Doctoring Freud

In 1915, while a medical student, Dr. Max Schur, the author of this latest biographical study of Freud, attended the course of lectures which were later published as the Introductory Lectures on Psycho-Analysis. After qualification, he practiced internal medicine and in 1928 became Freud’s physician and, as such, responsible for the management of the aftereffects of the cancer of the maxilla which Freud had developed in 1923—and of the surgery with which it had been treated. With one short interval he remained Freud’s physician until the latter’s death in 1939, becoming in the meantime a psycho-analyst himself. After Freud’s death he settled in New York, publishing numerous papers, of which at least two can be regarded as biographical essays on Freud. He himself died 1969 after having devoted many years to the preparation of this book.

Schur was therefore uniquely placed to write a monograph on Freud’s last illness. Even though he only came on the scene five years after the diagnosis of cancer had been made and the crucial surgery performed he had, of course, access to the earlier medical reports and knowledge of the standing and professional reputations of the various physicians and surgeons who had already treated Freud. However, Schur decided not to confine himself to matters which came within his own personal experience and professional competence as a physician, but to embark on a much more ambitious project—a psychoanalytical study of Freud’s attitude to death and of his relationships with men (Freud’s “latent homosexuality,” in both his own and Schur’s terminology).

To my mind this decision of Schur’s was unfortunate, even though—in view of his intimate knowledge of Freud as a friend and patient and his interest in psychoanalytical theory—one can easily understand and sympathize with his reasons for making it.

My reason for regretting that Schur did not resist the temptation to venture on a full-scale psychoanalytical study of Freud is twofold. First, Schur lacked the literary skill which might have enabled him to marry successfully a clinical account of Freud’s illness and a human one of Freud’s courage and endurance in the face of suffering. The sheer accumulation of clinical detail given in Schur’s last ten chapters does indeed leave the reader, especially if he himself happens to be medically qualified, in no doubt that Freud both suffered appallingly and bore suffering with fortitude, but Schur’s shifts from writing a case report to writing a human document, and from biography to autobiography, also leave the reader exhausted and confused.

Nor, incidentally, is Schur altogether successful in handling two embarrassing facts which emerge from his account of Freud’s illness. Freud behaved unwisely, and arguably even irresponsibly, when he first noticed that he had a growth in his mouth; and he was himself responsible for much of his suffering, since many of his later operations were the result of his refusal to give up smoking. “Refusal” not “inability” is unfortunately the right word; although Schur talks about Freud’s “nicotine addiction,” he also states unequivocally that he was capable of giving up smoking for weeks on end, but that the condition of his mouth was never his reason for doing so.

Secondly, Schur brought to his project a quality which I can only call intellectual innocence. He seems to have written Freud: Living and Dying without realizing the necessity of constructing any clear image in his mind of whom he was writing it for, and oblivious of the ironies and paradoxes involved in applying psychoanalytical concepts to the very person who first conceived them—and indeed of the methodological pitfalls that surround psychoanalytical biographies in general.

According to the introduction, “This book addresses itself not only to students of the behavioral sciences” but also to everyone interested in the application of psychoanalytical ideas to “education, anthropology, literature and sociology.” Nonetheless Schur uses not only psychoanalytical but also medical technical terms without explanation, so that in fact whole sections of the book will only be comprehensible to psychoanalytically trained doctors. He is also entirely haphazard in his selection of which characters mentioned in the text require introducing to the reader and what terms, social conventions, etc., require explanation. In general he assumes that his readers will be familiar with the names and careers of all the early analysts, even to the extent of knowing why Marie Bonaparte’s analysis had frequently to be interrupted on account of her “manifold private and social responsibilities,” but at the same time he finds it necessary to enlighten them as to the meaning of goy and in partibus infidelium. His definition of the latter is, incidentally, incorrect.

Schur’s obliviousness of the fact that there is something ironical and paradoxical about using Freudian ideas to analyze Freud himself shows itself in at least two different ways. First, one of Schur’s aims in writing this book was undoubtedly to affirm that Freud displayed exceptional courage and endurance in the face of illness and death, and that he achieved, after his self-analysis, an unshakable serenity, which enabled him, in spite of residual neurotic symptoms, in spite of occasional depressive moods, in spite of freedom from illusions, and in spite of years of continual physical pain, to remain creative and capable of enjoying life until the end. But it does not seem to have occurred to Schur that courage, endurance, and serenity are virtues which belong to a system of moral values which Freud himself unwittingly did much to undermine by his advocacy of psychic determinism. It is, after all, illogical to admire moral attributes if one believes that will is an illusion and that all behavior is causally determined, and paradoxical to admire them in the very person who converted the world to a determinist view of human nature.

