Women on the Couch: Genital Stimulation and the Birth of Psychoanalysis
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Psychoanalytic Dialogues: The International
Journal of Relational Perspectives
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Women
on the Couch: Genital Stimulation and the Birth of Psychoanalysis
DOI: 10.1080/10481885.2011.595316
Karen E. Starr Psy.D.a* & Lewis Aron Ph.D.a
pages 373-392
Published
online: 18 Aug 2011
Abstract
Following Freud's emphasis on his rejection of hypnosis as leading up to
the development of psychoanalysis, there has been little mention in the
psychoanalytic literature of the larger context of the somatic medical
treatment of hysteria within which Freud treated his hysterical patients, and
which Freud himself practiced. We contend that Freud's emphasis obscured his
association with massage, electrotherapy, and the procedure of genital
stimulation practiced by his medical colleagues in the treatment of hysteria.
We show that the history of genital stimulation—including its obfuscation,
desexualization, medicalization, and co-option from traditional women healers
by an exclusively male medical establishment—provides us with the background
for a more sophisticated understanding of the context in which Freud developed
his theories. Specifically, we examine the contribution of this understanding
to Freud's theoretical emphases on autonomy and individuality, abstinence and
the renunciation of gratification, penis envy, clitoral versus vaginal orgasm,
mature genital sexuality, and the “repudiation of femininity” as the “bedrock”
of psychoanalysis. We demonstrate that Freud's position as a Jew in an
anti-Semitic milieu fueled his efforts to distance his psychoanalytic method from
the more prurient practices of his day, including one his society associated
with Jewish doctors and patients.
Since the time of Hippocrates until the early 20th century, hysteria was
associated with the pathology of female sexuality and reproduction. As such,
the female genitals became the site of medical attention and intervention.
Genitals were massaged and electrically stimulated as well as shocked,
cauterized, and surgically altered. While all these interventions are relevant
to an understanding of the medical approach to hysteria—indeed they are “two
sides of the same coin of the patriarchal, medical control of female sexuality”
(, p. 165)—the present contribution focuses only on genital stimulation via
massage and electricity. Genital stimulation was a standard practice in the
treatment of hysteria, one of several procedures in the medical toolkit of
women folk healers and midwives, and later, male physicians and/or their female
assistants. What we mean by the term genital stimulation is literally the
bringing of the female patient to orgasm through the manipulation of the
genitals via manual massage (fingers of the medical practitioner or the
practitioner's assistant), hydrotherapy (water pressure massage aimed at the
pelvic area), vibratory massage (via electrically powered mechanical
vibrators), or the application of an electrical charge to the genital or pelvic
region (electrotherapy). Although this treatment was at times controversial—its
documentation in Western medical texts all but disappeared during the Middle
Ages, resurfacing in the Renaissance—it nevertheless remained an accepted
practice of Western medicine for over 2,000 years.
The history of this procedure as a treatment for hysteria is well
documented in feminist scholarship, the cultural history of sexuality, the
history of women in medicine, the history of electrotherapy in psychiatry, and
the history of women's orgasm and the electro-mechanical vibrator. Detailed
instructions for the medical practitioner are provided in ancient Greek medical
texts, Renaissance medical compendia, and modern 19th- and 20th-century medical
handbooks on massage, vibra-massage, and electrotherapy. Yet despite the
ubiquity of this documentation, and although the majority of these historians
reference the same primary sources, genital stimulation as a treatment for
hysteria is rarely mentioned in the major mainstream or even feminist histories
of medicine, psychiatry, or hysteria—and even then, only briefly, obscurely,
and in passing.
1 It is not, to our knowledge, ever referenced in the history of
psychoanalysis, Freud biographies, or intellectual histories, despite its being
one of the accepted medical treatments for hysteria practiced by gynecologists
and neurologists, integral to the backdrop of medical knowledge against which
Freud developed his psychoanalytic method and presented it to the European
medical establishment.
In “On Beginning the Treatment,” Freud's procedural recommendations for
practicing analysts, Freud
(1913) He writes,
I must say a
word about a certain ceremonial which concerns the position in which the
treatment is carried out. I hold to the plan of getting the patient to lie on a
sofa while I sit behind him out of his sight. This arrangement has a historical
basis; it is the remnant of the hypnotic method out of which psycho-analysis
was evolved. (p. 133)
We contend that the Freudian analytic couch, with its reclining, usually
female, patient, is an artifact not specifically of the practice of hypnosis,
as Freud maintained, but also of massage and electrotherapy—that is, the
general private practice neurology of Freud's day. We make the case that
Freud's emphasis on his rejection of hypnosis as leading to the creation of
psychoanalysis masked his knowledge of, and obscured his association with,
massage, electrotherapeutics, and the procedure of genital stimulation
practiced by his medical colleagues. Freud was German by culture, Jewish by
religion or ethnicity, and Austrian by nationality. Freud's position as both
insider and outsider—male German scientist and Jew—and his desire that
psychoanalysis be accepted as a universal, not a specifically Jewish, science
fueled his efforts to distance his psychoanalytic method not only from hypnotic
suggestion but also from the more prurient practices of his day. Although
genital stimulation as a treatment for hysteria was implemented in Europe and
North America by both Jewish and non-Jewish practitioners, in the region of
Europe in which Freud lived and worked, it was a procedure that was closely
associated with Jewish doctors and patients
Note that we are not claiming any direct knowledge that Freud himself
practiced genital stimulation. However, we do know that Freud acknowledged
doing full body massage as he listened closely to his early patients, owned the
best electrical equipment available, and claimed to practice all of the standard
treatments of his day so he may very well have done so, and would certainly
have been exposed to it in his years of training. We show that Freud was well
aware of and knowledgeable about this practice, obfuscated this knowledge in
his autobiographical narrative, and sought to distance himself and the
psychoanalytic method as far away from it as possible.
Muriel Dimen (2003) has articulated the need for a conversation among
psychoanalysis, social theory, and feminism in order to rethink our ideas about
gender and sexuality. Following her lead, we emphasize an overall cultural
history using these approaches. We examine some of the material realities
underlying the dualities masculine/feminine, active/passive, clitoral/vaginal,
professional/personal, and doctor/patient. Doing so uncovers a wide range of
variables, including attention to class, race, and sexual orientation; and the
inevitably associated varieties of classism, racism, anti-Semitism, homophobia,
and misogyny.
We briefly review the medical/sociocultural/historical understanding of
women's sexuality as it relates to the psychiatric treatment of hysteria and
show that the history of genital stimulation—including its obfuscation,
desexualization, medicalization, and co-option from traditional women healers
by an exclusively male medical establishment—provides us with the background
for a more sophisticated understanding of the context in which Freud developed
his theories. We must emphasize that in making our arguments, we are drawing
upon a distinguished body of existing historical research; however, our unique
contribution as clinicians is to highlight important implications for clinical
theory and practice. Specifically, we demonstrate that the history of genital
stimulation provides us with deeper insight into Freud's theoretical emphases
on autonomy and individuality, abstinence and the renunciation of
gratification, penis envy, clitoral versus vaginal orgasm, mature (genital)
sexuality, and the “repudiation of femininity” as the “bedrock” of
psychoanalysis (, p. 252).
