively, and affectively active, and so if hypnosis was necessary, then

patients needed to be in a very deep or somnambulistic trance. In prac

tice,

Freud would not always get a deep trance. This is what drove him to

g o

to Bernheim to learn to pe rfea his hypnotic technique in 1889.

Freud's dissatisfaaion with his skill as a hypnotist and his ultimate shift

away from hypnotism were both due in

part

to his requirement that his

patient be more verbally active. Freud did not want to be the one doing

a ll

of the talking; he wanted to listen to his patient, so that he

himself

could learn. This represents a major

turning

point in his use of the

method, and we will

return

to this shortly.

What did Freud aaual ly learn from his visit to Bernheim? Freud

( 1 9 2 5 )

later wrote that his visit to Bernhe im in 1889 taught him the limitations of

hypnotic suggestion (p. 21). I think that the visit to Nancy was pivotal for

Freud, because Freud clearly got the idea from Bernheim, although

Bern-

heim had not yet articulated it in this way, that he could do psycho

therapy, which was at the time synonymous with hypnotherapy, without

inducing formal hypnosis. A number of things point in this direction.

Freud had brought a patient of his (Anna von Lieben) with him to Nancy

fo r

Bernheim to hypnotize; Bernheim failed to hypnotize her and told

Freud that he had his greatest success with hospitalized patients.

Bern-

heim taught that hypnosis was easier to induce in people accustomed to

passive obedience, and he had poor results with people in the higher

and wealthier classes. It must be considered that the working class and

peasantry tended to be in far greater awe vis-a-vis physicians and edu-

* Somnambulism refers to a very deep state of hypnosis in which the chief feature is sponta

neous amnesia.

D o w n


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cated

people generally. Liebault, from whom Bernheim had learned hyp

notism, was a country doctor whose patients were largely poor city peo

ple and local peasants who paid only what they could afford to nothing at

all.

Keeping in mind that Freud was in private practice and that his clien

tele came predominantly from the

upper

and

upper-middle classes,

we

can see that Freud would have had to modify his approach to make it

more useful with these patients. On his visit to Nancy, Freud was im

pressed with Bernheim's contention that posdiypnotic amnesia, the sine

qua non of somnambul ism, was not complete, that with concentration,

the pressure technique, and skillful questioning, the patient could re

member what had occur red even while in hypnosis. It struck Freud tiiat

one could access the unconscious directly through consciousness, with

out bypassing consciousness through hypnosis.

Bernheim's

theory that hypnotism was nothing other

than

suggestion

led

the way for the abandonment of the need to formally induce a hyp

notic trance. If hypnosis was not a special altered state, but was rather just

die product of suggestion, then the possibility was opened to not induce

a

formal state that mimicked sleep, but rather to attempt to use sugges

tion directly. This was the di reai on that Bernhei m was ultimately to take,

making less and less use of hypnotism. By 1892, Bernhe im suggested that

the word

hypnosis

be

dropped

in favor of the term

state of suggestion

Years later, Bernheim would write that modern psychotherapy, emanci

pated from hypnotism, is the creation of the Nancy school (quoted in

Ellenberger,

1970, pp.

8 0 4 - 8 0 5 ) .

B y

the time of Bernheim's next book

( 1 8 9 1 ) ,

which Freud translated in

1 8 9 2 (cited in Ellenberger, 1 9 7 0 ) , Bernhei m maintained that therapeudc

success

was not directly related to the

depth

of hypnotic sleep. Most

subjects,

he now taught, remain partially conscious

during

hypnosis, and

most hypnotic phenomena can be obtained with the subject awake. Ulti

mately, Bernheim's position led him to conclude that hypnosis was not a

special

state, and that all of the phenomena described by the term

hypno-

tism could have been discovered in the waking state.

In a lecture of April 27, 1892, to the Viennese Medical Club, Freud

espoused Bernheim's view of hypnotism and advised physicians to go to

Nancy to learn it (E llenberger , p. 485 , f 288) . And as late as in his 1893

paper on clinical hypnotism, Freud used Bernheim's method and not

catharsis (Freud,

1 8 9 2 - 1 8 9 3 ) .