Schur’s book is indeed a pretty example of the point made by Geoffrey Gorer in his essay in Psychoanalysis Observed that, in practice, Freudian concepts are only invoked to explain what used to be called vices and never to explain virtues. “I know of no studies to show people are not really responsible for their heroism or piety, their diligence or their integrity.”

Schur does, however, have interesting things to say about how Freud retained his serenity throughout his illness and pain. He argues convincingly that Freud’s formulation of the death instinct concept (to which Schur himself does not subscribe) “enabled him to deal better with his own fear of death,” and that his refusal to give up smoking derived from his conviction that it enabled him to remain creative—presumably, though Schur does not quite say so, by helping him to “bind” anxiety.

Secondly, Schur seems not to appreciate that there is something tautological about analyzing Freud by applying his own ideas. If one grants, as one obviously must, that Freud was an honest and creative person, then the ideas that he formulated during his self-analysis must of necessity correspond in some way to his personality. To reapply, as Schur does, these ideas back again onto Freud is therefore to do no more than reassert the existence of the correspondence which can originally be assumed.

This tautology can, of course, be obviated in three different ways: by demonstrating that Freud’s genius resided precisely in a degree of detachment which enabled him to observe himself as though he were someone else; by showing that many of the concepts used by Freud in his self-analysis in fact arose during his contact with his patients, in which he would have been analyzed as much by them as by himself; and thirdly, by showing that the concepts Freud arrived at during his self-analysis are as applicable to others as to himself. This last course was in fact that adopted by Freud himself, and it would be possible to describe the development of psycho-analysis as a process by which Freud’s private, introspective hunches have been sifted clinically, by himself and his followers, some becoming public, scientific concepts, while others have been discarded.

Unfortunately, however, Freud’s authority has been such that there is a real possibility that ideas which should have remained part of his own private myth may have become accepted as universally valid. This is, I suspect, true of two concepts used by Schur in analyzing Freud’s attitude to death; so that, as a result, Schur’s interpretation of Freud’s personality is in all essentials identical with Freud’s own conception of himself.

The two concepts I have in mind are, first, that relationships to men can be explained in terms of “latent homosexuality” and, secondly, that the ego has a “narcissistic libidinal cathexis” derived from its identification with (introjection of) past lost and abandoned objects—in other words, that homosexuality is an instinct, against which defenses have to be erected before “aim-inhibited,” “sublimated” friendships with men can develop (rather than, as some contemporary analysts including myself would hold, a defensive strategy used by persons with conflicts about power and doubts about their sexual identity), and that the core of the ego is self-love and not a sense of community or identity with present objects.

These two ideas, “latent homosexuality” and the narcissism of the ego, play an essential part both in Freud’s general theory of the origin of the fear of death (which Freud assumed to be universal) and of Schur’s specific interpretation of Freud’s personal attitude to death. The intimate connection between them can be demonstrated by juxtaposing two apparently unconnected quotations from Freud, but before doing so it is necessary to summarize briefly the thread of Freud’s biography with which Schur is particularly concerned.

Freud’s father died in 1896 at the advanced age of eighty-one, when Freud himself was aged forty. Freud reacted to his father’s death by something other and more than normal grief. Why this was so does not emerge from either Schur’s or Jones’s account, but Freud’s later writings on religion suggest that he must have deified (or idealized) him. In any case, he developed anxiety, depression, and other neurotic symptoms, and embarked on his self-analysis. Although much of this self-analysis consisted of writing The Interpretation of Dreams (1900), another component of it was his relationship with Wilhelm Fliess, a nose and throat specialist in Berlin who was addicted to what now seem merely fanciful numerological speculations about biological periodicity. Fliess and Freud corresponded regularly and met for “congresses.” Their conversations were not recorded and Fliess’s letters to Freud do not survive, but Freud’s to Fliess do and form the basis of our knowledge of what Jones called “the only really extraordinary experience in Freud’s life.”