“SUFFOCATION OF THE MOTHER”
AND ORGASM-BY-PROXY
Early written medical references to the practice of genital stimulation
are unequivocally direct and explicit as to the sexual nature of the symptoms
and their treatment. Hysteria, derived from the Greek word for womb or uterus,
was considered a symptom of woman's insatiable and/or dislocated sexual desire.
Plato described the “wandering womb” as a lustful, angry, and suffocating
animal, ravenous for release. Lacking sexual satisfaction, it was thought to
pull up into the throat, causing the choking and shortness of breath associated
with hysteria. Following Plato's formulation, later writers referred to
hysteria as the “suffocation of the uterus” or the “suffocation of the mother” ,with
“mother” serving as a metonym for “womb.” The ancient Greek physician Galen
(130–200 C.E.) attributed hysteria to lack of sexual gratification, particularly
in passionate women, believing the uterus became engorged with unexpended seed,
in need of release through orgasm. Galen documented the treatment of a widow
with hysteria by the rubbing of her genitals with ointment until she released a
“quantity of thick seed” (as cited in Warren, 2004,p. 172), which cured her of
her symptoms.
A translation by Rudolph Siegel gives the following details:
Following
the warmth of the remedies and arising from the touch of the genital organs
required by the treatment, there followed twitchings accompanied at the same
time by pain and pleasure after which she emitted turbid and abundant sperm.
From that time on she was free of all the evil she felt. (as cited in Maines,
199941, p. 24)
Reflective of later sexual taboos and the power dynamics surrounding
female sexuality and medical authority embodied by this treatment, accounts of
Galen's case history vary in their translation as to who actually did the
prescribing and the rubbing—whether it was the widow applying the remedy to
herself on the advice of a midwife; a midwife practicing a commonly known folk
treatment of the day; a midwife instructed by Galen; or Galen, the male
physician, implementing this procedure on his female patient (Warren,
2004). The ambiguity of the practitioner's identity as evidenced by the
differing translations is indicative of the societal discomfort with women's
sexuality, the accompanying taboo against masturbation—autonomous clitoral
stimulation—and the eventual transformation of the midwife from general
practitioner to, at best, physician's assistant; at worst, a witch who would be
brutally exterminated.
As Ehrenreich
and English (1973) documented, until the creation of the upper-class,
university-based, church-controlled medical profession from which women were
excluded, women folk healers and midwives served as general practitioners to
the masses. It was these women, rooted out and burned as witches (together with
their hysterical patients) specifically because they practiced the healing
arts, who provided gynecological treatment and treatment for women with
hysteria. It was the midwives, not the university-trained male physicians, who
had empirical experience with remedies that actually worked. Following the witch
hunts, female healers were permanently discredited by the male medical
profession as “superstitious and possibly malevolent” (p. 19) and as
prescribing “old wives”' remedies. The practice of midwifery, previously the
function of these lower class women, was brutally co-opted by the upper-class
male medical profession. Ousted from her role as practitioner, the midwife was
relegated to assistant to the male physician. What came to be known in the
Western medical canon as “Galen's widow's treatment,” originally the personal
province of the female patient and her midwife was transformed by the
establishment of an exclusively male medical profession into a medicalized,
desexualized orgasm-by-proxy. What had once been an exclusively female domain
now required the intervention of the male physician, or, to avoid the
condemnation of the church and the “shame of the physician's probing hand,” his
female assistant (Schleiner,
1995 , p. 115).
Islamic physician Ibn Sina (930–1037 C.E.), the “father of modern
medicine,” better known by his Latinized name, Avicenna, incorporated “Galen's
widow's treatment” into his own medical system, which became part of the
standard medical corpus for centuries. While written documentation of genital
stimulation went underground in the West during the Middle Ages, due to the
church's control of the medical profession (Schleiner,
1995), the treatment continued to be documented in Islamic medical texts.
Later medical writers invoke Galen and Avicenna's authority when instructing
their contemporaries in use of this technique. Here is one example from the
Renaissance, from a chapter on the treatment of hysteria in Pieter van
Foreest's 1653 medical compendium, Observationem et Curationem Medicinalium
ac Chirurgicarum Opera Omnia:
When these
symptoms indicate, we think it necessary to ask a midwife to assist, so that
she can massage the genitalia with one finger inside, using oil of lilies, musk
root, crocus, or [something] similar. And in this way the afflicted woman can
be aroused to the paroxysm.
2 This kind of
stimulation with the finger is recommended by Galen and Avicenna, among others,
most especially for widows, those who live chaste lives, and female religious,
as Gradus [Ferrari da Gradi] proposes; it is less often recommended for very
young women, public women, or married women, for whom it is a better remedy to
engage in intercourse with their spouses. (as cited in Maines,
1999, p. 1)
While the instructions are unmistakably clear, it is important to note
the desexualization, medicalization, and assumption of patriarchal medical
authority inherently reflected in this prescription. We can read the author's
attunement to the religious and moral criticisms he is stirring up in the pains
he takes to deflect them. He attributes the procedure to established medical
authorities Galen and Avicenna; indeed, the term “Galen's widow's treatment”
continued to be used as a euphemism for genital stimulation into the early 20th
century. The male physician distances himself from the female patient and from
her sexual arousal, not to mention the possibility of his own sexual
arousal—which, notably, is an issue not raised in any medical texts—through the
introduction of the midwife as an assistant, while maintaining himself as the
one in charge. The patient's resulting physical contractions are called a
“paroxysm,” a term that simultaneously medicalizes and desexualizes female orgasm,
and which continued to be used in medical descriptions of hysteria well into
modernity. This term had a double use, further obscuring what was being done:
it was used for both the symptom of hysteria—the attack or fit—and for the
orgasmic release caused by the treatment.
Woman's desire and sexual satisfaction are erased; typical of most
medical writings on the subject, there is no mention of either in the text,
except to pathologize them. In fact, some medical authors instructed the
physician to test the patient for sexual desire by titillating the clitoris
first; if the physician detected any sign of sexual desire or pleasure in the
patient, the treatment was abruptly stopped (Schleiner,
1995). One can only imagine how these women patients dealt with this
paradoxical demand, which seems to have required an interesting reversal of
what today we might think of as “faking it.” Perhaps not surprisingly,
physicians often, at least publicly, conveniently blurred the distinction
between agony and ecstasy and interpreted the cries of women experiencing
paroxysm as cries of pain.
We can read in the above Renaissance author's selection of appropriate
treatment candidates his deference to the sociocultural and religious mores of
his time. He restricts the treatment only to a certain subset of unmarried
women—the chaste, religious, and widowed—while he prescribes married women
intercourse with their husbands. Later, as the treatment is further
medicalized, mechanized, and desexualized through the introduction of
electricity and its associated technology, we read of married women regularly
visiting spas or being brought by their husbands to physicians' offices for
this treatment (Maines,
1999.).
