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THE CUT
of The Cut and the Building of Psychoanalysis, Vol 1: Sigmund Freud and Emma Eckstein, by Carlo Bonomi (London: Routledge, 2015; 275 pp.).
The following reviews are reported in this page:

Jonathan Sklar,  Psychoanalysis and History, 2016/18: 278-282.
Michael B. Buchholz, Psyche – Zeitschrift für Psychoanalyse, 2016/70:363-366.
Grigoris Maniadakis, International Forum of Psychoanalysis, 2015/4:254-257.
Anne Golomb Hoffman,  Contemporary Psychoanalysis, Published online: 26 May 2016.

In italiano vedi la recensione di Gianni Guasto su Pychiatry online Italia, 18 febbraio 2017
Book review by Dr Jonathan Sklar, Psychoanalysis and History, 2016/18(2): 278-282.

This is an impressive and complex book that investigates the origins of psychoanalysis from the interiority of Freud’s self analysis of his dreams, centred on Irma’s injection dream, and his then analysis of Emma Eckstein. Bonomi suggests that this dream discovery acts as a hinge between the pre-analytic world of Freud the medical doctor and paediatrician, and the founding of psychoanalysis around the hidden trauma of circumcision behind the analytic cornerstone of castration. During 1860–90 it was normal practice for hysteria to be treated by gynaecologists by means of various surgical procedures such as amputation or scarification of the clitoris, on sexually mature women as well as little girls, as well as removal of the ovaries, cauterization of the labia, infibulations and circumcision (Hegar, Broca, Bohmi, Forel, Schroder, Tissier, Brown, Brown-Sequard, Kromer, amongst many surgeons of the time). In 1887 Friedrich Merkel noted in his book Beitrag zur Casuitistik der Castration bei Neurosen (Contributions to the Study of Castration in the Neuroses) that in just a few months the number of operations reported in the medical literature rose from 180 to 215 and listed 35 papers on the subject of castration as the treatment for hysterical women (Merkel, 1887). Between 1850 and 1879 masturbation was treated surgically more frequently than any other measure (Spitz, 1952, p. 499). Such castration practices involved punishment for neurosis and hysteria and were undoubtedly traumatic, attacking the body, the mind and the functioning of sexual life.

Around the same time, physicians were gathering observations on masturbation in babies and children into a theory that children needed to be protected from neurotic morbidity and general insanity due to such bad habits. For instance Behrend (1860) wrote

. . . we undertake a small operation in order to provoke such a pain with its wound that it would leave a child a lasting impression and would make any attempt at masturbation painful. In boys the operation should be done on the prepuce, making a cut, etc. In girls it should, similarly, consist of a strong cauterization on the labia majoram or inside the vagina entrance or, as doctor Gross suggests, of small excisions all around the clitoris’. (Behrend, 1860, pp. 328–329)

In 1877, Baginsky writing in his Handbook of School Hygiene indicated that childhood masturbation often arose from ‘loathsome nursemaids’. Later he remarked that the frequency of hysteria in children was mainly caused by ‘the bad example given by hysteric fathers or mothers’ (Baginsky, 1889, p.490). Masturbation was for Baginsky a plague; something evil and impure.

Bonomi uncovers the fact that Freud spent three or four weeks in Berlin in March 1885 training with Adolf Baginsky in his Poliklinic für kranke Kinder. On returning to Vienna, Freud worked in Kassowitz’s Public Institute for Children’s Diseases three days a week for ten years, from 1886 to 1896. Bonomi questions why Freud writes so briefly about castration as an actual medical treatment, as background to his thinking on hysteria, especially as some of his female patients had such operations (Bonomi, p. 39). Furthermore, he questions why Freud does not refer to his own paediatric observations on infantile sexuality rather than distancing himself, as in the following passage: he ‘learnt from colleagues that there are several publications by paediatricians which stigmatize the frequency of sexual practices by nurses and nursery maids, carried out even on infants in arms’(Freud, 1896, p. 207). Again in 1914, he wrote that his discovery of infantile sexuality had been founded almost exclusively on the findings of analysis in adults, which led back into the past, since he ‘had no opportunity of direct observations on children’ (Freud, 1914, p.18). The elusive key is in the hidden connection between castration and circumcision. Freud is only open about circumcision in 1933, ‘as a cure or punishment for masturbation’, and as Bonomi trenchantly states, even then only in reference to his American patients (Freud, 1933, p.87). Yet, despite this apparent oversight, it is Freud who makes the great leap from treatments for hysteria in women, as well as for masturbation in children, which were punitive, cruel and traumatic – on the mind as well as the body – to the talking cure. He thereby created a new psychic treatment based on the concept of the unconscious mind.