Let

me then put forth my own reconst ruaion of Freud' s development

as a hypnotist

thus

far. Having begun with a strong neurological and

D o w n


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1 0 8 L E W I S ARON,

Ph.D.

somatisist approach to hysteria and hypnosis, Freud began using hypno

tism cautiously, along with the standard and more acceptable methods of

treatment of the day. He soon

felt

increasingly frustrated with these

meth ods—a nd bo re d by them as we ll —si nce they did not shed any light

on the orig ins or mean ings of hysterical symptoms. While it was under

Charcot's influence that he became seriously interested in the phenome

non of hypnosis and the descriptive diagnosis of hysteria, it was under

the inf luence of Be rnh ei m that Freud began to think psychologically

about t he dynamics of hypnot ism.' O nc e Freud was abl e to se e that hyp

nosis was largely a psychological phen omen on , he was abl e to begin to

move beyond the formalisti c induction o f trance. Freud, I bel ieve, was

mostly interested in investigating the p.sychological origins of his patients'

symptoms, their memories. Breuer had been lucky in his work with

Bertha Pappenheim because she went into deep trance states sponta

neously. As a matter of

fact,

as HirschmuUer 1 9 7 8 ) emphasizes, it was

only after she went into trances by herself, spontaneously, that Breuer

began to induce hypnosis in her. Freud went to Bernheim in the hope

that he would learn to deepen his patients' trance states, so as to allow

the patients to talk to him and thus investigate the orig ins of their symp

toms, and then eliminate the symptoms through suggestion. Instead,

Freud learned that he could have his patients talk with him directly,

while awake, and accomplish as much.

Freud was not alone in coming to these conclusions following his ex

posure to Bernheim. Freud was among a number o f leading hypnothera

pists who we re attempting to develop methods o f psychotherapy that did

not rely upon formal hypnotic induction. Bern he im, by showing that hyp-

noüsm was a

psYcV\o\ogica\

phenomenon—n ame\ y, that it was a form of

in te φ er sonal suggesti on—created the possibility for the shift from hyp

notic suggestion to verbal psychotherapy in the waking state. Bernheim

showed that the distinction bet ween states of consciousness was not ab

solute, and that through an act of will, patients could recall what hap

pened in hypnotic amnesia.

From

1889 to 1892, following his expe ri ence with Bernheim and coin

ciding with his treatment of Anna von Lieben, who Peter Swales ( 1 9 8 6 )

has documented as the patient Freud brought with him to Nancy, Freud

would place less and less emphasis on hypnotic trance and more and

•̂ This

is so in spite of tlie

fact that,

as Gauld

( 1 9 9 2 )

points out, it is an oversimplification to

de,scribe Bernheim's

theory

as psychological since his

early

speculations as to the

nature

o f the hypnotic state were neurophysiological.

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F R E U D

AS A

P S Y C H O T H E R A P I S T

109

more on understanding the meaning of symptoms and tracing their ori

gins.

Freud may have stopped trying to hypnotize her, or perhaps he just

stopped worrying about the

depth

o f her trance state. If patients could

overcome hypnotic amnesia while awake, then they could overcome

other motivated forgetting o r repression while awake as well. As Swales

( 1 9 8 6 ) has documented, Freud used the pressure technique that he

learned from observing Bernhe im; he questioned and probed re

lentlessly,

and free association asserted

i t s e l f

more or less spontaneously

in Freud's attempt to unravel the most intricate threads of his patient's

memory.

T h e claim that I am making is that by the early 1 8 9 0 s , largely due to the

impact of Ber nhe im's teachings, a number of leading hypnotherapists

were quickly abandoning the hypnotic procedure and evolving a variety

o f

forms of talking therapies that were conducted in the waking state.

