Literature and Medicine I

6In the Austrian countryside sanatorium he and Thomas have opened together, Jacques takes on the case of Fräulein Katharina von A, also known as Kitty. In the first paragraphs of his report, he records her as “a young woman, aged twenty-five years, [who] had been complaining for some time of severe lower abdominal pain, accompanied by infrequent vomiting” (379) and “in addition [...] reported chronic joint pain in the shoulders, elbows and fingers” (380). This is where Jacques’ scientific observations end. Instead of starting his treatment with a physical examination to either determine the physical cause of Kitty’s pains or to eliminate any potential physical reasons for her illness, Jacques immediately begins to probe his patient’s social background and life story to establish grounds for a psychoanalytic analysis of her problems. From the outset, he is convinced that Kitty is “a young woman of outstanding character” (379) as well as “of considerable education and self-possession” (380), but he also quickly forms the opinion that all these traits merely mask the hysteria which must be lingering underneath, that “the initial impression that this evidently thoughtful young woman gave to the world concealed an extremely troubled interior life” (382). Despite his observation that Kitty “seemed bemused by her symptoms” (381), he attributes her ability to bear her suffering to “what Charcot called the belle indifference of the hysteric” (382, emphasis in original), that is, the patient’s lack of concern regarding the causes and consequences of his/ her symptoms.

7An adaptation and amalgamation of the cases of Freud’s Ida Bauer (Dora) and Emma Eckstein, as well as of Josef Breuer’s Bertha Pappenheim (Anna O.),[3]See Lisa Appignanesi and John Forrester for detailed descriptions and analyses of these cases. Jacques’ fictions regarding the connection between Kitty’s physical pains and her life and sexuality grow increasingly improbable as his treatment of her continues. Like Freud’s Ida, Kitty has had homosexual fantasies and encounters as an adolescent and, like both Ida and Bertha, she has experienced brief losses of her ability to speak. Similar to the case of Emma - in which Freud persisted there were psychological reasons for a bleeding which had, in fact, been caused by a half-meter gauze which was left in Emma’s nasal cavity after a surgery – Jacques insists in the psychological causes of Kitty’s afflictions, which are later revealed to originate from ovarian cysts and rheumatic fever. Like Freud, then, Jacques misreads the narrative of Kitty’s bodily symptoms. His determination to find traumatic sexual encounters as the causes of Kitty’s somatic troubles leads him to several astonishing interpretations of her relationships with friends, parents and lovers.[4]I will only refer to parts of the case history which are particularly illustrative of my point here. For the full case history see Human Traces 379-98. Once his patient has told him about her affectionate relationship with her father, her fear of small animals, her homosexual desires and experiences as an adolescent, her subsequent habit of masturbating and her anger at her dying father’s replacement lawyer entering her bedroom without knocking, Jacques believes that this information provides him with “a fairly clear picture of the trauma that had precipitated her hysteria” (390). Not only that, but he is certain that this picture “must by now also be taking shape in the mind of anyone to whom the outline of the case has been related” (390). Hence mistaking his approach and interpretation of the case as common sense, he finds that

beyond doubt [...] a traumatic incident had been deliberately suppressed by her conscious mind because she found the implications of it intolerable [and] this sum of psychological excitation, being denied proper release, had converted itself easily through the pathways of somatic innervations into the distressing symptoms. (391)

Yet, Jacques believes himself an objective observer, much like his idol Charcot, who despite his sensational stage performances famously explained: “I am absolutely only the photographer; I register what I see” (qtd. in Showalter, The Female Malady 151).

8In his version of Kitty’s life story, Jacques claims that her abdominal problems, which first occurred when she heard of her father’s death, not a reaction to the loss of a man she had been close to, but are supposedly a sign of her desire for her father’s lawyer, Herr P, whom she has always disliked.[5]This is not dissimilar to the way in which Freud, in the case of Ida Bauer, argued that Ida’s desire for and relationship with Frau K was actually a displaced desire for Frau K’s husband, Herr K. Kitty’s anger at Herr P’s abrupt entrance on an occasion before her father’s death is, consequently, also easily explainable: not only was it actually Herr P – rather than his replacement – who entered the room that day but he also, contrary to Kitty’s memory and narrative, caught her masturbating. The aphonia Kitty reports to have experienced twice in her life is therefore, too, magically explained, since it is apparent to Jacques that at the time Kitty was caught masturbating, she was also fantasising about performing an act of fellatio on Herr P, which later physically manifested itself in the loss of her ability to speak. Finally, and possibly both most amusingly and disturbingly for the modern reader, Kitty’s fear of small animals apparently stems from the nickname “little weasel” (393), which she was given by Frau E, the woman with whom she had her first sexual encounter. To Jacques, the significance of this is that

in Katharina’s unconscious, the act of masturbating had become associated with the idea of small animals in their holes or burrows; doubtless Frau E-’s successful manipulation had involved the appearance of the clitoris from within its protective hood, like a timid animal that subsequently withdrew. (393)

Sexual fantasy, vivid imagination, and professional ambition merge, here, into one. Jacques plans to present and receive praise for his case history at a symposium in Vienna, an event at which the surely predominantly male audience would ponder collectively and scientifically over women’s “timid” and animal-like genitals during lesbian intercourse. Once Jacques has finished his “psychophysical resolution” (420) of Kitty’s case, the last step towards a cure, so he believes, is for her to accept his fiction as her own narrative, one he insists reflects the true traumatic events responsible for her physical illness. However, to his surprise, Kitty is unwilling to believe his invention of events which never happened and he notes: “Fräulein Katharina [...] would not concede that the incident I had interpolated into her story was necessarily true [and] she was not in a position to recognise it as something she had actually experienced: I believed it would have taken hypnosis to achieve that” (397-98, emphasis added). Jacques’ unconscious intention with Kitty is therefore the same as Freud’s was with Ida, namely “to penetrate the sexual mysteries of [...her] hysterical symptoms and to dictate their meanings to her” (159).

