FREUD AS AN EXPERT WITNESS
K. R. Eissler
Madison, Connecticut, International Universities Press 1986, 449 pages

Garcia, MD, Emanuel E.

English

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Book Review: The Soft Voice of Reason

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Jefferson Journal of PsychiatryVolume 5 | Issue 2 Article 15January 1987Book Review: The Soft Voice of ReasonEmanuel E. Garcia, MDInstitute of Pennsylvania Hospital, PhiladelphiaFollow this and additional works at: https://jdc.jefferson.edu/jeffjpsychiatryPart of the Psychiatry CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inJefferson Journal of Psychiatry by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationGarcia, MD, Emanuel E. (1987) "Book Review: The Soft Voice of Reason," Jefferson Journal of Psychiatry: Vol. 5 : Iss. 2 , Article 15.DOI: https://doi.org/10.29046/JJP.005.2.014Available at: https://jdc.jefferson.edu/jeffjpsychiatry/vol5/iss2/15The Soft Voice of ReasonFREU D AS AN EX PE RT WITNESSK. R. Eissle rMadi son, Connecticut , International Unive rsities Press1986, 449 pagesEmanuel E. Garcia, M.D.On December 19 , 1918, after th e devastation wroug ht by th e First WorldWar, Austria's provisional National Assembly responded to the outcries of itsexha usted , angry and desperate populace by e nac t ing legislatio n initiating theinvestigation of wartime derelictions of military duty. A co mmission was createdand empowered to determine whether high-ranking military personnel hadcommitted violations oflaw whi ch warranted th e institution ofj udicial proceed-ings. Almost immediately, the army medical se rv ices ca me under attack. Profes-sor Wagner-Jauregg's psychiatric clinic in Vienna was singled out by Lt. WalterKauders, who brought forth accusations of gross maltreatment. J ul ius Wagner-Jauregg, who had been appointed to th e commission 's panel at the t ime of itsinc eption, suddenly found himself th e object of its inqui ries. T he co mmission'schair man , Professor Loeffler , call ed upon Sigmund Freud to provide experttestimony for the inv estigation into Wagn er-Jauregg 's war time co nduct as apsych iatrist.The ramifications of the confrontation between Freud , founder of adiscipline e ither reviled or ignored by most psych iatrists of the day, andWagner-Jauregg, popular and prestigious representati ve of academic psych iatryand future recipient of the Nobel Prize, I form th e subject of Eissler's masterfulhistorical inquiry in Freud as an Expert Witness. The meeting between Freud andWagner-Jaureggbrought into relief two vastly different conceptions of man. Onthe one hand, was ps ychoanalysis, which envisioned man as a suffe ri ng animal,fraught with internal psychological conflicts, and buffeted by th e hardsh ips of anindifferent universe ; on the other hand was clas sical academic psychiat r y, whichscorned th e distinction between the conscious and unconscious realms of themind, and sanctioned inherently cruel attitudes and practi ces in its quest forexactitude in the description , classification , and treatment of mental disorders.Dr. Garcia is a second-year resident at the In stitute of Penn sylvania H ospital, Philade lphia,Penn sylvania.lWagner-Jauregg was awa rded th e Nobel Prize in 192 8 for his d iscovery of themalaria-cure for general paralysis of the insane.96BOOK REVI EW 97Eissler devotes a sign ificant portion of his book to a biography o f the man whoinstigated th e fate fu l confrontation , demonstrating th ereby the human impactof th e th eoretical issues at stake . T h us, a recapitulation of the major eve nts ofKauders' course is necessary.Walter Kauders was born in Vienna in 1889. At th e o utbreak of the war hewas living in Switzerland with every opportunity to enjoy a safe haven from th ewar in favorab le economic circumstances. In stead, he volun teered his se rv icesfor th e Au strian army. He came to ex perience first hand not only the traumatichazards of combat, but also th e unforgivable lack of preparatio n and ineptitudeof the Austrian forces. In September of 191 4 he sus ta ined a concuss ion in th efield after a shell exp loded nea rby. An in itial x-ray revealed a partial sku llfrac tu re, and raised th e susp icion of a hemat oma. Kauders ex perienced head-aches, nausea, dysequilibrium and visua l di sturban ces; he was declared unfit fo rduty. He continued to su ffe r th ese di sabling sympto ms an d in August 1917 wasreferred to German y's premier neurologist , Professor Er b, who diagnosed apartial fr ac ture of th e left parietal bone with possible pach ymeningitis chronicaor cyst. Later