We now turn to Fliess and Emma Eckstein and the commencement of psychoanalysis with Freud’s famous dream of 24 July 1895 about Irma’s injection. Bonomi’s contention is that there is a hidden motif as Eckstein had undergone an operation as a child that cut one of her labia short. The traumatic scene of Freud witnessing Fliess re-operating on her nose and removing a piece of gauze causing suppuration led Freud to feel faint and temporarily leave the operation (this is reminiscent of a similar later collapse in the presence of Jung). In Bonomi’s new reading, it is her childhood trauma that precipitated a psychic reaction in Freud, which, despite his efforts to defend against it, determined a number of central aspects of his self-analysis and theorizing. This led to several consequences that consumed Freud with guilt; in particular, the putting of his analytic patient at risk by referring her to a nasal surgeon who ‘castrated’ her by removal of a turbinate bone in her nose, which connected Freud with the gynaecological castrating practices of the day. It led to his distancing himself from Fliess and to his own sexual model, which allowed Freud the freedom to develop within his own self-analysis.

Yet for Bonomi the motif of castration found in the dream served as a trigger for a sexual phantasy of fellatio. At that time it was common practice for the mohel to suck the penis after circumcision to reduce the bleeding from the cut (a practice associated with orthodox East European Jews which included Freud’s father Jacob), called metzizah b’peh. Freud’s younger brother by two years, Julius died six months after his birth. The argument is that when Alexander was born (when Freud was ten years old), he attended the ceremony, saw the cut, the fellatio and the pain that became, by après coup, a traumatic primal scene for Freud and was part of his self-analysis, including the idea that his father was perverted. On 15 October 1895, Freud arrived at the conclusion that his sexual phantasy had all along been informed by what he would later identify as the Oedipus complex. For Bonomi castration has the act of circumcision in its shadow as a subject deeply uncomfortable to discuss openly in the Interpretation of Dreams, as it gave psychoanalysis too Jewish a base in the openly anti-Semitic Vienna of the day. Freud sheds his Jewish identity, preferring the Greeks and victorious Hannibal over his father who had to pick up his fur hat from the gutter following an anti-Semitic attack witnessed by young Freud. It seems he even suggested Alexander’s name during family discussions about the name of the baby, as a break with orthodox family tradition of naming a child after dead grandparents.

Freud’s determination to break free from social and religious binds are examined in great detail through the analysis of Emma Eckstein and the extraordinary links that Bonomi makes for her being Freud’s Other, as it were, in his self analysis. She is the Eck-Stein (Eck means corner), the corner stone of psychoanalysis. Bonomi regards Freud as having identified with his patient in such a way as to allow him the possibility of tracing out the themes of punishment for masturbation and castration anxiety. Emma’s phantasy of having a penis developing as a consequence of genital mutilation reiterates Fliess’s theory of bisexuality, but now deeply discovered within the dream as the centre of the unconscious. Reading this complex book inevitably takes one back to rethinking the unconscious origins of psychoanalysis itself, as discovered in Freud’s self-analysis. The difficulty in believing some of the new and re-found chains of association that Bonomi uncovers from Freud’s own dreams recalls the psychic leap one has to make in reckoning with Freud’s original revelations about the content of the unconscious. This is even more the case given the moments when Freud decides to go no further, partly for reasons of maintaining some privacy and self confidentiality, but also partly due to the resistance of the unconscious to interpretation (the hidden navel of the dream).

Controversy has dogged Bonomi’s path for many years as he has honed and gathered more evidence for his thesis. He records here how an earlier chapter of the book, sent as a paper, had been rejected by the IJPA in 2011 as he had failed to present solid, convincing evidence that Eckstein had undergone a castration procedure as a child. Moreover, there was no evidence to support that Freud had not circumcised his male children, with one reviewer stating ‘This seems highly unlikely since Freud’s parents were alive and along with Martha, would have been deeply disturbed’ (Bonomi, p. 9). From this Bonomi realized that the decision not to circumcise was the ‘concrete and factual way in which Freud had symbolically killed his father’. The practice of metzizah b’peh was even described by a New York lawyer, writing to Bonomi, as impossible and wrongly described. Yet in 2004, out of concern for the potential spread of herpes infection, the New York City of Health and Mental Hygiene advised parents and mohelim that metzizah b’peh with direct oral suctioning of the circumcision wound should never be performed. To return to the theme of actual castration, it was as late as the 1920s that Marie Bonaparte, whilst in analysis with Freud, underwent clitoridectomy: a subject rather veiled and somewhat dissociated from her history with Freud.

