The premise of Mikkel Borch-Jacobsen's book is that although people think they know Sigmund Freud, the founder of psychoanalysis, and the famous pseudonyms of his ‘patients’, only by reconstructing the lives of Freud's ‘patients’ can we really understand both doctor and patient. ‘Patient’ and ‘patienthood’ are problematic terms, heavily laden with medical and sociocultural values, which not only changed over time but also varied dependent on context. The use of the term ‘patient’ to discuss the lives of individuals raises important questions as to the extent that patienthood defines the person. The emphasis of this book is on how these people and their friends and families perceived Freud and his work, and how in many cases this could change over time, and thus how we can understand Freud and his practice through them. This is achieved through thirty-eight accounts selected from patients with symptoms (rather than those who were undergoing training or were curious about his work) and with sufficient evidence. The author emphasizes the importance of these biographical narratives, noting that he has ‘tried to reconstruct the sometimes comical, most often tragic and always captivating stories of these patients who have long been nameless and faceless’ (p. 7). The evidence, Borch-Jacobsen argues, demonstrates that ‘Freud's cures were largely ineffectual, when they were not downright destructive’ (p. 9).
The book is structured around the historical narratives of Freud's patients. It begins with a preface of just over two pages that outlines Borch-Jacobsen's key ideas and premise. To a large extent, the book assumes that the reader already knows and understands the work of Freud. There is no contextual foundation or discussion of his work. Nevertheless, the reader encounters different aspects of Freud's practice through these lives and in presenting them the book attempts to foreground the patient rather than the doctor. Biographical chapters charting the lives of thirty-eight patients form the basis of the publication. These are organized by chronology based on date of treatment, ranging from the 1880s to the 1920s. Each chapter presents biographical information about Freud's patients from birth or childhood through to death, including family, educational and occupational or social background, the onset of ‘symptoms’ and their experience of the ‘treatment’, and then the aftermath.
We encounter a range of ‘complaints’ or ‘symptoms’, noted personally or by relatives, that led individuals to Freud and psychoanalysis. In most instances, we find out about the person beyond the patient – their interests, their hopes, their fears – but also how being one of Freud's patients shaped their lives. In addition to Freud's case notes, the evidence used to construct these narratives includes autobiographies, letters and interviews. These include those authored by the patient but also accounts of family members and friends. The inclusion of the latter raises interesting questions about methodological approaches to reconstructing the patient narrative, especially where evidence from men about female relatives contained gendered perspectives on ‘health’ and ‘illness’ or where family members were friends with or followers of Freud. Particularly insightful are accounts written by patients that not only reflect on their experiences but also demonstrate an awareness of what Freud wrote or said about them. For example, Ilona Weiss, the subject of Chapter 11, read her case study and later in life noted Freud's inaccurate assumptions. Likewise, Sergius Pankejeff, the subject of Chapter 28, claimed he could not recognize himself in Freud's case history and reflected that ‘instead of doing me some good, psychoanalysts did me harm’ (p. 173). Some accounts are unavoidably brief and sketchy whereas others are more in-depth, owing to the evidence available. All chapters are illustrated with photographs of those people who feature in the written account, including the ‘patient’ and their family and friends.
Inevitable tensions arise between the accounts constructed by doctor and those by the patient. Borch-Jacobsen's book documents these tensions through the thirty-eight biographical accounts of Freud's patients. It maps the patchwork of biographical information reconstructed here to the ‘official’ narrative constructed by Freud, showing not only where it differed but also how patients and their families reacted to this. Studying medical encounters and illness from the patient perspective, foregrounding the experiences and voices of the patient where feasible, is undoubtedly important. Indeed, although often reduced to ‘cases’ or statistics in medical accounts, these were real people with complex lives. However, there are important ethical and methodological challenges of working with patient voices in a historical context that are not explored in this book. Some of its subjects explicitly noted their reluctance or outright refusal for their experiences to be discussed. Bertha Pappenheim, known as Anna O, the subject of Chapter 1, rejected psychoanalysis, destroyed all documentation of her breakdown and asked her family not to give out information after her death. Olga Hönig (Chapter 14) also did not want to talk about her experiences. Some of the people documented in the book only died within the last fifty to sixty years. Historians working with patient records or other accounts of illness and death need not only to be aware of these ethical issues but also to consider how they can explore them with their readership.
This is not to say that patients should not be the subject of historical research. The patient experience or voice, often marginalized, can transform our understanding about health, illness and medical care. Amongst the work that responded to Roy Porter's call for more patient-centred histories, two edited collections stand out as providing invaluable context to these methodological challenges: Robert Ellis, Sarah Kendal and Steven J. Taylor's edited volume Voices in the History of Madness: Personal and Professional Perspectives on Mental Illness (2021) and Anne Hanley and Jessica Meyer's edited volume Patient Voices in Britain, 1840–1948 (2021). Readers of Freud's Patients might be interested in engaging with this wider work to further understand the significance and challenges of this approach. Borch-Jacobsen's book should appeal to those interested in the work of Freud and psychoanalysis and those interested in the lives, experiences and voices of patients. It reminds us of the importance and value of listening to the patient voice, in whatever form that takes, for both historians researching past lives and modern practitioners.