These practitioners were , each in thei r own way, evolving from hypno

therapists to psychotherapists. To some degree we must take into consid

eration here that hypnotism had indeed attracted a lot of quacks, real

quacks,

who tended to bring it into disrepute, or at least to foster suspi

cions and mistrust among the public and within the medical community.

As

Swales remarks, by the early

1 8 9 0 s

hypnotism was far from being a la

mode. Freud's development of the free association method and of psy

choanalysis

was a part of this trend in the late 1 8 8 0 s and the 1 8 9 0 s and, in

this respect, it was absolutely a

part

of the Zeitgeist. However, Freud was

eager

to substitute something for hypnotic suggestion that was more his

own, and the very

specific

form that Freud's psychotherapy was to take

was highly distinct and reflected his own personal complex synthesis.

Let

me give a few examples to document this trend that I am describ

ing of hypnotherapists who were evolving into psychotherapists, largely

under the influence of Bernheim, during the early 1 8 9 0 s . Following his

b r i e f

visit to Nancy in 1889, Freud came to Paris, in the company of

Bernheim and Liebault, to attend the first International Congress on Hyp

notism. It is unclear whether Freud was in attendance when H. Bourru

and P. Burot presented a joint paper. However, these authors had pub

lished their ideas in a book the year before , and what is most important

is that these ideas were in wide circulation at the time. Bourru and Burot

proposed that the retrieval of traumatic memor ie s and the relieving of

the associated memories, both within and outside of hypnosis, was cura

tive. These authors emphasized the return to origins as well as the neces

sity for a kind of discharge or explosion (s ee Ell enberger, p. 76 0) .

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1 1 0

L EW I S

ARON, Ph.D.

At the same congress, A W. van Rente rghem and F. van Eeden de-

scribed their Clinic of Suggestive Psychotherapy. Ellenberger suggests

that this may have been the first time that the word

ρ

/€Ο ο ώ β τ α ρ \>

was

used in a congress (p. 760). These two Dutchmen were

under

the influ-

ence

o f Ber nhei m and established their

clinic

in 1887. Van Eeden pre-

ferred not to put his patients into a

deep

or somnambulistic state, be-

cause he bel ie ved that this interfered in furthering his aim of enlarging

the sph ere of effect iveness of the patient 's will. Instead, he devel ope d the

met hods of having patients passive lying still with closed eyes, and he

avoided using the terms

hypnosis

or

hypnotism

and pre fer red the term

psychotherapy

(quot ed in Gauld, 1992, p. 34 0) . Van Renterghem, while

still using hypnotism,

taught

that hypnotic suggest ion was not enough . He

emphasized that one must locate the underlying causes of the probl em

and try to alleviate it. Van Renterghem and Van Eeden's work was well

known among their contempor ari es, beca use of the detailed statistics

they published regarding their success rate.

Earlier I mentioned the work of Benedikt in Vienna and his ambiva-

lence regarding hypnotism. Benedik t had bee n attracted to hypnotism

following

his exposure to Charcot, but he was concerned about the deep,

almost mystical depe ndency of the patient o n the hypnotist. By 1891 ,

Benedikt argued veheme nt ly against hypnoti sm and in favor of psycho-

therapy on a conscious verbal level. Interestingly as well, Benedikt sug-

gested that the actual cause of hysteria was either a psychic trauma or a

functional d isturbance of the genital system or the sexual l i fe, and he

emphasized the ext re me impor tance of the patient's fantasy

l i fe

(see

Ellenberger, p. 76 4) .

As further evidence of how prevalent was the trend away from trance

induction, consider this statement by St rümpell in his inaugural lecture

as vice-rector of the University of Erlangen, in November of 1892, titled

On the origin and healing of diseases

through

mental representations.

He said, No heal ing occurs

through

hypnosis that could not have been

caused by other means (quoted in Ell enberger, p. 766, f 73)· Ellen

be rger concluded, Thus we can see that in 1892 there was a choi ce of

psychotherapies ranging from hypnotic suggestion and catharsis to the

combinati on of supportive, expressi ve, and directive therapy (p. 76 7) .