So, in the twenty-first century, we appear to have returned to the earliest controversies about such psychoanalytic connections and chains of associations, in a way that harks back to the publication of The Interpretation of Dreams in 1900, where the uncovering of meaning from the hidden depths of the unconscious was experienced as an attack on that which was thought to be known in consciousness. To this extent, Bonomi is restoring the radical potential of psychoanalysis. Perhaps, this book suggests, Freud today can still surprise us with the possibility of mining and weaving further and complex ideas behind the surface of what we think we know.

This volume is the first of a pair of books. The second will have the subtitle ‘Sigmund Freud and Sándor Ferenczi’. It is likely that Bonomi will continue on his pathway and will flesh out their profound theoretical disagreements about the role of early trauma in the development of the mind. In particular, the first volume, by placing an actual trauma of ‘the cut’ at the bedrock of the soma-psyche, may already allow for a more balanced and refined reading of their great debate on the role of trauma in the development of the unconscious, which has continued within psychoanalysis ever since Ferenczi read his original paper, ‘Confusion of tongues between the adults and child’, to a diffident Freud in 1932.

References
Behrend, F. J. (1860) Über die Reizung der Geschlechtstheile, besonders u¨ ber Onanie bei ganz kleinen Kindern, und die dagegen anzuwendenden Mittel. J. Kinderkrankheiten 35, pp. 321–329.
Freud, S. (1896) The Aetiology of Hysteria. In S. Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud. Trans. from the German by J. Strachey. London: Hogarth Press, vol 3, pp. 187–221.
Freud, S. (1914) On the History of the Psycho-Analytic Movement. SE 14, pp. 1–66.
Freud, S. (1933) New Introductory Lectures on Psychoanalysis. SE 22, pp. 1–182.
Merkel, F. (1887) Beitrag zur Casuistik der Castration bei Neurosen. Nuremberg: J. L.Stich.
Spitz, R. A. (1952) Authority and masturbation: some remarks on a bibliographic investigation. Psychoanalytic Quarterly 21: 490–527.



DR JONATHAN SKLAR, MBBS FRCPsych, is a training analyst and fellow of the British Psychoanalytic Society. He teaches regularly in London, Chicago, Cape Town and Eastern Europe. From 2007–2011 he was Vice President of the European Psychoanalytic Federation. His psychoanalytic papers have been published in Italian, Spanish, French and Portuguese. He is presently on the board of the International Psychoanalytic Association. Address for correspondence: Flat 4, 33 Priory Terrace, London NW6 4DG. [jonathan@sklar.co.uk]

Buchbesprechung (Review by) Michael B. Buchholz, Psyche – Zeitschrift für Psychoanalyse, 2016/70:363-366.