The idea of autonomous clitoral self-stimulation is implicitly negated,
in keeping not only with the public moral and religious proscriptions against
masturbation in both sexes but also, and most significantly, with the confused
and conflicting medical views of female sexual pleasure as pathological,
nonexistent, or requiring male penetration. Professional medicine was
inextricably linked with cultural and theological considerations. In 1627,
French physician Francois Ranchin posed in writing the question of “Whether One
is Allowed to Rub the Vulva of Women in Hysterical Paroxysm.” While
acknowledging it as “a well proven therapy” and judging it “inhuman to
recommend against the use of that salutary method,” he nevertheless concluded,
“We, however, following the teaching of the theologians, hold friction of this
kind to be abominable and damnable, particularly in virgins, since such
pollution may spoil virginity” (as cited in Blackledge,
2004, p. 204). In order to further avoid the implication of sexual
impropriety and to guard against the inadvertent titillation of the lay reader,
the practice of genital stimulation was often described in medical texts only
in Latin; the texts were sold only to doctors and lawyers, and were not
available to the public. Through the 19th century, doctors would turn to Latin
also when speaking about sexual matters in front of their patients (Furst,
2008; Schleiner,
1995).
Although medical practitioners went to great lengths to denude genital
manipulation of its (to us) obvious sexual implications, they still drew moral
criticism, often from their own competitors! Dr. Thomas Nichols, who together
with his wife, Mary Gove Nichols, owned a hydrotherapy establishment in New
York City in the 1800s, castigated a fellow New York physician, a “mercenary
and libidinous wretch” whose medical practice included “manipulations and
anointings, managed in such a way as to stimulate the passions and produce a
temporary excitement of the organs which his deluded victims mistake for a
beneficial result.” Nichols noted that this masturbatory cure was “extremely
lucrative,” attracting “thousands of women” in New York City alone, and “has
been taken up in other places.” While Nichols assumed that “every pure-minded
woman” condemned these “shameful practices,” his own water cure offerings
included “local treatment best fitted to give tone to the whole region of the
pelvis,” including “frequent vaginal injections” and wet bandages “carefully
and tightly applied” (as cited in Sklar,
1974, para. 37, 38).
“WOMAN EXISTS FOR THE SAKE OF
THE WOMB”
By the 19th century, the euphemistic terminology for genital stimulation
reflected the reflex theory of hysteria, which held that hysterical symptoms
could result from irritations in any organ or body part. Interventions applied
to the hypothesized origin of irritation were referred to as “local”
treatments; in women, who made up the vast majority of hysterical patients, it
was usually the ovaries, uterus, or genitals that were considered the source of
the problem (Shorter, 1992). This view was consonant with the general medical
attitude of the time, which not only equated woman with her reproductive
function—propter uterum est mulier, “woman exists for the sake of the
womb” went one famous medical saying (Holbrook,
1875, p. 14)—but also considered the uterus a “highly perilous possession”
(Wood,
1973, p. 29). The perils of menstruation, including its onset, absence, and
irregularities, as well as the precarious position of the morbidly mobile
uterus, were considered responsible for women's propensity to nervous illness,
thought to be more than double the rate of men's. In an 1870 medical
conference, Professor Hubbard of New Haven lectured his physician colleagues,
The sympathies of the uterus with every other part of the female
organism are so evident, and the sympathetic relations of all the organs of woman
with the uterus are so numerous and complicated, so intimate and often so
distant, yet pervading her entire being, that it would almost seem … “as if the
Almighty, in creating the female sex, had taken the uterus and built up a
woman around it.” (Holbrook,
1875, p. 15)
In combination with reflex theory, the proposed link between the uterus
and every other part of the woman's body led to what Shorter
(1993)called a “busybody approach to the vulva” or “clitoral
meddlesomeness” (p. 82) in the treatment of hysteria. These interventions all
fell under the category of “local” treatments and ranged from the more benign
to the downright sadistic. Genital stimulation via massage and electrotherapy
was called “local massage” or “local friction,” referring to the application of
manual massage, hydro-massage, the mechanical vibrator, or electrical charge
directly to the pelvic, genital, or rectal local region responsible for the
hysterical reflex. Other, far less pleasant, “local” treatments included
leeching, injections, electrical shocks, cauterization, clitoridectomies, and
other gynecological surgeries.
Paradoxically, although medical stimulation to paroxysm—desexualized
orgasm by proxy—was acceptable, autonomous masturbation was not. To be
clear—masturbation in both sexes was discouraged; autonomous orgasm, which fell
outside the realm of procreation, was considered unhealthy and immoral.
However, there was an additional factor for discouraging clitoral masturbation
in women that was not true for men, namely, the entire concept of women's
sexual satisfaction via the clitoris was intolerable because it had no
connection with reproduction and made women seem too much like men—capable of
autonomous sexual pleasure without penetration. Women who performed clitoral
self-stimulation were considered as wanting to be like men.
Male discomfort with this active (and therefore, “masculine”) aspect of
female sexuality is evident in the centuries-long lacuna in documented medical
information about the clitoris. Although much was known about the clitoris'
structure and role in sexual pleasure in the 17th century, for the next 300
years, most of this information was dismissed, overlooked, or, in a magical
medical vanishing act, made to disappear altogether from anatomy textbooks (Blackledge,
2004. Laqueur
(1990) documented that while 19th-century scientists were well aware of the
anatomical role of the clitoris in orgasm, many medical writers claimed, with
no evidence, that most women did not feel the sexual pleasure of
clitoral orgasm. Viewed through the lens of a male-centric medical model,
women's sexuality was put in its place—in a passive position and dependent on
men. Men, in defining their own masculinity—in order to feel themselves “real
men”—believed women needed to be passively penetrated in order to achieve
sexual satisfaction.
The clitoris was equated with the penis, and as such, fell short; the
vagina, which required a man to penetrate it and was necessary for
reproduction, was more comfortably considered by the male medical profession
and society in general to be the locus of a woman's sexual satisfaction. Female
sexual satisfaction, if its existence was posited at all, was relegated to
penetration via intercourse with a husband, with conception as its aim (Blackledge,
2004
). A common prescription for the cure of hysteria was “women married
happily and at a sufficiently early age becoming mothers” (as cited in Kneeland
& Warren, 2002
, p. 31). Masturbation in both sexes was considered a moral evil, a
source of the genital irritation responsible for hysteria; cauterization and
genital surgeries were regularly practiced on children in order to prevent them
from masturbating (for a review, see Bonomi,
2009
). Immediately following his training with Charcot in 1886, Freud
trained in pediatrics with Adolf Baginsky, a German professor of diseases of
children, who was well known for identifying masturbation as a main cause of
hysteria in both children and adults (Bonomi,
19986. Bonomi , C. 1998. Freud and castration. Journal of the
American Academy of Psychoanalysis, 26: 29–49.