B y reducing hypnotism to suggestion, Bernheim made hypnotism less

appealing to those physicians trained in a somaticist tradition, who might

have been more attraaed to it as a method for exploiting a neuro-

pathological

condition, as it had been presented by the Paris school. On

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1 1 2 L E W I S ARON,

Ph.D.

technique, which was first thought to be important because of its neuro-

anatomical and neurophysiological underpinnings, Freud developed a

method that would ultimately

turn

out to be important because it al

lowed one person to understand and influence another psychologically.

With the abandonment of hypnotism, and the shift in interest away from

the depths of trance and the forms of consciousness and to the contents

o f

the patient's history and dynamics, much was gained, but there was

also much lost. It is only now, a century later, that as analysts we have

once again be come quite interested in our patient's states of conscious

ness.

For example , witne.ss the rising interest in the phe nomenon of dis

sociation. In a recent article, cowritten with Annabella Bushra (Aron &

Bushra, 1 9 9 5 ) , we have examined this resurgence of interest by contem

porary psychoanalysts in states of consciousness. Ther e we conc luded

that one important contr ibution of the p.sychoanalytic setting, as devel

oped by Freud, was that it created the condit ions wherein both patient

and analyst could move freely back and forth between a wide variety of

mental and behavioral states; that is, the analytic situation allows for mu

tual and optimal levels of regression within the analytic dyad.

With the shift from hypnotism to free association, the change was not

only from neurology to psychology, but practically, Freud's work re

versed the general flow of the conversation between the patient and the

doctor. Instead of using hypnotism to put the patient into a passive sleep

like

state, in which she was to listen to the doctor as he told her what she

felt

and what to do about it, Freud (following Br eue r) developed a

method in which the doctor was to listen to the patient as she told him

about her

life,

and thus, as Jessica Benjamin

( 1 9 9 5 )

described, patients

were transformed from passive

objects

of his investigations to become

speaking subjects. Of course, as Jo hn Forrester

( 1 9 9 0 )

points out, Freud

maintained his authority, in that it was he who decided what the patient 's

stories meant; nevertheless, a crucial step had been taken in destabilizing

the .structure of authority relat ions between doctor and patient.

Freud's method permitted him to be very much him.self as a therapist.

His tendency was to be an explorer, an investigator, an archeologist, a

puzzle solver, and the traditional methods of his day not only did not

work, but he frankly admitted that they bo red him, because they did not

permit him to use these aspects of himself fully. The method that he

developed had the distinct advantage, as he pointed out repeatedly, that it

was at one and the same time a method of treatment and of investigation

and research. To put this differently, Freud was comftmable with the fact

that the method met his own needs as wel l as the needs of his patients.

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114 LEWIS ARON, Ph.D.

243

West

End

Avenue

New York, NY

10023

Micale,

Μ . S.

{\99 )). Approaching hysteria.

Princeton, NJ: Princeton University Press.

I^iue,

J .

W., I.ynn, S.

J .

& Kirscli, I. ( 1 9 9 3 ) . Handbook of clinical hypnosis. Washington, Π Χ ;:

American

P.sychological Association.

.Swales, P.

( 1 9 8 6 ) .

Freud, his teacher, and the binh of p.sychoanalysis. In: Freud: Appraisals

an d

reappraisals: Contributions to Freud studies,

V.u.

P. E. Stepansky. Hillsdale, >f): The

Analytic

Pre.ss, pp. 3- 82.

Swales, P. ( 1 9 8 8 ) .

Freud, Katharina,

and the first

wild

analysis. In:

Freud: Appraisals and

reappraisals: Contributiom to Fretui studies, Ed. P. E. Stepansky. Hillsdale, .NJ: The Ana

lytic Press, pp. 8 1 - 1 6 6 .

Wolberg, L. R. ( 1 9 4 8 ) . Medical hypnosis: Volume 1, Ihe principles of liypnotherafiy. New

York: Grune & Straton.

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from hypnotic suggestion to free association: freud as a psychotherapist, circa 1892–1893

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