Bonomi legt den ersten Band eines Projekts vor, das aufschrecken konnte. In der Psyche 5/1999 hatte er darüber berichtet, wie Ferenczis angeblicher “geistiger Verfall” von Interessierten als Gerücht herbeigeredet wurde. Um den nachwirkenden Intrigen-Schaden ausheilen zu helfen, hatte Bonomi mit Bollas, Etchegoyen, Kernberg, Roudinesco, Anne-Marie Sandler und Wallerstein eine Initiative zum Ankauf von Ferenczis Haus in Budapest gestartet (http://www.ferenczi.it/house.ferenczi.it/index.html), in dem er seine Patienten empfing und in dem das “klinische Tagebuch” geschrieben wurde. 2013 hat er einen großen Kongress zu Ferenczis Werk mitorganisiert und von ihm gelernt, dass man sich nicht in ausgetrampelten Pfaden der Tradition und Loyalitaten bewegen sollte, wenn man Interessantes entdecken will.
Ein erster Teil, “Medical context”, provoziert mit der Kapitel-Überschrift: “The castration of women and girls”. Die Beschneidung von Frauen im Wien Freuds war breit diskutierte Praxis, um hysterische Störungen zu “behandeln “. Lange Zeit dachten wir etwa so über die Ursprunge der Psychoanalyse: Freud habe in “splendid isolation” die sexuelle Ätiologie der Neurosen und die infantile Sexualität entdeckt, eine Entdeckung, die unter Verzicht auf die Verführungstheorie möglich wurde. Seine Selbst-Analyse galt als Ur-Tat eines einsamen Helden, mit der er Zugang zu einer neuen Psychologie fand. Einzig Wilhelm Fliess habe ihm beigestanden. Sexuelle Ätiologie, infantile Sexualität und Selbstanalyse bei der Entdeckung des Unbewussten – Bonomi wird mit dieser, von Jones in die Welt gesetzten Drei-Komponenten-Legende aufräumen. Die Realität weiblicher Kastration wurde verleugnet.
Der zweite Teil des Buches beschäftigt sich zentral mit dem Zusammenhang von Emma Eckstein und Freuds Irma-Traum. Anzieu, der wohl beste Kenner von Freuds Selbstanalyse, hatte vermutet, dass der Irma-Traum eine traumatische Genese beherberge und auf “Reparation” des Traumas abziele; Freud habe ihn geträumt, um ein Trauma zu bewältigen, das ihm selbst nicht klar werden durfte. Erikson war aufgefallen, dass Freud den Irma-Traum als Konversion, als Bekehrungserlebnis, geträumt hatte. Aber ihm wie Lacan war der dramatische Ausgang von Emmas Nasenoperation durch den unseligen Fliess (Fliess “vergas” bei der Operation von Emmas Nase einen Streifen medizinische Gaze von einem Meter Lange in Emmas Operationswunde, woran sie beinahe verblutet wäre) noch ganz unbekannt. Bonomi entwickelt darauf aufbauend neue Interpretationslinien.
Freud war vom unerfreulichen Verlauf der Behandlung Irmas so bedrängt, dass er nachts aufstand, um ihre Krankengeschichte zu schreiben – verärgert, dass er den ungünstigen Behandlungsverlauf rechtfertigen musste. Der Irma-Traum müsse, so Bonomi, als Totem und Tabu des analytischen Raumes betrachtet werden. Dessen Schrecken sei gemildert, weil Freud ihn träumen konnte; er war kein Alptraum! Bonomi betont, dass das Wissen um die Operation unsere Einsicht in den Traumbildungsprozess allerdings eher verdunkelt habe. In der Korrespondenz aus dieser Zeit kommt die Beschneidung eines Mädchens vor. Diese Themen haben in der Behandlung von Irma eine Rolle gespielt. Im Zusammenhang damit entwickelt Bonomi die Idee von Freuds fundamentaler Identifikation mit einer traumatisierten weiblichen Figur.
Bonomis Quellen zeigen nun neue Bezüge zu diesem Traum. Ein Buch des Gynäkologen Alfred Hegar etwa, zu dem Freud eine andere Patientin überwiesen hatte (S. 73), war von Freud gründlich gelesen worden. Bonomi stellte fest, dass Freud die Stellen in seinem Exemplar angestrichen hatte, nach denen die Kastration ein ruhiges Temperament hervorbringe und nervöse Symptome, die sich in sexueller Pathologie manifestierten, beseitige. Freud rezensierte dies Buch, als er sich intensiv mit Fliess’ Theorie von der nasalen Reflex-Neurose auseinandersetzte. Freud war über weibliche Kastration keineswegs nur als Leser informiert. In einem Brief an Martha vom 15. Mai 1886 schrieb er, dass eine Patientin von Chrobak operiert wurde, und er war in Kontakt mit Wiener Pädiatern, die diese Praxis ausübten.
Warum hat Freud Irma eigentlich gestattet, sich der Nasen-Operation durch Fliess zu unterziehen? Bonomis Antwort lautet: Weil Freud mit der Praxis weiblicher Kastration aus dem Medizinstudium vertraut war! Bonomi bringt viele Nachweise. Ein Autor der damaligen Zeit bemerkte, dass es Dutzende Studien dazu gab: Das Thema stand im Mittelpunkt psychiatrischer Auseinandersetzungen. Ludwig Fleischmann etwa, angesehener Wiener Chirurg, schrieb 1878 einen Beitrag, in dem er forderte, die gewohnheitsmäßige Masturbation von jungen Mädchen mit Klitoridektomie zu behandeln. Fleischmann war zusammen mit Adolf Baginski im Abteilungsvorstand der Wiener Allgemeinen Poliklinik. Mit Baginski wiederum war Freud aus seiner pädiatrischen Ausbildungszeit im Marz 1886 bekannt.
Das Thema der Masturbation, später in der "Mittwochsgesellschaft“ auf psychoanalytischer Ebene geführt, war hier medizinisch mit der von manchen Ärzten ausgesprochenen Empfehlung weiblicher Kastration vorbereitet worden, die sich auch auf Kauterisierung der Labien bezog. Der Zusammenhang von Neurose, Sexualität, Selbstbefriedigung und Kastration war im medizinischen Format vorgedacht und vorpraktiziert; Freud, ebenso wie Breuer, opponierte gegen diese Praxis. Freuds Leistung kann als Umbuchung dieses Zusammenhangs auf das psychologische Terrain gewürdigt werden. Bonomis brisante Frage lautet, ob und wie diese Praxis für die Gründungsakte der Psychoanalyse konstitutiv war. Die Antwort fuhrt über den Initialtraum der Psychoanalyse.