). It must be emphasized that Freud's understanding both of hysteria and
of women's sexuality was situated squarely in the midst of this medical and
cultural milieu, a context that undoubtedly influenced his later psychoanalytic
theorizing.
“PLAYING WITH THE JEW”
In late 19th-century France, genital manipulation was commonly used both
to elicit and stop hysterical fits, a practice Foucault called the “laying on
of hands” with regard to Charcot's treatment of women hysterics (Micale,
2008). Although maintaining that hysteria was not exclusive to women,
Charcot still retained the gynecological model, transposing it onto men! He
applied testicular compression to his male hysterical patients, resulting in
the paradoxically male version of “suffocation of the mother”—the sensation of
something moving from the stomach toward the neck, creating a sense of
suffocation. Gilles de la Tourette was reportedly so inspired by this
phenomenon that he labeled these hysterogenic areas “les zones
pseudo-ovariennes” (Micale,
2008, p. 155).
Not only did Charcot extend what was commonly viewed as the female
illness of hysteria to men, but he also applied it in particular to Jewish men,
who were considered feminine in the eyes of the larger anti-Semitic European
culture, while Jewish women were considered masculine and hypersexual (Boyarin,
1997; Gilman,
1993b). In a perfect blending of anti-Semitic fantasy and pseudo-scientific
anatomy, the circumcised penis of the male Jew was equated with the female
clitoris; both were considered an inferior penis. In the German vernacular of
Freud's day, female masturbation was called “playing with the Jew” (Gilman,
1993b).
As an acculturated German Jew, well acquainted with his society's
anti-Semitic insults, Freud was undoubtedly familiar with this felicitous
phrase. In fact, in later developing his theory of castration anxiety, Freud
specifically posited a connection between the hatred of Jews and feelings of
superiority over women, with circumcision and castration at its root. In a
footnote to the case of Little Hans, Freud
(1909) wrote,
The
castration complex is the deepest unconscious root of anti-Semitism; for even
in the nursery little boys hear that a Jew has something cut off his penis—a
piece of his penis, they think—and this gives them a right to despise Jews. And
there is no stronger unconscious root for the sense of superiority over women.
(p. 36)
Charcot, who represented the cutting edge of the somatic treatment of
hysteria, maintained it evident from his scientific research that Jews had a
strong predisposition to hysteria, a fact he attributed to their unwillingness
to intermarry (Gilman,
2010). In the medical literature of Freud's day, Jewish endogamous marriage
was medicalized as “inbreeding,” lending scientific authority to the
anti-Semitic characterization of Jews as an incestuous, perverted, and degenerate
race (Gilman,
1993b). In a Judaicized variation of the “suffocation of the mother” theme,
French historian Leroy-Beaulieu, informed by Charcot's ideas, wrote in his
(pro-Jewish) 1895 study of anti-Semitism, The Jew is the most nervous of men,
perhaps because he is the most “cerebral,” because he has lived most by his
brain. All his vital sap seems to rise from his limbs, or his trunk, to his
head. On the other hand, his overstrained nervous system is often apt, in the
end, to become disordered or to collapse entirely. (p. 168)
Again, we see the male Jew identified with the hysterical woman.
Ironically, although Leroy-Beaulieu deplored anti-Semitism, he emphasized that,
unlike the other anti-Semitic depictions of the Jew detailed in his study, the
foregoing characterization was in fact true.
Western acculturated Jews, including Freud, internalized the surrounding
culture's anti-Semitic perception of the Jew as nervous, feminine, depraved,
and degenerate, and in turn placed these attributes squarely upon the Eastern
European Jews, from whom they were careful to differentiate themselves (Gilman,
1993a, 1993b).
Both the Jewish predisposition to nervous illness and the inherited taint of
Jewish degeneracy were commonplaces of the scientific and medical discourse of
Freud's time. Freud was particularly sensitive to the argument that hysteria
was an inherited disease, because it contributed to the racialized anti-Semitic
view of the Jews as an incestuous and degenerate race; this view was prevalent
in the medical and scientific community in which he practiced (Gilman,
1993a, 1993b30.
Gilman , S. L. 1993b. Freud, race, and gender, Princeton, NJ:
Princeton University Press.).
Freud trained with Charcot in Paris in 1886, an experience that made a
lasting impres
sion on him, influencing both the beginnings of his medical practice
with hysterical patients and his later rejection of suggestion in favor of the
psychoanalytic method. Charcot, the most famous neurologist of his day, was
acknowledged as making valued contributions in the area of local vibratory and
electrical treatments and to have owned the latest equipment, including
portable vibrators, encouraging his students at the Salpêtrière to experiment
with these new devices (Didi-Huberman,
2003; Hastings
& Snow, 190432. Hastings , M. L. and Snow , A. 1904. Mechanical
vibration and its therapeutic application, New York, NY: Scientific
Authors' Publishing. ).
Enthusiastically advocating “the use of static electricity in medicine,”
Charcot supervised an electrical studio containing “electrostatic baths” and
“Holz-Carré machines,” and named an apparatus that provided local electrical
stimulation the “electric paint brush” (Charcot, Oeuvres Complétes, as
cited in Didi-Huberman,
2003, pp. 197–199).
Freud was certainly exposed to the use of these treatments with
hysterical patients during the time of his training. The standard handbooks on
massage and electrotherapy, including the textbook Freud relied upon for his
electrotherapy practice, contain explicit instructions on local stimulation of
the genitals for the treatment of hysteria, neurasthenia, and various other
disorders thought to be related to the dysfunction or irritation of the sexual
or reproductive system. In his “Autobiographical Study,” Freud
(1925)wrote, “My knowledge of electrotherapy was derived from W. Erb's
text-book [1882], which provided detailed, instructions for the treatment of
all the symptoms of nervous diseases” (p. 16). Erb
(1883)
, a highly respected German neurologist and the leading electrotherapist
of Freud's time, provided detailed instructions on electrical stimulation for
the treatment of nervous diseases, noting that “the majority of cases also
require direct electrical treatment of the genitals” (p. 352). He attributed
the nervous disorders in part to a “congenital neuropathic taint” (p. 292),
identifying Jews (Gilman,
1993b) and women as being particularly susceptible. Erb noted that in the
treatment of hysteria, deception was often effective, and “confidence in the
physician and in the remedy is the best guarantee of success”; nevertheless, he
stated it could be “favorably influenced” by local electrical applications (p. 293)
such as those applied in the visceral neuralgias, which included electrical
stimulation of the rectum, uterus, ovaries, and genitals.