in 1917 Kauders was call ed before a military board for reevalua-tion of fitness for se rv ice , after wh ich he was immediately ordered to Wa gner-Jauregg 's clinic.At th e clinic, Kauders was placed in so lita ry confinement for 77 day s, andsubjected to a form of e lectro the rapy ca lled faradi zati on on two occasions.Hygiene th ere was atrocious and scenes of brutality abun da nt. To h is horror,Kauders witnessed the extreme sad ism of one of Wagn er-Jauregg 's assistants,Dr. Mich ael Kozlowski , who used the faradic appara tus as a means of torture, onoccasions applying the electrode brush to the exquisitely sensitive tips of fingers,toes, to th e nipples and even the te sticles. Kauders himsel f, like many at th eovercrowded clinic, was branded a malingerer by Wagn er-Jau regg. The for malcharges, instigated by Kauders and tak en up by th e co mmission, conce rned : I )the harmful effec ts of electrotherapy; 2) th e misuse of so lita ry co nfinement, andthe cruel and inappropriate administration of emetics and other fou l substances;and 3) th e general strategy of torture , ma squerading as treatment, whose solepurpose was returning as many so ld ie rs as possible to the fro nt.Freud was fir st asked to submit wri tten test imony, wh ich he did in th e formof a beautifull y co mposed , lucid memorandum on the treatment of warneuroses, reprinted in full for th e reader's conven ience ( I) . In it , the majorthemes that would arise during the verbal testimony were given th eir first airing.He described the "war neuroses" - typ ica lly, motor d isturbances suc h astremors and paralyses which resulted from th e traumatic shock of combat-andidentified th eir immediate cause in th e unconscious desire of the patients towithdraw fr om the demands of the service. Malingering , he asse rted, was rare.He of course considered it an error to ignore th e difference between consciousand unconscious intention , a consequence of whi ch would be to treat warneurotics as malingere rs. He exposed th e real purpose of electrotherapy asmerely providing a painful counterstimulus th at would cause th e so ld ie r to flee98 J EFFER SO N JO UR NAL OF PSYCHIATRYback to the front , its primary aim assuredly not the restoration of the patient'spsychological health. Furthermore, he drew attention to th e great dangers ofpracticing medicine in such a way that the fundamental claims of humanity andservice to the individual would be sacrificed for pragmati c concerns, e .g., thedemands of war and national purpose. Finally, Freud noted how modifications ofhis psychoanalytic technique had been employed successfull y in th e treatment ofsevere war neuroses by Dr. Ernst Simmel.The commission 's hearing, the pertinent portions o f wh ich Eissler repro-duces from the available transcripts, lasted two days. Freud testi fied only on thefirst. He gave the opinion that Kauders probably su ffe red from an acutetraumatic neurosis which was, as it were, grafted onto a ce rebra l injury. Freud,who trained initially as a neurologist, drew attention to a part of Kauders'smedical history documenting a slowing of the pulse , whi ch he inte rpreted as aprobable indication of the presence of an organic ce rebra l lesion- a notiondismissed altogether by Wagner-Jauregg. Freud flatl y decl ared the use ofelectrotherapy inappropriate and stressed his belief that Kauders was not amalingerer. On these points he was at loggerheads with Wagner-Jauregg, whodefended his clinic's treatment, citing th e harmlessness and success of electro-therapy, and who vehemently denounced Kauders as a dodger , refusing toconcede the existence of either an organic lesion or an unconsciously motivatedtraumatic neurosis. Clearly his concept of neurosis was a far cry from Freud's, ascan be shown by his veritable equation of neuroses and malingering on the basisof the "imaginary" nature of the physical complaints. Despite hi s basic scient ificdisagreements with Wagner-Jauregg, Freud nevertheless was co nv inced of thelatter's personal integrity and honesty of purpose.On the second day of the hearing, in Freud's absence, psych oanalysis wassubjected to a vicious, ill-founded and gratuitous attack by Wagn er-J auregg 'sfollowers . Glowing testimonials to Wagner-Jauregg's brilliance and self-sacrificeduring a most arduous period were given, and in th e end Wagn er-J a ureggemerged full y rehabilitated and professionally unscathed.In addition, however, evidence that abuses had been carried out at theclinic, presumably without Wagner-Jauregg's knowledge, was brough t forward .Accusations against Dr. Michael