The dream diagnosis Dr Freud missed

The most famous of all the dreams Freud analyzed was one of his own, the Irma Dream. In The Interpretation of Dreams he gives a lengthy account of this 1895 dream and his work with it. In the dream, he inspects the mouth of a patient called Irma and discusses her condition with several doctors.

     His work with this dream, by Freud’s own account, led him to invent psychoanalysis. He wanted a “marble tablet” to be placed at the house where he analyzed the Irma Dream, with the following inscription:

IN THIS HOUSE, ON JULY 24th, 1895,
  THE SECRET OF DREAMS WAS
REVEALED TO DR. SIGM. FREUD

 The tragic irony is that in all his work on this dream, Freud may have missed a health warning that could have saved his life. Dr. José Schavelzon, a cancer surgeon who is also a psychoanalyst has concluded, after careful review of Freud’s personal medical records, that the Irma Dream contained an amazingly exact preview of precise symptoms of the oral cancer that killed Freud 28 years later.

The night before the dream, Freud received a visit from a junior colleague, “Otto”, with whom he was in the habit of sitting up playing tarok (a card game related to Tarot) and smoking cigars. They discussed the case of “Irma”, whom Freud had been treating for hysteria. Freud was irritated when Otto reported, “She’s better, but not quite well.” He spent part of his evening writing up Irma’s case history.

He then dreamed that Irma arrived in a large hall where he was receiving guests. He immediately took her aside and told her. “If you still get pains, it’s really only your fault.” She was pale and puffy, and told Freud she was suffering dreadful pains, especially in her throat: “It’s choking me”. Freud was alarmed, and began to fear he had been missing “some organic trouble” in his approach. He took Irma to a window and peered into her mouth. He had a hard time getting it open because “she showed signs of recalcitrance, like women with artificial dentures.” When he got a good look inside, he found very disturbing symptoms – “a big white patch” inside the mouth on the right side, and also “extensive whitish grey scabs.” Freud gave an oddly specific description of these scabs; they reminded him of “the turbinal bones of the nose.”

He called for a second opinion on his patient. His senior colleague Dr. M. appeared looking pale and clean-shaven, repeated Freud’s examination, and gave a positive prognosis; there was certainly an “infection” but “the toxin will be eliminated.” Another medical colleague, Leopold, was less confident; he found infection had spread to the patient’s left shoulder and that there was “a dull area low down on the left.”

The dream scene became a medical gathering. Freud’s associate Otto was there too. All four doctors – including Freud himself – had no doubt of the origin of the patient’s illness. Otto had given her an injection of “a preparation of propyl, propyis…propionic acid…trimethylamin”. Freud saw the formula for the last chemical printed in heavy type, underscoring its importance. He concluded his dream report: “Injections of that sort ought not to be made so thoughtlessly…And probably the syringe had not been clean.”

In commenting on his dream, Freud began by noting that he had been thinking and writing about his patient the night before. Yet this left the content of dream totally mysterious to him, since his actual patient did not have symptoms anything like the ones that concerned him in the dream. “Constriction of the throat played scarcely any part in her illness. I wondered why I decided upon this choice of symptoms in the dream but could not think of any explanation at the moment.”

Freud wondered whether Irma, in his dream, was actually a stand-in for another patient, who had experiences of choking. Freud’s analysis wandered off through many other associations. When he pondered the names of the chemicals in his dream, he recalled a conversation in which a colleague suggested that trimethylamin might be an element in sexual arousal. This carried him away into “Freudian” thoughts about the probable source of hysteria in sexual frustration.

He wrapped up his interpretation of his Irma dream by declaring that it was a text-book example of wish fulfillment in dreams. He had been jarred the night before by Otto’s suggestion that his patient had not been fully cured. In his dream he got his “revenge” on Otto by establishing that her pains were Otto’s fault, not his own.

In all his discussion of “substitution” – how a dream character may stand in for another person, or several other people – he paused for only a heartbeat to consider the possibility that the real patient might be the dreamer himself. He wondered whether the “scabs” that resembled nasal structures could be a warning to him about the possible effects of his excessive use of cocaine – but moved briskly on from that thought without considering other substances and their possible effects.

Twenty-eight years after the Irma dream, Freud’s oral surgeons were looking at the precise symptoms he had dreamed – in Freud’s own mouth.

Early in 1923, a surgeon performed an excision of a cancerous growth resembling the “big white patch” on the right side of Irma’s mouth “at the right anterior palate.”

In a series of surgeries and treatments over the next fifteen years, Freud’s doctors worked to excise “proliferative papillary leukoplakia” inside his mouth resembling the unusual “scabs” in the 1885 dream. His many surgeries produced further scabs.

     In the Irma dream, the patient had difficulty opening her mouth. After Dr Pichler performed radical surgeries on Freud late in 1923, Freud - like the patient in his dream - had to wear "dentures", actually a removable prosthesis. Because Freud developed lockjaw during his multiple surgeries there was often difficulty inserting the prosthesis. Towards the end of his life, there were times when he “could not open his mouth.” 

     The reference to structures of the nose in the 1895 dream report may have been a preview of Freud's condition after surgery left the nasal cavity visible from the oral cavity.

     What about all the doctors who figure in the Irma dream? Stripped of their pseudonyms, they were medical colleagues who gave Freud differing advice on his smoking habit.  “Dr  M”, who gives a cheerful but wrong prognosis for the patient, was  actually Dr Joseph Breuer, a friend and mentor who was persuaded by Freud - despite misgivings - to drop his opposition to Freud's heavy cigar smoking.

   “Leopold” was a “slow but sure” medical colleague who had cautioned that smoking could contribute to serious diseases.

