Sunday, May 18, 2008

A Biographical Interlude - Wilhelm Fliess (1858-1928)

Wilhelm Fliess (October 24, 1858 – October 13, 1928) was a German otolaryngologist, or in simpler terms an Ear, Nose and Throat surgeon or an ENT specialist who practised in Berlin. On Josef Breuer's suggestion, he sought Freud out to share his theories with him.  To us today, these theories seem wild and outlandish - perhaps even in those Victorian times they appeared somewhat so also. Fliess attended lectures given by Freud in Vienna.  He was about the same age as his mentor and came from a similar background.  Like Freud, he had a wide range of intellectual interests and, as Stephen Wilson points out "both men were uninhibited by convention." (Wilson and Zarate, Introducing The Freud Wars, Icon Books, 2002, 16).   Being both intellectuals and scholars, they became firm friends.  Indeed, for a period of ten years - between August 1890 and September 1900 -  they corresponded regularly.  They also met frequently for dialogue and discussion over weekends.  These extended dialogues, they called rather cryptically "congresses".  Fliess was to become in Freud's opinion the "Kepler of biology" and any praise from his protégé he was to soak up as veritable "nectar and ambrosia."  Freud was then working on his general theory of psychology based on the notion of instinctual drive and its expression in psychic energy - to this he was to give the name Libido, from the Latin for "lust" or "desire."  Fliess was highly eccentric and was prone to let his speculation lead him into much wilder and stranger ideas that even Freud had the luxury to propose.  However, Freud subscribed to many of Fliess's thoughts and proposals.  Fliess was before his time in proposing the idea of "bio-rhythms" which he thought were somehow determined by special numbers in a quasi-mystical way (shades of the ancient belief in numerology here.)

Then, he made what may be termed a very strange contention indeed, namely that the mucous membranes in the nose were connected in some way to the functioning of the genitals - this Fliess called reflex nasal neurosis.  How Freud went along with this strange idea is mystifying to say the least, but he did subscribe to it, and sent patients to Fliess for nose operations in this regard.  Indeed, he even had Fliess operate twice on his own nose. Wilson refers to Fliess's idea as "The Genital Nose" and I have read elsewhere that his theory was described also as "The Sexual Nose." (See Wilson and Zarate, opus citatum supra, 18-23)  It is at this stage that the case of Emma Eckstein, to which I referred in the last post, comes in.  Eckstein was a young woman of 27 years who, among other complains, suffered from stomach ailments and menstrual problems.  As the Freud critic Jeffrey Masson says in his 1994 book, The Assault on Truth , these complaints would undoubtedly have been attributed by both Freud and Fliess to masturbation.   Here is what the WIKI states:

Emma Eckstein (1865-1924) had a particularly disastrous experience when Freud referred the then 27-year old patient to Fliess for surgery to remove the turbinate bone from her nose, ostensibly to cure her of premenstrual depression. Eckstein haemorrhaged profusely in the weeks following the procedure, almost to the point of death as infection set in. Freud consulted with another surgeon, who removed a piece of surgical gauze that Fliess had left behind. Eckstein was left permanently disfigured, with the left side of her face caved in. Despite this, she remained on very good terms with Freud for many years, becoming a psychoanalyst herself.  (I have left in the WIKI links.  See this link for the actual quotation Fliess )

Freud went on to ascribe total blame to the patient with respect to this bleeding or haemorrhaging by insisting that her post-operative condition was attributable to hysteria.   I shall quote a little from Freud's letter to Fliess in an effort to deflect blame from the latter:

Dearest Wilhelm,

Just received your letter and am able to answer it immediately. Fortunately I am finally seeing my way clear and am reassured about Miss Eckstein and can give you a report which will probably upset you as much as it did me, but I hope you will get over it as quickly as I did.

I wrote you that the swelling and the haemorrhages would not stop, and that suddenly a fetid odour set in, and that there was an obstacle upon irrigation. (Or is the latter new [to you]?) I arranged for Gersuny to be called in; he inserted a drainage tube, hoping that things would work out once discharge was reestablished; but otherwise he was rather reserved. Two days later I was awakened in the morning--profuse bleeding had started again, pain, and so on. Gersuny replied on the phone that he was unavailable till evening; so I asked Rosanes to meet me. He did so at noon. There still was moderate bleeding from the nose and mouth; the fetid odour was very bad. Rosanes cleaned the area surrounding the opening, removed some sticky blood clots, and suddenly pulled at something like a thread, kept on pulling. Before either of us had time to think, at least half a meter of gauze had been removed from the cavity. The next moment came a flood of blood. The patient turned white, her eyes bulged, and she had no pulse. Immediately thereafter, however, he again packed the cavity with fresh iodoform gauze and the haemorrhage stopped. It lasted about half a minute, but this was enough to make the poor creature, whom by then we had lying flat, unrecognisable. In the meantime--that is, afterward--something else happened. At the moment the foreign body came out and everything became clear to me--and I immediately afterward was confronted by the sight of the patient--I felt sick. After she had been packed, I fled to the next room, drank a bottle of water, and felt miserable. The brave Frau Doctor then brought me a small glass of cognac and I became myself again...

Now that I have thought it through, nothing remains but heartfelt compassion for my child of sorrows. I really should not have tormented you here, but I had every reason to entrust you with such a matter and more. You did it as well as one can do it. The tearing off of the iodoform gauze remains one of those accidents that happen to the most fortunate and circumspect of surgeons, as you know from the business with your little sister-in-law's broken adenotome and the anaesthesia. Gersuny said that he had had a similar experience and therefore he is using iodoform wicks instead of gauze (you will remember your own case). Of course, no one is blaming you, nor would I know why they should. And I only hope that you will arrive as quickly as I did at feeling sympathy and rest assured that it was not necessary for me to reaffirm my trust in you once again. I only want to add that for a day I shied away from letting you know about it; then I began to feel ashamed, and here is the letter.  (My italicisation and bolding) See this link for Freud's letter: Eckstein Letter.

Wilson tells us that Freud's infatuation with Fliess finally came to an end in the summer of 1900, when they met for a holiday in the Austrian Tyrol by a lake called Achensee.  According to Fliess, Freud took exception when he remarked that periodic biological processes were at work in the psyche "and consequently neither sudden improvements nor sudden deteriorations in a person's mental state can be attributed to analysis alone." (Wilson, op.cit., 24) In 1906, in a published account of the quarrel between the two doctors Fliess maintained that Freud had shown "a violence towards me which was at first unintelligible to me." (ibid., 24)

Some years later Freud ordered that his correspondence with Fliess be destroyed. It is only known today because Marie Bonaparte bought their letters and refused to permit their destruction.

Above I have uploaded a caricatured photograph of Fliess. The image says it all.

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