Die Theorie, dass hysterische Symptome "Erinnerungssymbole“ seien, ruckt so in neues Licht. Freud schuf den Weg von der chirurgischen Manipulation zu ihrer psychologischen Analyse. Freud, so Bonomis starke Vermutung, müsse von Irmas Beschädigung etwas geahnt haben, weil ihm diese Diskussionen geläufig waren. Aber der Preis war, dass er die Geschichte von der geläufigen medizinischen Praxis in Wien umschrieb – von den Frauen auf die Kastrationsangst der Männer. Als Martha zum sechsten Mal (mit Anna) schwanger war, gab es eine eheliche Krise. Freud dachte über Fellatio als mögliche Alternative zur gewöhnlichen sexuellen Befriedigung nach; eine Hypothese, die Kurt Eissler so attraktiv fand, dass er sie zur Grundlage seiner Re-Lektüre von Freuds Irma-Traum
machte. Der manifeste Traumsatz, dass Irmas Mund nicht aufgehe, bekommt neue Bedeutung ebenso wie die einleitende Traumformulierung von den Gasten in der Halle: “Wir empfangen…”. Die Geburt von Anna fiel auf den 3. Dezember 1895, ihre Zeugung muss, so rechnet Bonomi nach, zwischen dem 5. und 12. Marz erfolgt sein. Am 8. Marz hatte Freud in einem Brief Fliess über den Zwischenfall mit Emma Eckstein unterrichtet – so zeitlich nah beieinander liegen diese Verhältnisse! Kein Wunder, dass Freud sich für die Theorie der kritischen Empfängniszeiten, die Fliess extensiv überdehnte, interessierte. Die “double scenes”, von denen Bonomi mit klugen Referenzen auf den “Szene”-Begriff (siehe z.B. S. 150) spricht, die Szenen mit Emma und die Szenen seiner Ehe überlagern sich dicht. Im Januar 1897 schreibt Freud an Fliess von einer “Szene von Mädchenbeschneidung”; einer 13-Jahrigen sei ein Stuck des Labium minor beschnitten worden. Bonomi (S. 104) zitiert andere Autoren, die verstört fragen, wie um Himmels willen Freud davon wissen konnte, dass die eine Hälfte von Emmas Schamlippen kleiner war als die andere. Auch die Traumszene von Irmas Mund, der nur schwer aufgehe, erfahrt eine neue Bedeutung. “There is no doubt that Freud, in his letter to Fliess, had been referring to a real cut on the external genitals of one of his female patients at the time, supported by the existence of a disparity in the lengths of his patient’s labial lips” (S. 104). Bonomi schließt darauf – soweit die historischen Quellen diesen Schluss zulassen –, dass Freud sich gefragt haben muss, ob er
einen aktiven Part in der Retraumatisierung von Emma gespielt hat, und dass er sich selbst unbewusst sowohl als verführendes wie als traumatisierendes Objekt ihrer inneren Welt sah. In der aktiven wie in der passiven Identifikation müssen ihn schwere Schuldgefühle geplagt haben; auch er hatte sich von Fliess einmal an der Nase operieren lassen. Für die Rolle der Selbstanalyse kommt Bonomi nun zu einer überzeugenden Folgerung: “Crucial here is that Freud was infiltrated by Irma’s pain, and further, that this infiltration in time slowly turned him into his own patient, initiating a process whose terminal
point was Freud’s dream of him self-dissecting his own pelvis, a definitive point of Freud’s analytic initiation” (S. 106; Hervorh. M.B.B.).
Die Emma-Episode erweist sich als “Eckstein”; Bonomi widmet dem ein eigenes Kapitel im dritten Teil. Freud verwendete den Begriff des “Ecksteins” in seiner Neuen Folge der Vorlesungen im Zusammenhang der Probleme, die der Masochismus für die Libidotheorie darstellte (Bonomi, S. 155). Eckstein – das bezieht sich auf den biblischen Satz, wonach der Stein, den die Zimmerleute verworfen haben, zum “Eckstein” geworden ist. Diese Formel galt auch für den “Widerstand”: statt ihn zu verwerfen, wurde er zum “Eckstein” der Behandlungsführung. Auf diesem Eckstein ist das “building” der Psychoanalyse gebaut – und dieser Eckstein ist ein “cut”. Im komplexen Norekdal-Traum Freuds kommt wiederum “ek-” als Vorsilbe vor (S. 159ff.), aber Bonomi erinnert auch an eine Fülle von Irrtümern Freuds in Auseinandersetzungen mit Ferenczi um biblische Themen (S. 163ff.). Steine sind, als Felsen oder Säulen, Gegenstande vielfaltiger religiöser Verehrung; sie markieren Orte, an denen viel Blut vergossen wurde. Von hier aus wiederum gehen Bezuge zum Orakel von Delphi, wo Pythia an einer Felsenspalte sas, aus der betäubendes Gas gestromt sein soll, von dem manche meinten (wie Freud wusste), es habe sich um Ethylen gehandelt – wiederum ein Bezug zu Operation/Anästhesie
und chemischen Formeln im Irma-Traum. Sein reichhaltiges Buch hatte Bonomi mit einer Diskussion darüber begonnen, ob Freud seine Sohne beschneiden lies oder nicht; hier schließt sich ein Kreis. Die Geschichte (die Geheim-Geschichte?) der Psychoanalyse hat Potential, uns zutiefst zu beunruhigen. Zu wünschen wäre, dass sich ein Verlag für eine Übersetzung dieses Buches findet. Vor 23 Jahren hatte Bonomi bereits ein Paper “Why have we ignored Freud the Pediatrician?” publiziert. Es konnte die Zeit gekommen sein, unsere Historiker einen Blick auf diese verstörende Angelegenheit werfen zu lassen.

