Agony of Emma Eckstein, the First Female Psychoanalyst

Emma Eckstein was 'one of Sigmund Freud's most important patients and, for a short period of time around 1897, became a psychoanalyst herself': she has indeed been described as 'the first woman analyst....Emma Eckstein became both colleague and patient' for Freud. She came from a prominent socialist family and was active in the Viennese women's movement.

An exploration into the messy baby steps of psychoanalysis

Eckstein underwent disastrous nasal surgery, undertaken by Freud's friend and confidant, Wilhelm Fliess. 

When she was 27, she came to Freud seeking treatment for vague symptoms including stomach ailments and slight depression related to menstruation. Freud diagnosed Eckstein as suffering from trauma, secondary to childhood sexual abuse. Freud suspected, in addition, a "nasal reflex neurosis," a condition popularized by Fliess, an ear, nose and throat specialist. 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.

Eckstein's surgery was a disaster. She suffered from terrible infections for some time, and profuse bleeding. Freud called in a specialist who removed a mass of surgical gauze that Fleiss had not removed. 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. The incident provided source material for Freud's dream of "Irma's injection".

Emma's Nose: Freud's letter to Fliess on the aftermath of Emma Eckstein's surgery

Agony of Emma Eckstein - Solo paper theatre performance

In 1904, 'Eckstein had published a small book on the sexual education of children', although in it 'she does not mention Freud'. A few years later, however, in his open letter on "The Sexual Enlightenment of Children", Freud refers to her book approvingly, highlighting 'the charming letter of explanation which a certain Frau Emma Eckstein quotes as having been written by her to her son when he was about ten years old'.

Ernest Jones placed her with such figures as Lou Andreas-Salomé and Joan Riviere as a 'type of woman, of a more intellectual and perhaps masculine cast...[who] played a part in his life, accessory to his male friends though of a finer calibre'.

Emma Eckstein (1895)

Emma's Nose: Freud's letter to Fliess on the aftermath of Emma Eckstein's surgery

March 8, 1895

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 hemorrhages would not stop, and that suddenly a fetid odor 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 odor 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 hemorrhage stopped. It lasted about half a minute, but this was enough to make the poor creature, whom by then we had lying flat, unrecognizable. 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.

Rosanes stayed with the patient until arranged, via Streitenfels, to have both of them taken to Sanatorium Loew. Nothing further happened that evening. The following day, that is, yesterday, Thursday, the operation was repeated with the assistance of Gersuny; [the bone was] broken wide open, the packing removed, and [the wound] curetted. There was scarcely any bleeding. Since then she has been out of danger, naturally very pale, and miserable with fresh pain and swelling. She had not lost consciousness during the massive hemorrhage; when I returned to the room somewhat shaky, she greeted me with the condescending remark, "So this is the strong sex."

I do not believe it was the blood that overwhelmed me--at that moment strong emotions were welling up in me. So we had done her an injustice; she was not at all abnormal, rather, a piece of iodoform gauze had gotten torn off as you were removing it and stayed in for fourteen days, preventing healing; at the end it tore off and provoked the bleeding. That this mishap should have happened to you; how you will react to it when you hear about it; what others could make of it; how wrong I was to urge you to operate in a foreign city where you could not follow through on the case; how my intention to do my best for this poor girl was insidiously thwarted and resulted in endangering her life--all this came over me simultaneously. I have worked it through by now. I was not sufficiently clear at that time to think of immediately reproaching Rosanes. It only occurred to me ten minutes later that he should immediately have thought, There is something inside; I shall not pull it out lest there be a hemorrhage; rather, I'll stuff it some more, take her to Loew, and there clean and widen it at the same time. But he was just as surprised as I was.

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 anesthesia. 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.

Beside this, other news really pales. As far as my condition is concerned, you are certainly quite right; strangely enough it is far easier for me to be productive when I have mild troubles of this kind. So now I am writing page after page of "The Therapy of Hysteria."

An odd idea of a different sort I shall entrust to you only after we have Eckstein off our minds. Here influenza is quite widespread, but not very intense. Your mama is not yet quite well either.

I shall soon write to you again and, above all, report in detail on Emma E. Scientifically, otherwise quite desolate. Influenza has been eating up the practice of specialists. That it really took its toll of you I know. Just allow yourself a proper rest afterward. I am determined to do the same if it should strike me.

With cordial greetings,
Your
Sigmund

(Masson, 1985, pp. 116-118) The complete letters of Sigmund Freud to Wilhelm Fliess, 1887-1904

Photograph of the Austrian psychologist Sigmund Freud (1856–1939) and the German biologist and physician Wilhelm Fliess (1858–1928).

The Cut and the Building of Psychoanalysis: Sigmund Freud and Emma Eckstein

Buy The Cut and the Building of Psychoanalysis here.

This volume presents a fresh perspective and new narrative of the origins of psychoanalysis, taking into account social, cultural and contemporary relational views. Exploring Freud’s unconscious communication and identification with his patients, Emma Eckstein in particular, the book sheds new light on the logic which informed a number of events central to Freud’s self-analysis, and the theories he formulated to found and establish psychoanalysis.

Divided into three parts, chapters trace how Freud’s oscillations between the reality of trauma and the creative power of fantasies were a direct result of his encounter with and treatment of Emma. Part 1 presents a historical reconstruction of the practice of castration in the treatment of hysteric women between 1878 and 1895; Part 2 examines the theories and practice produced by Freud between 1895 and 1896; and Part 3 explores and reconstructs Freud’s self-analysis (1896-1899).

The Cut and the Building of Psychoanalysis argues that Freud’s unconscious communication with Emma provided him with a crucial framework and path for his self-analysis. It will appeal to psychoanalysts, psychotherapists and psychologists, as well as historians of medicine, science, social scientists and scholars interested in the history of western thought and the mind in general.