Such was the context in which Freud opened his neurological practice in
Vienna on Easter Sunday 1886, soon after his return from his Paris training
with Charcot. Unable to get a university medical appointment because he was a
Jew, Freud, like most Jewish doctors faced with the anti-Semitic policies of
the Viennese government and a medical establishment that specifically excluded
Jews from its ranks, was forced to become a specialist in private practice, a
far less prestigious occupation. In fact, because of this institutionalized
anti-Semitism, most private practitioners were Jews; they became
dermatologists, gynecologists, and neurologists, treating mostly Jewish
patients (Killen,
2006). Freud, a neurologist, specialized in the treatment of patients with
neurological disorders and hysteria. He invested a significant amount of money,
borrowed from his childhood friend Ernst Fleischl, to purchase the most
expensive and up-to-date electrical equipment available for electrotherapeutic
treatment of his almost exclusively Jewish female clientele (Gilman,
2010).
3
In addition to electrotherapy, Freud employed the other commonly
practiced somatic treatments of hysteria, including massage, hydrotherapy, and
hypnosis (also considered a somatic approach). Although Freud acknowledges his
use of these physical therapies, in his autobiographical and historical narratives,
he places far greater emphasis on his practice of hypnosis and his subsequent
rejection of hypnotic suggestion when discussing the events leading up to his
development of the psychoanalytic method. Following Freud's emphasis, the
narrative history of psychoanalysis has traditionally linked the birth of
psychoanalysis specifically with Freud's rejection of hypnosis and hypnotic
suggestion. There has been almost no mention in the psychoanalytic literature
of the larger context of the somatic medical treatment of hysteria within which
Freud treated his hysterical patients, nor, given this context, has any
particular attention been paid to what Freud was actually doing. But if
we keep in mind the context of the somatic therapy in which Freud was trained
and in which he practiced, and look closely at Freud's own writing, we realize
that not only was he hypnotizing his female patients, he was also electrically
stimulating them and giving them full body massages while listening intently to
their every word. Freud
(1893) writes in his case study of Emmy von. N, “I shall massage her whole
body twice a day” (p. 50), describing Emmy's agitation when “I had to look for
the towels needed in massage” (p. 63). While we have no definitive proof that
Freud used genital massage—no “smoking gun,” so to speak—nevertheless we read,
“I therefore asked her in hypnosis why she was so restless this morning … she
informed me that she had been afraid that her period was going to start again
and would again interfere with the massage” (p. 67).
“THANK YOU, MR. EDISON”
While genital stimulation as a treatment for hysteria was implemented in
Europe and North America by both Jewish and non-Jewish practitioners, in
Austria and Germany, Jews made up a disproportionately large percentage of the
electrotherapists, and most of the illustrious figures in German neurology were
Jews (Killen,
2006). There is no doubt that while Freud was massaging Emmy von N, many of
his contemporaries, mostly Jewish gynecologists and neurologists, were
performing genital stimulation on their female patients, made possible by the
discovery of electricity and the invention of the electromechanical vibrator.
Although the salutary effects of vibration on hysteria were known long
before the advent of electricity, the available technology was inefficient, at
best. Women with hysteria but no husband were often prescribed horseback riding
or long and bumpy train and carriage rides for their rhythmic and erotic
benefits (Furst,
2008). Electricity sped the process along considerably. In The
Technology of Orgasm, historian Rachel Maines
(1999) compellingly documented the widespread use of the mechanical vibrator
in the treatment of hysterical women in the 19th and early 20th centuries.
Based on Maines' book, the recent Broadway play, In the Next Room (or the
Vibrator Play), portrays 19th-century physicians using vibrators to bring
women to orgasm in the treatment of hysteria (“North
Shore Native,” 2009
). Says Dr. Givings, the play's protagonist, Thanks to the dawn of
electricity—yes, thank you, Mr. Edison … I have a new instrument which I will
use. It used to be that it would take me or it would take Annie—oh—hours—to
produce a paroxysm in our patients and it demanded quite a lot of skill and
patience … but thanks to this new electrical instrument we shall be done in a
matter of minutes. (Ruhl,
2010
4 )
We are indebted to playwright Sarah Ruhl for granting us permission to
cite these lines from In the Next Room (or the Vibrator Play).
Although the medical practice of electrically eliciting orgasms from
hysterical women has been portrayed in popular culture,
5 For a popular treatment of manual genital massage, see the
1993 novel The Road to Wellville, which refers to a mysterious Dr. Spitzvogel,
portrayed as a German quack, who practices Die Handhabung Therapeutik on his
grateful female patients. “Well, I can't say what-all goes on in there,” says a
cab driver in the novel. “But the ladies? They sure seem a whole lot calmer on
the way out than when I drop 'em—so it must work, whatever it is.” (Boyle,
1993, p. 358) there has been astonishingly little, if any, mention of genital
stimulation in the mainstream or feminist medical histories of psychiatry
and/or hysteria. Maines herself came upon this practice by accident, while
researching needlepoint. Unable to find well-researched histories on the
subject (she theorizes it was because it was a woman's domain), she turned to
women's magazines, where she came across 1906 advertisements for vibrators,
“equipment strongly resembling the devices now sold to women as masturbation
aids” (Maines,
1999, p. x). Thus began a historical treasure hunt that combined both
“scholarly and prurient” interests (p. xi). What is particularly interesting is
that the sources upon which Maines draws include the same sources used by the
more widely known medical histories. A detailed check of these primary sources
confirms they indeed include genital stimulation; yet remarkably, this practice
has been omitted, or at best, only briefly mentioned, by the better known
texts.
Although the equipment was costly, mechanization made the tedious task
of bringing a woman to orgasm via manual massage less tiring and more efficient
and, hence, doctors' private practices far more lucrative. Female patients
diagnosed with hysteria could return for treatment on a regular basis, be
brought to “paroxysm,” and leave satisfied customers. In a pamphlet endorsing a
medical manufacturer of electrotherapy equipment, a Viennese physician
addresses doctors' concerns about the high cost of the apparatus, exhorting,
The open road to success does not lie in decreasing some forms of
expense but in increasing them. Money makes money and the money money makes makes
more money. An equipment of this character is an investment, not an expense. (Matijaca,
1916, p. 120)
Not having a vibrator in one's arsenal was bad for business. In 1906,
physician Samuel Spencer Wallian complained about the time-consuming and
tedious practice of manual massage, which “consumes a painstaking hour to
accomplish much less profound results than are easily effected by the other
in a short five or ten minutes,” the other being a mechanical vibrator
(as cited in Blackledge,
2004, p. 259). Many physicians had vibratory operating rooms like the one
shown in Figure
1 (Hastings
& Snow, 1904, Plate III).
FIGURE 1 Vibratory operating room. From Mechanical Vibration and Its
Therapeutic Application by M.
L. Hastings and A. Snow, 1904
, New York, NY: Scientific Authors' Publishing, Plate III.
Caption: “Like most doctors Freud was excited by a new, apparently
scientific, therapy which could be practiced on the premises. … Patients felt
that they were being taken seriously when they saw the imposing
apparatus—switchboard covered in dials and lamps, wires with electrodes and
brushes on the end, wooden bathtub to soak in and receive tingling sensations.”