Michael B. Buchholz, Prof. Dr. phil., Dr. disc. pol., Dipl.-Psych., ist Lehr- und Kontrollanalytiker am Lou-Andreas-Salomé-Institut in Göttingen, Professor an der Internationalen Psychoanalytischen Universität in Berlin und leitet derzeit ein Projekt zur vergleichenden Untersuchung von Empathie in Verhaltenstherapie, Psychoanalyse und Tiefenpsychologie.


Book review by Anne Golomb Hoffman, Ph.D., Contemporary Psychoanalysis, Published online: 26 May 2016.

With this volume, Carlo Bonomi makes a significant contribution to the history of psychoanalysis. Highlighting medical practices categorized as circumcision and castration in girls and women, Bonomi asks us to consider their influence on Freud’s thinking in the 1880s and 1890s. Drawing on archival research, Bonomi argues for the likelihood that Emma Eckstein underwent this kind of surgery in childhood as a treatment for hysteria. Bonomi reads the Irma dream, the specimen dream of psychoanalysis, in light of this conclusion and finds evidence of the resonances of Eckstein’s childhood trauma in the complex play of identifications between doctor and patient that the dream contains.
With a focus on the years in which Freud carried out his self-analysis and began to formulate the ideas that would lead to the development of psychoanalysis as a treatment modality and a theory of mind, Bonomi argues for recognizing “(1) the generic impact of the castration of women and girls on Freud as a young medical doctor; (2) Freud’s private choice not to have his children circumcised; and (3) the specific emotional resonance on Freud as analyst of the genital trauma which Emma had endured as a child” (p. 6). Arguing that Freud took a “position against the practice of female castration as a cure for hysteric women” (p. 11), Bonomi’s offers a new reading of the Irma dream that takes into account Freud’s unconscious reaction to Emma’s childhood trauma. Moreover, convinced of the unconscious impact of medical practices concerning the pelvic/genital region, Bonomi links the inaugural Irma dream to the concluding dream in Freud’s self-analysis, the “self-dissection of the pelvis.” Thus, Bonomi organizes his analytic reading around the pelvic domain as emblematic of the analytic space, an embodied space whose boundaries are vulnerable to violation.
As Bonomi demonstrates, the term “castration” runs through the titles of articles in the medical literature over the years 1876 through 1896, with 1896 a crucial moment, marking Freud’s first usage of the term “psychoanalysis” (pp. 17–18). He notes there is a certain blurriness in the “anatomical criteria” for the procedure termed castration (p. 18). This blurriness enters the historical record, making it hard to discern what “female castration” actually consisted of. Bonomi cites “removal of the ovaries” (p. 18) as a treatment for hysteria and refers to extirpation of the clitoris as a method of addressing the problem of masturbation in girls, particularly among the bourgeoisie (p. 23). Bonomi delineates the medical profession’s concern about children’s involvement with their genitals. (He is therefore critical of Laqueur’s [2003] history of masturbation for its neglect of children in favor of a focus on the adult imagination [p. 28].)
Bonomi documents Freud’s involvement in the care of children, beginning with a period of training he undertook with the eminent pediatrician Adolf Baginsky in Berlin in March 1885 (p. 31). Baginsky brought an attention to “social hygiene” into pediatrics, with a distinct focus on the sexual etiology of many childhood illnesses (p. 33). In effect, then, Freud’s attention was initially drawn to the domain of childhood sexuality by prevailing medical practices in the treatment of children. For Bonomi, the neglected history of the practices known as castration leaves an “uncanny trace” in the history of psychoanalysis. By his own account, he has been committed to elucidating this uncanny history since 1993, with the goal of understanding its powerful impact on Freud’s theoretical work in its formative years.
In effect, Bonomi compels us to confront the entanglement in the 19th century of concepts of subjectivity and mental life with scientific theories of the reflex arc and spinal irritation, that is, the idea that shocks to the nervous system might manifest themselves in a range of bodily and psychic symptoms. He places Freud in this context in order to trace the emergence of Freud’s understanding of mental life and symptom-formation, at a moment of intense cultural anxiety, amid moralizing concerns with sexuality.
Bonomi’s project therefore deepens the psychoanalytic commitment to exploring the enigmas of sexual traumas and fantasies in the lives of subjects, whether in the analyst or the analysand. In this instance, it is Freud’s self-analytic work that leads Bonomi to study a rich and intricate web of relationships. He situates Freud in relation to family, patients, supervisors, the practice of medicine generally, and in the broader context of anxieties surrounding the body, sexuality and femininity. He argues that Freud’s unconscious memories of his own circumcision were stirred by his encounters with the pediatric practice of female circumcision and the use of castration in the treatment of hysteria.
