314
PARTISAN REVIEW
If Irma's pains had an organic basis, once again I could not be
held responsible for curing them; my treatment only set out to
get rid of
hysterical
pains. It occurred to me, in fact, that I was ac–
tually wishing that there had been a wrong diagnosis; for, if so,
the blame for my lack of success would also have been got rid of.
The question, however, is obviously not whether Freud could be
"held responsible for curing" Irma's symptoms, but whether he was
responsible for Irma's
not
having been cured.
If
there had been a
wrong diagnosis, surely he was responsible for that too . If he had
mistaken an organic illness for hysteria, and if he treated Irma in
psychotherapy when she should have been treated for an organic ail–
ment (as may have been the case), then he would indeed have been
responsible for the persistence of her symptoms. Freud twice repeats
the thought that he wished for a misdiagnosis to exonerate him. And
this repetition does make a curious sort of sense within the logic of
dreams. The confusion begins to clear when we read Freud as
having equated his life with his scientific odyssey (metonymy or con–
densation). It is dispelled if we understand the physician in the
dream to have been preoccupied with solving the riddle of hysteria;
more interested in solving this riddle than in curing the patient
(Irma as a metaphor or displacement). This possibility exposes
another dimension of Freud's anxiety represented in the dream . Not
only might he be anxious about practicing an unrecognized therapy
and placing himself under suspicion of malpractice, he might also be
anxious about violating the Hippocratic oath in not putting the
welfare of his patient first. His consuming interest in solving the rid–
dle of hysteria and finding a niche for himself in the history of
medical science entailed this risk.
Before condemning Freud for his callous treatment of Irma,
however, let us remember that we could equally well congratulate
him for persevering in his quest despite this anxiety about her. And
the dream text does represent him anxious about her too.
What would be a crime for another, less ambitious doctor
reveals itself to be a heroic gesture for Freud. The passage represents
Freud with a choice: to admit that his therapy has failed to dispel
Irma 's symptoms and turn her over to another physician (like Otto) ,
or
to
persevere in his quest for an understanding of hysteria even if
he cannot cure Irma. He chooses the latter course. The risk of
malpractice could not be avoided if he would solve the riddle of
hysteria . A more timid physician (like Joseph Breuer) would have