Kozlowski alleged that faradization became ameans of sadistic torture in his hands. Furthermore, from th e testimony of Prof.Arnold Durig, who held no overt bias for or against e lec t rothera py, we are ableto learn not only that these accu sations were well-founded, but that e lec trother-apy was actually a gross treatment failure. Durig also revealed that war neuroticshad indeed been returned to the front , albeit against Wagner-J au regg' s inten-tions.In Eissler's estimation, the result of exhaustive and scr up ulous research inthe service of historical reconstruction, Wagner-Jauregg is neithe r villain norhero. There is no question that Wagner-Jauregg was inadequate to th e task hefaced during the war, not to say negligent of duty, if th e individual's health isBOOK REVIEW 99understood as a physician 's primary responsibility. In th e case of Kauders, forexample, it becomes clear that no attempt to e licit a decent psychiat ri c h isto ry,the work ofa mere hour, was ever made. If it had been, it would ass ured ly haveproved inconceivable to brand a man like Kauders a malingerer . But thi s wasultimate ly a reflect ion of th e inadequacy and negl igence of classical psychiat ry atth e time , which must be seen in histo r ical perspective. After all , th e approac h ofthe classical psychiatr ist , as woefully impotent in the treatment of mentald isorders, and as replete wit h cruelties as it was, nevertheless led to a detail eddescrip tion and classification of the disorders . Thus it fulfilled an essential andvaluable service that helped to pave the way for th e next great advance , namely,the Freudian revolution .Such a brief outline as this does little justice to the richness of Eissler'smethod, the multip licity of his insights, o r his keen understanding of th e greatsoc ia l fo rces forming the backd rop against which the drama between Freud andWagn e r-Jauregg was played. Eissler presents not only a detailed histo rica laccount of the war neuroses an d the evolution of their treatment, but afascina ting life history of Kauders as well, based on data from his own persona linte rviews wit h the man. He a lso discusses the important problem of mali nge r-ing at considerable leng th, d rawing on his own experience as a psychiatrist in theU . S. Army during World War II. Eissler clearly identifies th e centra l role o f thepsychiatrist 's subjective atti tude in the diagnosis of malingering, and providesev idence to suppor t the co ncept of true malingering as an illness itself, "wh ich inreality is the result of a seriously deranged an d permanently defective personali-ty" (p . 275)-not the co n-job of a wily and psych ologica lly whole manipulator.iEissler's work is a beauti ful ex ample of historical investigation , and itshou ld be required read ing fo r all concerned with the psychology of man .Interestingly eno ug h, and not unexpect edly, one need not look far to percei veparallels in our own e ra. T he ascendancy of the biological psychiatrist , with hisemphasis on the chemical basis of behavior and thought, carries th e danger th atthe approaches of Wagner-Jauregg and Kraepelin will be revi ved, marked bytheir tacit assumption of the incomparable superiority of the psychiatrist to th epatient, and ignorance-or d isavowal-of the psychology of the un conscious.Paradoxicall y enough, one of the great humanistic movements in history,psych oan alysis, now find s itsel f crit icized-by feminists, Marxists, historian s,soc iologists and psychiat ri sts, among others-for its ostensibly oppressiveinfluences. Perhaps th e bureaucrati zation of th e profession of psychoan alysisand th e inevitable pe rversions of the di scipline have deflected attention from th ehisto r ical t ruths about Freud's science. A nd perhaps those analysts wh o have2This definit ion excludes t hose who, like physicist Leopold Infeld , feign ed illness forideali st ic purposes. As a so ldier in the Austro-H ungarian Army, Infeld set o ut to do a ll heco uld to bring about defeat for Germany and Austria.100 JEFFERSON JOURNAL O F PSYCHI ATRYgone on record supporting th e death penalty, co ndem ning homosexua lity, orexcluding nonmedical people from analytic training, views whi ch Freud h imselfabhorred, have forgotten their roots. For them Eissler's magnifice nt bookshould serve as a much-needed reminder.REFERENCE1. Freud S: Memorandum on the e lectr ica l treatment of war ne urotics. StandardEdition , 17:211-215, 1955

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Book Review: The Soft Voice of Reason

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