(Ferris,
1997, p. 76)
The vibratory operating room shown in Figure
1 appears remarkably similar to a psychoanalyst's consulting room, replete
with what seems to have been the precursor to the analytic couch. Reduction in
battery size and electrification of the home led to the design of portable
vibrators suitable for home use. “Aids That Every Woman Appreciates” ran an ad
for vibrators, electric mixers, and butter churners in the Sears, Roebuck
Catalog (Maines,
1999, pp. 19–20). One brand of vibrators was advertised as “the little home
doctor” (Stein
& Kim, 2009, p. 50), selling the appliance along, perhaps, with the
masturbation fantasy. It is important to note that in the early 1900s these
vibrators were not explicitly linked with sex or masturbation. It was only in
the 1920s, when they appeared in pornographic films, that the public readily
identified them with sex (Maines,
1999). Just as the doctors split off sexuality and orgasm from paroxysm, so
too did advertisers disavow the vibrator's sexual and orgasmic purpose.
6 Advertisers continue to split off the vibrator's orgasmic
function when marketing to the public—for a contemporary example, see
“Advertising: Trojan Makes Concessions to Place a Suggestive Ad” (New York
Times, September 28, 2010). Indeed, the portable home vibrator soon put doctors
out of business, led to the “rediscovery” of the clitoris, and led to the
eventual disappearance of hysteria as a diagnosis. Yes, we are indeed asserting
that the well-documented disappearance of hysteria was related to the cultural
recognition and gradual acceptance of women's sexual pleasure and fulfillment (Stein
& Kim, 2009).
“A CONSTRUCTION OF PHANTASY”
Even while extensively employing electrotherapy as a standard somatic
treatment for hysteria, Freud began to doubt its physical usefulness and to attribute
its main curative effect to the “physician's influence,” that is, suggestion.
Obviously well acquainted with the prevailing gynecological model of hysteria,
Freud began to question genital irritation as the source of hysteria, positing
a psychic rather than somatic cause for this nervous illness. Freud
1888) wrote,
Whether
changes in the genitals really constitute so often the sources of stimulus for
hysterical symptoms is in fact doubtful. Such cases must be more critically
examined. Direct treatment consists in the removal of the psychical sources of
stimulus for the hysterical symptoms, and is understandable if we look for the
causes of hysteria in unconscious ideational life. (p. 56)
Freud became disappointed with electrotherapy, and with Erb's
electrotherapy textbook, upon which he relied for his practice. Freud
(1925) wrote,
Unluckily I
was soon driven to see that following these instructions was of no help
whatever and that what I had taken for an epitome of exact observations was
merely the construction of phantasy. The realization that the work of the greatest
name in German neuropathology had no more relation to reality than some
‘Egyptian’ dream-book, such as is sold in cheap book-shops, was painful, but it
helped to rid me of another shred of the innocent faith in authority from which
I was not yet free. So I put my electrical apparatus aside, even before Moebius
had saved the situation by explaining that the successes of electric treatment
in nervous disorders (in so far as there were any) were the effect of
suggestion on the part of the physician. (p. 16)
Freud's development of psychoanalysis was not simply spurred by his
rejection of hypnosis and hypnotic suggestion, as has traditionally been
implied. Freud discovered early on that suggestion was a principal factor in
electrotherapy's effectiveness, and so dismissed it contemptuously as an
“Egyptian dream-book.” Significantly, this was the same term he later used in
reference to The Interpretation of Dreams in his letter to Fliess (Freud,
1899
), anticipating the disparaging reception of his work by the German
medical community. Clearly, Freud was sensitive to the possibility that
psychoanalysis would be linked with suggestion and with the quackery of
electrotherapy. By positing a psychological cause to hysterical
symptoms, Freud positioned psychoanalysis in opposition not only to suggestion
but also to the biologically, usually genitally, based somatic treatments of
hysteria practiced by his medical colleagues (Bonomi,
2009). Bonomi
(2009) convincingly argued that Freud deliberately avoided any reference to
these treatments as well as to his own background in pediatrics in order to
disassociate himself and psychoanalysis from the taint of the sadistic,
unnecessary, and ubiquitous gynecological surgeries, cauterizations, and castrations
that were performed even on young children. Further, there is an added
dimension to Freud's rejection of these physical therapies: In opposing
psychoanalysis to these treatments, Freud was at the same time distancing
himself from the anti-Semitic racialized biological characterization of the
Jews as a depraved and incestuous race, genetically predisposed to biologically
inherited nervous illness. Freud aspired to separate his psychoanalytic method
as far as possible not only from the taint of suggestion but also from the
somatic treatments conducted in the private practices of his—mostly
Jewish—Austrian and German medical colleagues, on their mostly Jewish female
hysterical patients (Killen,
2006).
Freud's acute sensitivity to the perceived links between psychoanalysis
and suggestion and Jews and genital stimulation is vividly apparent in the
following anecdote. On March 29, 1910, at a meeting of the Medical Society of
Hamburg, Freud presented his psychoanalytic approach to the treatment of
hysteria to what turned out to be a violently hostile and disparaging audience.
Describing this contentious meeting, Ernest Jones (1955) reported,
Weygandt, the gentleman who talked of calling in the police, was
particularly virulent. Freud's interpretations were on a level with the
trashiest dream books. His methods were dangerous since they simply bred sexual
ideas in his patients. His method of treatment was on a par with the massage
of the genital organs [emphasis added]. … Nonne was concerned about the
moral danger to the physician who used such methods. … Saenger [commented that]
fortunately … the North German population was very far from being as sensual as
that of Vienna. (p. 130)
Freud, clearly insulted, commented to Jones,
There one hears just the argument I tried to avoid by making Zurich the
centre. Viennese sensuality is not to be found anywhere else! Between the lines
you can read further that we Viennese are not only swine but also Jews. But
that does not appear in print. (Jones, 1955, p. 131)
Bristling at the implication of a connection between psychoanalysis and
genital massage, Freud reads between the lines of German medical criticism the
not-too-subtle anti-Semitic innuendo regarding the depravity of Jewish doctors
and their Jewish patients (Vienna was known for its high concentration of
Jews). “Making the Zurich the centre” refers of course to Freud's appointment
of Jung as the next leader of the psychoanalytic movement in the hopes that
having an Aryan at the helm would dispel any notion of psychoanalysis being a
“Jewish national affair.” And, as Freud had feared 20 years prior,
psychoanalysis was indeed likened by his German critics to the “trashiest of dream
books,” implying not only that it was Jewish and therefore perverted but also
that it employed suggestion and was therefore unscientific.
While Freud rejected the somatic treatments of his day, he still
retained the biologically based model of excitation and discharge in his
psychological theories, and frustration and gratification of libidinal wishes
came to dominate his drive theory. Makari
(2008)
noted that the primary purpose of the clitoridectomies performed by 19th-century
gynecologists was to lessen internal stimulation. As we have seen, the goal of
genital stimulation was to release tension that had already built up. Although
these interventions approached the problem of internal stimulation from
opposite sides, they both had the same rationale—the elimination or discharge
of tension.