According to Schur, Freud’s letters to Fliess display “transference-like manifestations with their effusive admiration and hidden, denied ambivalence,” while Jones refers to the relationship as a “passionate friendship.” Both agree that Freud identified Fliess with his father, though in other respects their interpretations of the “Fliess episode” do not always tally.

However, like so many passionate friendships between men, that between Freud and Fliess ended bitterly. Freud eventually found it impossible to conceal from either himself or Fliess his disbelief in Fliess’s numerological theories, and was also deeply mortified by Fliess’s dismissal of his psychological theories with “The thought-reader merely reads his own thoughts into other people”; while Fliess, in 1906, some years after intimacy between the two had ceased, publicly charged Freud with leaking his (Fliess’s) ideas about bisexuality to one of his patients.

However, in 1910 Freud was still preoccupied with Fliess, as a letter to Ferenczi shows:

You not only noticed, but also understood, that I no longer have any need to uncover my personality completely, and you correctly traced this back to the traumatic reason for it. Since Fliess’s case, with the overcoming of which you recently saw me occupied, that need has been extinguished. A part of homosexual cathexis has been withdrawn and made use of to enlarge my own ego. I have succeeded where the paranoiac fails. [Schur, page 256]

In other words, Freud, in his own view, got over the loss of his friendship with Fliess at the cost of losing his need and capacity for intimacy and by becoming more than averagely self-sufficient and narcissistic.

This is the first of the two quotations I wish to juxtapose. The other is from The Ego and the Id (1923).

It would seem that the mechanism of the fear of death can only be that the ego relinquishes its narcissistic libidinal cathexis in a very large measure—that is, that it gives up itself, just as it gives up some external object in other cases in which it feels anxiety. I believe that the fear of death is something that occurs between the ego and the super-ego. [Schur, page 367]

Now, although this second quotation purports to be an objective and generally applicable explanation of the fear of death, comparison with the first, admittedly subjective letter entitles one to question its universal validity. It is, in fact, by no means self-evident that Freud’s relationship with his father and then Fliess has its counterpart in everyone’s biography, or that everyone becomes so preoccupied with their past objects that their attitude to death can be explained without reference to their present ones. Freud’s idea that “the fear of death is something that occurs between the ego and the super-ego” assumes, it seems to me, a greater degree of internalization, introversion, and self-sufficiency than is usual, and ignores completely the role played by fear of separation from those who are loved now and concern for the future of those who will be left behind.

There is, however, no need to believe that Freud’s explanation of the fear of death was true even for himself, since to do so would be to take it for granted that the surviving, written evidence, whether personal or theoretical, left by Freud is an accurate and complete reflection of his attitude toward living and dying. Inhibitions, personal reserve, social conventions, the fact that people have no need to write letters to those they live with and see daily, and the further fact that many people adopt a specific attitude when they put pen to paper, or only do so in particular moods, may all contribute to produce a biased weighting of the available written evidence. Although Freud wrote more about his (and other people’s) relationships with his father and other men, he also had largely unrecorded relationships with his mother, his wife, his sisters, and his daughters.

Schur, I think, fails to appreciate this methodological pitfall to psycho-analytical biography. He also falls into the rather similar trap of interpreting single threads in Freud’s life in isolation from its total pattern. For instance, he discusses Freud’s “latent homosexuality” in relation to his father, to Fliess, and to his disciples but not in relation to his brothers and sons, and does so as though it were possible to interpret a man’s attitude to other men without considering his attitude toward women. Although Schur may perhaps have had good discretionary reasons for restricting himself in this way, he gives no indication of appreciating the extent to which he diminished the psycho-analytical value of his book by doing so.

He seems also to have been oblivious of one further catch about writing psychoanalytical biographies. This is that what is sauce for the goose is sauce for the gander. Schur assumes that his knowledge of psychoanalytical theory enables him to make valid interpretations about Freud’s unconscious motives, and to use slips of the pen and even turns of phrase as evidence of, for instance, Freud’s unconscious ambivalence toward father figures. But since Freud was patently a father figure to Schur, the same assumption would enable and entitle any reader of Schur to recognize and draw attention to evidence of Schur’s unconscious hostility toward Freud. I shall, however, refrain from doing so and confine myself to expressing the opinion that Schur committed an error of taste in recounting the clinical details of Freud’s final physical decay in a book intended for the general reader.