Circumcision is in Jewish tradition the sign of the covenant. (In Genesis 17, God addresses Abraham, commanding him and his male descendants to undergo circumcision as the “sign of the covenant” between Abraham and God). Bonomi adds to the work of Freud scholars on this subject, as he links ritual practice of circumcision to concerns about infection that include not only the practice of metsitsah (in which the mohel or circumciser would suck on the infant’s penis to stanch the blood flow [p. 142]), but also to more general concerns about infection that included syphilis and diphtheria. Bonomi links these fears to the figure of Freud’s teacher, the pediatrician Alfred Baginsky. In a lecture delivered around the time that Fliess operated on Emma Eckstein, Baginsky (1895) referred to Mosaic law as an “anticipation of modern hygiene” (as cited in Bonomi, p. 142). The pediatrician was known as well for his fights against diphtheria and masturbation. Bonomi suggests that Freud may have identified with his teacher’s role as a savior of children. This complex and even contradictory set of identifications may have contributed to Freud’s refusal to have his own sons circumcised. (Whether or not Freud’s sons were circumcised remains a point of contention for scholars.)
The nose inevitably enters into this complex of symptoms and zones of the body. Central to this historical narrative is Freud’s receptivity to Wilhelm Fliess’s concept of the nasal reflex neurosis, a concept grounded in a more general understanding of the connection of the nose to the sexual organs. In Bonomi’s reading, the nose links Freud to his female patients, most prominently Emma Eckstein, and plays a key role in his reading of the Irma dream. In a tight weave of documentary evidence, Bonomi focuses on the years 1892 through 1895. Laying out Freud’s own cardiac symptoms during these years, Bonomi notes his depression and panic attacks, along with his introspective efforts to understand the somatic origins of anxiety. Moreover, at around the time that he first began to treat Emma Eckstein (1894) and eventually referred her to Fliess for nasal surgery, Freud reviewed the work of Alfred Hegar, a well-known gynecologist and authority on female castration (pp. 73–74). And, before Fliess operated on Emma, he performed a procedure on Freud’s nose to address stuffing and swelling, symptoms associated with Freud’s use of cocaine.
All of this material links analyst to analysand in an intimate bond that Bonomi terms a suggestive “mimesis between doctor and patient” (p. 77). This mimetic correspondence is foundational to psychoanalysis, insofar as it constitutes the analytic space and links it to an inner bodily domain that is vulnerable to traumatic disruption. The injection in Freud’s Irma dream is for Bonomi the emblem of that traumatic intrusion. What we have here is in effect a theory of the traumatic formation of the subject. Of course, that is no simple thing. Thus, Bonomi takes note of evidence in the dream that counters Freud’s feminine identification with his patient. He points out that Freud dreamt the dream at a point midway in his wife’s pregnancy with Anna, an observation that lends additional meaning to the dirty syringe and links the dream to fantasies of male omnipotence. Taking this complex play of identifications further, Bonomi links Martha’s “physical pregnancy” to the “spiritual fertilization” that her husband was experiencing in the creation of psychoanalysis (pp. 99, 118).
Bonomi’s speculations are suggestive. Indeed, he draws on virtually all the major interpreters of the Irma dream, as he builds his case. Turning to Emma herself, Bonomi argues that Fliess’s botched surgery on her nose reawakened in her the impact of an earlier traumatic experience, the procedure she may have undergone as a child in which the labia minora and/or the clitoris were cauterized or excised (pp. 107–108). The counterpart to Emma’s retraumatizing can be seen not only in the dreaming Freud’s confusion of himself with her, but in the reverberations in Freud of his own circumcision and his early witness of the circumcision of his brother Julius, who was to die six months later. The conclusion to these speculations is a reading of the Irma dream as the “analyst’s introjection of the psychic reality of a patient who had been traumatized” (p. 108; emphasis in original). Guilt is diffused throughout these proliferating associations, a guilt that Bonomi, following Searles (1966), reads as paradigmatic to the field of psychoanalysis.
In the concluding chapters of this volume, Bonomi explores the resonances of bisexuality and bilaterality in broader contexts, which engage not only Freud’s relationship with Fliess and his dream of Irma, but the cultural atmosphere of anti-Semitism in which he worked. Offering his study as a critique of earlier tendencies to read Freud as a mind operating in isolation with his self-analysis a “triumph of autonomy” (p. 198), Bonomi draws on scholarship by Sander Gilman and others that links circumcision, as the “privileged signifier,” that associates Jews with femininity, passivity, and homosexuality (p. 204).
Bonomi notes that readers of Freud may experience the “intrusion of foreign and alien thoughts,” a valuable observation that draws our attention to the unconscious dimensions of the experience of reading (p. 134). In this volume, Bonomi has turned resolutely to exploring associations that others might disregard, in order to uncover the traces of bodily fantasies and early traumas in the analytic work that Freud carried out with his patients and in his self-analysis. The drawback to this project is its insistently speculative nature and its strategy of building on speculation to construct an argument. Consider this passage:

