From my own experience, dreams of their very nature have multiple layers and many possible denotations and connotations. Likewise the Irma dream has many layers. Here are some of the associations that Freud states in The Interpretation that sprang automatically to his mind: - a tragic case in which a drug he had prescribed in good faith had led to a patient's death; another case in which he exposed a patient to needless risks; his wife's suffering from her veins during her recent pregnancy; an illness of his eldest daughter, Mathilde and many more, we're sure, which Freud did not allude to in this foundational work on dreams. Freud's interpretation of this dream, as Gay points out in his magisterial biography of the pioneer was simply to vindicate himself as a sincere doctor and healer. Hear are Gay's words:
The burden of the wish the dream portrayed was, then, that Irma's sufferings should be truly seen as not his fault but the fault of others. "In short I am conscientious." (Peter Gay, Freud: A Life for Our Time, Max, 2006, 83)
Oftentimes, too, dreams admit of several meanings as in layers of meaning - they do, in all likelihood, have one over-riding meaning for the dreamer, but this in no way rules the other layers or strata out of court. I have often found in my own dreams that characters can blend into one another, even change from one persona to another quite fluidly and easily. We may refer to this phenomenon as the prevalence in dreams of "composite characters."
Here, interpreters, through vast research and reading, are convinced that Irma is one such composite character. This composite character of Irma in this dream is not alluded to by Freud. In a previous post I have mentioned that Freud himself equated Irma with Anna Hammerschlag, daughter of Freud's Hebrew teacher Samuel Hammerschlag and a close friend of Freud's wife Martha. However, there is one other glaringly obvious equation which is possible. Anna (Lichtheim) Hammerschlag resembled another of Freud's patients, namely, Emma Eckstein. Here is Gay again on this possibility, indeed some would say probability:
And it was Emma Eckstein who figured as a principle in a medical melodrama of early 1895 (The year in which, of course, Freud had his famous dream - my parenthesis - TQ) in which Freud, and far more Fliess, played unenviable roles. In Freud's unconscious, making up his dream, the figure of Emma Eckstein and that of Anna Lichtheim seem to have merged to become Irma. (Op. cit., 84)
Indeed two pages previously Gay tells us in far from flattering terms about Freud's cunning as it were:
What Freud did not tell Fliess on July 24, 1895, or the readers of The Interpretation of Dreams, was that the dream of Irma's Injection was a carefully constructed, highly intricate scenario designed at least in part to rescue Freud's idealized image of Fliess in defiance of some damning evidence. A fuller, less protective interpretation of this dream than the one Freud published leads to what must be the most dismaying episode of his life. (Ibid., 82)
Dr Wilhelm Fliess, for whom Freud admitted feelings bordering on the homosexual (Both Freud and Jung subscribed basically to the theory that all human beings (and all animals one would presume) are by nature bisexual), was a very close friend and colleague of Freud's. Fliess, who was an ear, nose and throat specialist and surgeon had some strange ideas, one of which was the so-called "nasal reflex neurosis," which I have read about in several places, and which one commentator wittily called "the sexual nose." Fliess had been treating the nasal reflex neurosis in his own patients with local anesthesia, specifically cocaine, and found that the treatment yielded positive results, in that his patients became less depressed. Fliess conjectured that if temporary cauterization was temporarily useful, perhaps surgery would yield more permanent results. He began operating on the noses of patients he diagnosed with the disorder, including Eckstein and even Freud himself.
Anyway, to cut a long story short, Fliess operated on Emma Eckstein on referral from Freud, but the operation was a complete disaster - one great botched job. She suffered from terrible infections for some time, and profuse bleeding. Freud called in another specialist who removed a mass of surgical gauze that Fliess had failed to remove during his botched operation. Eckstein's nasal passages were so damaged that she was left permanently disfigured. Freud initially attributed this damage to the surgery, but later, as an attempt to reassure his friend that he shouldn't blame himself, Freud reiterated his belief that the initial nasal symptoms had been due to hysteria. Many competent interpreters and scholars suggest that in all likelihood this incident provided source material for Freud's dream of "Irma's injection".
Above I have uploaded a picture I took of a "dreamy" sunset July 2006.