Freud psychologized this biological rationale but never gave up the
belief that bodily functioning and the regulation of somatic tensions remain
involved in the maintenance of the neuroses. Early in his work, he
differentiated the actual neuroses from the psychoneuroses, and never abandoned
this distinction. The actual neuroses, which included anxiety neurosis and
neurasthenia, and later hypochondria, were thought to result from built-up
sexual tension. Unlike the psychoneuroses, which were rooted in the patient's
early history, psychic conflicts, and repressed sexual impulses, the actual
neuroses were physical and contemporary (Laplanche
& Pontalis, 1967). Freud and later analysts did not see these
categories as mutually exclusive; rather, they understood that within what
looked like a psychoneurosis could be found a hidden nucleus of the actual
neurosis. This aspect of Freud's theorizing was an effort to maintain some
rootedness in the body, in the patient's biological functions, and in the
present contemporary life of the patient, even while his overall emphasis had
dramatically, even revolutionarily, shifted to psychical conflicts, personal
meanings, and the historical roots of the illness.
The actual neuroses had in common their source in contemporary sexual
problems of tension regulation. As Makari
(2008) documented, while neurasthenia was caused by sexual overindulgence,
anxiety neurosis was a disorder of the sexually frustrated—virgins, prudes,
abstainers, and those practicing coitus interruptus (as Makari pointed
out, this would certainly have included Freud). Freud's theory of excess
stimulation and release is a direct parallel to Breuer's rationale for
catharsis and Fliess' nasal cauterizations. This theme permeated all of Freud's
work, in that much of what would be called the economic point of view,
fundamental to Freud's drive theory, was the buildup or release of instinctual
tension, hence the overriding importance within drive theory of the object's
being either frustrating or gratifying and the consequent emphasis on
abstinence.
Freud's emphasis was clearly on the idea that the neuroses are
precipitated by sexual frustration, leading to the damming-up of libido. This,
we maintain, is exactly the theoretical rationale that was provided in
physicalistic terms by the long tradition of inducing paroxysms in hysteric
women, although the sexual meaning was repressed or dissociated. We may also
speculate that it was the same principle that was captured by the idea of
catharsis or abreaction, the discharge of “strangulated” affect. Is it possible
this is what Anna O, Bertha Pappenheim, had in mind when she coined the
expression “chimney sweeping”? Dimen wrote,
Without a
doubt, the image of the chimney, a passageway for heat and smoke, evokes the
desirous vaginal interior, the phallic entry of the cleaner and his brush. “Chimney
sweeping is an action symbolic of coitus, something Breuer never dreamed
of,” writes Freud to Jung in 1909. (Dimen,
2003, p. 168)
At the heart of the dialectic between body and mind is the issue of
actual versus fantasized sexual stimulation. Although Freud later “abandoned
the seduction theory” (Ahbel-Rappe,
2006, p. 171), he originally believed that many of his hysterical women
patients had been sexually abused, writing,
I therefore
put forward the thesis that at the bottom of every case of hysteria there are one
or more occurrences of premature sexual experience, occurrences which
belong to the earliest years of childhood but which can be reproduced through
the work of psycho-analysis in spite of the intervening decades. (Freud,
1896, p. 203)
Given what we now know about the frequency of childhood sexual abuse,
and taking into account the disparaging attitude of 19th-century medicine
toward women, we must conclude that a proportion of these hysterical women had
actual sexual trauma as the source of their symptoms. One shudders to imagine
the impact of these treatments' genital meddlesomeness—gynecological exams,
surgeries, cauterizations, and stimulations—on these women who had already been
traumatized (J. Davies, personal communication, June 5, 2010).
“JEWISSANCE”
7
Although stunning in their originality, Freud's psychological theories
were inevitably shaped by the larger context in which they were developed. It
is only if we take into account Freud's reaction to anti-Semitism as well as
the broader context of 19th-century medicine, that the theoretical
underpinnings of psychoanalysis make sense. Building especially on the work of
Gilman and many scholars following him: Boyarin, Yerushalmi, Brickman, Slavet,
Frosh, Geller, among others, in our forthcoming book (Aron
& Starr, in preparation) we elaborate how Freud dealt with his
conflicted position as an acculturated German Jew in an anti-Semitic milieu. We
show that he did so in part by appropriating the binaries split by his society
between gentile and Jew—masculine/feminine, civilized/primitive,
autonomous/dependent, to name only a few—and incorporating them into his
theories, transforming their biologically racial specificity into psychological
universality.
It is much easier to understand why Freud constructed the Oedipus
complex as the nucleus of neurosis and castration anxiety as bedrock when we
realize that his people, Jews, were accused of being neurotic and perverse
because of generations of incest and that Jewish men were viewed by others and
by themselves as castrated and effeminate because they were circumcised. In
Freud's transformation, rather than Jews being incestuous, we all have Oedipal
desires; it is not Jews who are castrated (circumcised), we all have castration
anxiety; rather than Jews being primitive and perverse, we all have these
aspects within our unconscious. Unfortunately, in the process of universalizing
these dichotomies, Freud projected onto women the negative characteristics
attributed to Jews (Gilman,
1993a).
There is perhaps nothing in Freud's theorizing more puzzling to the
modern reader than the notion of penis envy. The idea set forth by Freud, that
girls in their developing sexuality do not discover their own sexual organ and
instead “all the child's interest is directed towards the question of whether
it [the penis] is present or not” (Freud,
1926, p. 212) seems to us today to be preposterously male-centric. But if
we consider the context in which Freud developed his theories, namely, the
19th-century male-centered medical model of female sexuality, it makes perfect
sense. “The habit of using a man's penis to grade a woman's genitalia led to
some strange genital scenarios” (Blackledge,
2004, p. 77), including Freud's formulation of penis envy, mature genital
sexuality, and clitoral versus vaginal satisfaction. Freud, like his medical
colleagues, saw the clitoris not as the locus of female sexuality, but as an
inferior penis. He wrote,
But we have
learnt that girls feel deeply their lack of a sexual organ that is equal in
value to the male one; they regard themselves on that account as inferior, and
this “envy for the penis” is the origin of a whole number of characteristic
feminine reactions. (Freud,
1926, p. 212)
It is not the vagina Freud is talking about in the previous paragraph,
but the clitoris, the female penis equated by his society with the circumcised
penis of the male Jew. Famously referring to adult female sexuality as a “dark
continent” (Freud,
1926, p. 212), Freud equated women's sexuality with dark, uncivilized,
primitive, savagery, the same qualities his society projected onto Jews, who
were considered primitive, off-white, mulatto (Gilman,
1993a
cogently demonstrated just how thoroughly Freud incorporated the
colonial dichotomies of primitivity and civilization into his theoretical
formulations, viewing psychoanalysis as a civilizing process. In a similar
vein, Dimen
(2003) highlighted the psychoanalytic conception of female sexuality as
primitive and uncivilized, writing, “Shoved to the margins of society, the female
body, with its savage little clitoris, becomes rather like a wild animal on the
outskirts of civilization” (p. 146). While the Aryan was seen as civilized,
phallic, male, and autonomous, the male Jew was primitive, castrated
(clitoral), female, and suggestible. The clitoris, thought to be a vestigial,
and therefore primitive organ, literally had no place in the civilized society
of Freud's time; neither, according to anti-Semitic rhetoric, did Jews.