Freud’s reluctance to broach the topic of circumcision early on in his career was undoubtedly tied to the rampant and virulent anti-Semitism which plagued Vienna at the time. It was also joined to Freud’s traumatic past and aversion towards Jewish rituals and ceremonies. Freud, moreover, had likely encountered the practice of female circumcision at the time of his pediatric training and was most likely shocked and scandalized by it. He most likely never felt fully free to denounce the practice, however, as some of the leading medical authorities in Vienna, and in Europe, vigorously endorsed it at the time. We can also surmise that Freud must have experienced similar feelings in relation to Jewish authority figures around him when he decided against having his male children circumcised. One such figure must have been Professor Samuel Hammerschlag, his childhood Hebrew teacher and father of Anna Hammerschlag, a patient he treated in 1895 and who appeared to him as the central figure in his Irma dream. (pp. 238–239, emphasis added)

One is tempted to characterize this volume’s scholarly project as a psychoanalytic fantasy, which is not simply meant as denigration. It is rather a register of the extent to which Carlo Bonomi has employed psychoanalytic modes of interpretation and a sensibility deeply attuned to the intimacy of the analytic space in all its fantasmatic variants. These variants include an awareness of the analytic space as reflective of an inner bodily terrain where gender is rendered unstable and dichotomies between active and passive come undone. Thus, Bonomi’s speculations call upon psychoanalytic readers to reenter a domain in which subject and object mingle, where early experiences are reawakened through the associative processes of dreaming that are central to the work of analysis.

REFERENCES
Baginsky, A. (1895). Die hygienischen Grundzüge der mosaischen Gesetzgebung [The hygienic foundations of mosaic constitution.] Deutsche Vierteljahresschrift für öffentliche Gesundheitspflege, 27, 465–491.
Laqueur, T. W. (2003). Solitary sex: A cultural history of masturbation. Cambridge MA: Zone Books.
Searles, H. (1966). Feelings of guilt in the psychoanalyst. Psychiatry, 29, 319–323.

Anne Golomb Hoffman, Ph.D., is Professor of English and Comparative Literature at Fordham University. She is a member of the Research Faculty of the DeWitt Wallace Institute for the History of Psychiatry at Weill Cornell Medical College and a Special Member of the Association for Psychoanalytic Medicine of the Columbia University Center for Psychoanalytic Training and Research.

 
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