9Yet, despite these clear representations, Faulks lacks confidence in his readers (and in Kitty) to recognise the at best suspicious nature of the medical narrative Jacques has constructed. It is Thomas, who, having been asked by Jacques to give his opinion on the case history, instantly realises that Kitty is by no means a hysteric, but instead suffers from rheumatic fever and, as the hospital surgeon finds, has two cysts in one of her ovaries. With Thomas thus having heroically rescued Kitty from the potentially fatal misdiagnosis of his partner, Faulks feels the need to explain to us, step by step, the flaws of Jacques’ analysis in a painfully unsubtle way, namely by presenting us with Thomas’ written evaluation of the case. For Thomas, whom the modern reader is clearly supposed to trust and identify with, the problem with Jacques’ practice of psychoanalysis is his lack of consideration for physical symptoms and causes of illness, his misreading of them as a narrative which suits the needs of his theories and interpretations rather than serving an effective diagnosis and treatment of the patient. As Thomas aptly puts it, for Jacques even Kitty’s “apparent sanity is a symptom of her insanity” (429, emphasis in original) and, therefore, “she is trapped either way” (429). In fact, the only consistent rule underlying Jacques’ analysis of Kitty’s life, sexuality and dreams is, as Thomas cynically observes, that “everything is the opposite of what it seems – unless it is not, when it may be itself again. Anything can represent anything else – or its opposite!” (433). For Thomas, a firm believer in the potential of emotional care, it is not the act of talking as a therapeutic method which is at fault, but the fact that Jacques abuses his patient’s narrative to construct his own story. Jacques’ aim is, consequently, not to cure his patient by whatever means, but to find what he wants to find, that is, to alter Kitty’s narrative with his rigid, still underdeveloped theory rather than shaping his theory with consideration of her narrative. Thus mirroring the way in which “some of the openness to women’s words and feelings displayed in Studies on Hysteria had becomes codified in the interests of Freud’s emerging psychoanalytic system” (158), Jacques’ supposedly scientific case history, then, is more representative of the male doctor’s than the female patient’s fears and desires. Appignanesi argues that today, “depending on the interpreter or historian,” Freud is either “the heroic conquistador of the secrets of the unconscious, the great innovator whose talking cure definitively altered the treatment of madness, or the manipulative fraudster who launched a movement out of a mixture of fabrication and speculation” (194), and in Jacques it becomes clear that, for Faulks, he is certainly the latter. 

10Despite this critique of psychoanalysis as male overwriting of women’s narratives, from a feminist point of view Human Traces evokes a sense of disappointment. The cases of Ida Bauer, Emma Eckstein and Bertha Pappenheim have all acquired feminist significance in their own rights: Ida’s story has become an admired expression of female homosexuality, her decision to walk out on Freud and quit his treatment has been championed by feminists of various camps, providing, as Emma’s case, “a paradigm case for catching patriarchy with its pants down” (Appignanesi and Forrester 146). Similarly, Bertha’s hallucinations and her frequent loss of the ability to speak her native tongue have been considered as feminist rejections of the patriarchal order (see Hunter). However, although Faulks utilises these cases in his construction of Kitty, the novel lacks a gendered critique of psychoanalysis and its power relations, as its interrogations of mental health practices remain strictly scientific ones. Accordingly, the story’s female characters are of little consequence. Unlike Ida with Freud, Kitty does not walk out on Jacques, but has to be rescued from his misdiagnosis by Thomas instead. Even though she does not fall in love with her psychoanalyst, like Bertha did with Breuer, she does eventually marry her heroic rescuer Thomas and, ironically, does not become the first female analyst as Bertha did, but is content with co-managing the sanatorium’s accounts. Sonia, Thomas’s sister and Jacques’ wife, as well as Kitty are generally portrayed as relatively witty and intelligent, but they always remain within the realm of the famous angel of the house and act as their husbands’ complements, not their equals. Sonia in particular is repeatedly noted to be perfectly content and fulfilled by her role as mother and (betrayed) wife. Thomas is the rescuer of helpless women throughout the novel, from his secret removal and employment of two misdiagnosed and ill-treated inmates (Daisy and Marie) from an English asylum, to Kitty, with whom he falls in love when he reads her case history before having really met her. Whilst the ambiguous power relations of psychoanalysis are critiqued, they are reinstated through Thomas’ relationships with these female characters. Daisy tells him towards the end of the novel: “You gave us a life [...]. It was like being born again into a better world” (771-72). The modest and good doctor supposedly employed his power for the right purposes, but nevertheless the women he has rescued now fall on their knees before him to display their infinite gratitude – an ambiguous liberation.