The neglect and devaluation of the clitoris neither began nor ended with
Freud. Freud consolidated into theory a long tradition of devaluing the
clitoris, differentiating between paroxysm and orgasm, and limiting the
definition of sexual orgasm to vaginal penetration. However, as Laqueur
(1990)demonstrated, it was Freud who actually invented the notion of the
vaginal orgasm. Freud's formalization into psychoanalytic theory of the
19th-century view of female sexuality had the effect of perpetuating its
negative consequences for women long into the 20th century. Even among
assertive feminist critics, such as Horney and Klein, the emphasis continued to
be on the girl's early awareness of the vagina, but not on the sensitivity and
exquisite sexual capacity of the clitoris. As late as the 1960s, many women
analysts were reluctant to acknowledge the leading role of the clitoris. (For a
comprehensive review of early feminist reactions to Freud's “genital
transference” theory as well as the great orgasm debate of the 1960s, see Buhle,
1998) We must acknowledge the continuing detrimental effect on women,
especially true believers in psychoanalysis, who were told by their
psychoanalysts that they were frigid because they were not having vaginal
orgasms. A most extreme example is Princess Marie Bonaparte, Freud's patient,
disciple, and benefactor, who had numerous unsuccessful surgeries to move her
clitoris closer to her vagina so she could achieve vaginal orgasm (to his credit,
Freud tried to dissuade her from doing so;( Appignanesi
& Forrester, 1992).
For Freud, the “repudiation of femininity,” by which he meant penis envy
and castration anxiety, was ultimately a biological fact, the “bedrock”
underlying psychic life, part of “the great riddle of sex” (Freud,
1937, p. 252). Development, he stipulated, proceeds through renunciation of
infantile wishes, whereas gratification leads only to primitivity. For men, to
achieve civilized, masculine, autonomy meant overcoming castration anxiety by
giving up feminine passivity in relation to other men, including
suggestibility, which was equated with penetration and castration (Freud,
1937) . For women, renouncing penis envy meant accepting their place in a
society that equated them with their reproductive function. Women were expected
to renounce the desire to be men and replace it with the desire to have a baby;
to renounce autonomous masculinity, as symbolized by the clitoris, and replace
it with passive femininity, represented by the vagina in need of penetration;
to renounce the phallic desire to participate fully in the world, and accept
their passive female position in male-dominated society.
On the surface we are faced with a puzzling inconsistency in Freud's
theory—one goal for men, another for women. But if we take into account the
anti-Semitic equation of the clitoris with the circumcised penis of the male
Jew, the common denominator in Freud's theorizing becomes clear. In this
equation, the clitoris, simultaneously representing Jewish female masculinity
and Jewish male femininity, must be renounced—both men and women have to give
up their “Jew”—in order to have a place in German civilization. In Freud's
civilizing project of psychoanalysis, women must relinquish their desire to be
autonomous and masculine, while men must surrender their longing to be passive
and feminine. As Aron
(2009) delineated, and as we shall further address in our book, this view
continues to have longstanding implications for contemporary psychoanalytic
theorizing and practice.
LA PETITE MORT
Since its inception, the history of genital stimulation as a treatment
for hysteria has been fraught with controversy on moral, religious, and
professional grounds. Although we have documented proof that it was practiced,
including detailed instructions in medical massage and electrotherapy handbooks
written for physicians, because of the controversial nature of the treatment
and institutionalized Victorian prudery, accounts of this treatment are often
obscured by medical and moral circumlocution. We have no written record
available to us from the patient's point of view about what it was like for the
women undergoing this procedure. We don't know if they considered it a sexual
procedure, if they understood the paroxysm as orgasm, or whether married women
told their husbands about what was going on “in the next room.”
We do know genital stimulation was part and parcel of the somatic
approach to hysteria in which Freud was trained and that he used at the
beginning of his practice. Although Freud was inevitably shaped by his culture,
he was nevertheless far ahead of his time. By proposing a psychological
understanding of hysterical symptoms, Freud significantly reduced the
likelihood that women with hysteria would be subjected to the genital fiddling
of professional medicine. At a time when few, if any, doctors listened to their
patients' life stories, Freud took his patients seriously, listened to them
carefully, tried to understand the meaning of their lives, and made it possible
to talk about sex without shame. Nevertheless, we cannot ignore the continued
negative ramifications for women of Freud's consolidation into theory of the
19th century medical views of female anatomy. It is only by understanding this
background and taking into account Freud's experience as a Jew in a virulently
anti-Semitic milieu that we can make sense of his theoretical construct of
female sexuality.
We hope that by providing this historical context for the development of
Freud's theories, and incorporating the history of genital stimulation into the
background of the birth of psychoanalysis, we will stimulate further discussion
and galvanize future research.
Acknowledgments
We thank Celia Brickman, Jody Davies, Muriel Dimen, George Makari, and
Ann Pellegrini for their valuable feedback. Thanks also to Deborah Berry for
contributing her knowledge of this practice from within the field of sex
therapy.
Notes
1The absence of reference to genital stimulation is so ubiquitous that
throughout this article we cite those exceptional sources that document this
history.
2The word the author uses in the original is “paroxismo” (as cited in Schleiner,
1995, p. 154), a Latin derivative of the Greek “παροξυσμός,” or “paroxysm.”
3We are indebted to Gilman's groundbreaking work on Freud and
anti-Semitism and his documentation of Freud's use of electrical treatments. We
are building on that body of work to consider the prevalence of genital
stimulation, which has not been addressed by Gilman.
4We are indebted to playwright Sarah Ruhl for granting us permission to
cite these lines from In the Next Room (or the Vibrator Play).
5For a popular treatment of manual genital massage, see the 1993 novel The
Road to Wellville, which refers to a mysterious Dr. Spitzvogel, portrayed
as a German quack, who practices Die Handhabung Therapeutik on his
grateful female patients. “Well, I can't say what-all goes on in there,” says a
cab driver in the novel. “But the ladies? They sure seem a whole lot calmer on
the way out than when I drop 'em—so it must work, whatever it is.” (Boyle,
1993, p. 358)
6Advertisers continue to split off the vibrator's orgasmic function when
marketing to the public—for a contemporary example, see “Advertising: Trojan
Makes Concessions to Place a Suggestive Ad” (New York Times, September
28, 2010).
7 Boyarin
(1997, p. xxiii).
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