   “Otto” was Oskar Rie, a friend who shared Freud’s taste for cigars and may have brought him a gift of cigars the night before the dream.

    Whether Freud’s dream doctors represented aspects of himself – or their actual personalities and positions – their role in the dream held up a mirror to the dreamer’s behavior and attitude. Unfortunately, he was able to see in that glass only darkly.

   Freud thought the syringe (the German word also means “squirter”) was a penis and that the cure for the patient's symptoms was sexual intercourse. But a “dirty syringe” could also be a nicotine delivery system - one of the cigars Freud was almost certainly smoking the night before. All the chemicals named in the Irma Dream are found in cigar smoke. Though trimethylamin is not regarded as a carcinogen, when mixed with nitrites in an acidic environment (such as the smoker's mouth) it can be “nitrosated” into a very toxic carcinogen, dimethylnitrosamine (DMNA).

     The evidence suggests that Freud’s dream gave him a rather exact picture of both the origin and the histology of the oral cancer that subjected him to a painful and protracted death. Although Freud became interested in the idea that dreams can contain messages from the body, he missed this one - unlike Jung, who gave up smoking because of a dream.

     An important question for our understanding of the nature of diagnostic dreams is whether the Irma Dream may have contained a warning message from inside Freud’s cellular system, as it was at the time of the dream. In other words, could the Irma dream have been a “tumor marker”? It is possible that a single affected cell could trigger a dream, sending a distress signal out via neighboring cells, or via the endocrine system, that was shaped into a dream by the production company in the brain.

Freud may have paid an enormous penalty for forcing his own dreams to run along narrow-gauge rails of interpretation. Since the bigger story of the Irma Dream has such large resonance for dream interpretation, it seems appropriate that the pseudonym Freud chose for his patient means “universal”.

Somehow this tragic episode has escaped most of the legion of students and biographers of Freud. It suggests that Freud may have paid a terrible price for ignoring both the premonitory and the somatic aspects of dreams, and it offers a cautionary message for all of us as dreamers: let’s remember to check for diagnostic content in dreams.

Adapted from The Secret History of Dreaming by Robert Moss. Published by New World Library. All rights reserved.

News from Ephesus: dream divination is applied science

Artemidorus, the most famous dream interpreter of the Hellenistic world, lived and practiced in the great temple city of Ephesus in Anatolia. Only one of his many books survives, The Interpretation of Dreams, or Oneirocritica. The title was borrowed by Freud many centuries later, but their approach could hardly be more different. While Freud is plumbing the basements of the personal subconscious, Artemidorus is searching in dreams for knowledge of the future that can be used for the good of an individual, a family or a whole community.
    The dreamer of Ephesus states his general objective at the start of his book. He wants to make a rational and effective case for divination, based on his personal experience and the case studies he has collected.  He also wants to offer a practical guidebook that any intelligent reader can use. He gives his credentials in his opening pages: “I have not only taken special pains to procure every book on the interpretation of dreams, but have consorted for many years with the much-despised diviners of the marketplace…In the different cities of Greece and at the great religious gatherings of that country, in Asia, in Italy and in the largest and most populous of the islands, I have patiently listened to old dreams and their consequences.” His authority is based on experience: “Everything has been the result of personal experience, since I have always devoted myself, day and night, to the study of dream interpretation.” [1]

     Artemidorus proceeds to distinguish different types of dreams. A fundamental difference is between oneiros, which he defines as a dream that “indicates a future state of affairs” and enhypnion – stuff “in sleep” – that “indicates a present state of affairs”, ranging from the state of your digestion to your desire to be with your lover or the haunting images of things that you fear. People who lead “an upright life” try to discipline themselves to avoid being “muddled” by the fears and desires reflected in such sleep experiences, which are the stuff of much modern dream analysis
     In the Oneirocritica, Aretmidorus is interested only in dreams that reveal the future, and especially in those that do this through allegory rather than by literal depiction of possible scenes and events. Allegorical dreams are “those which signify one thing by means of another.” 

      Artemidorus states bluntly, “The mind predicts everything that will happen in the future.” He gives examples of precognitive dreams that presented future events in an entirely literal way. A man dreams of a shipwreck and then his boat is wrecked and he narrowly avoids drowning, as in the dream. Another dreams he is wounded in the shoulder by a friend in a hunting accident, and again the dream is played out exactly.

      If it is possible to dream the future with this kind of clarity, why do we need allegories? Artemidorus offers two reasons. The first is that we may lack the experience to understand a future event perceived in a dream – for example, because we have not yet encountered a person or situation that features in the dream. By setting us a puzzle to figure out, the “allegorical” dream gives us a rational way to access what the larger mind knows about things to come. Second, the kind of dream dramas Artemidorus describes can bring an emotional charge that leads to action; “it is the nature of the oneiros to awaken and excite the soul by inducing active undertakings.”

       Artemidorus notes that while the gods do not lie, they like to speak in riddles. This is because “they are wiser than we and do not wish us to accept anything without a thorough examination”. He gives the example of a man who dreamed the god Pan told him that his wife would poison him via his best friend. It was the relationship that was poisoned, when the wife proceeded to have an affair with the friend. 

     Artemidorus is very clear about what the Oneirocritica is, and what it is not. He is going to show us how to decode allegorical dreams in order to discern the future. He is well aware that other kinds of dreams require other kinds of dream work, and he wrote about other types of dreams in books that have not survived, as well as a book of augury – divination by bird-watching. 

      Artemidorus recognized that every dream may be unique. The snake in your dream is not the same as the snake in mine. To read the meaning of a dream symbol correctly, you must know the dreamer’s identity, position in life, habits and medical condition. You must also question the dreamer’s feelings about a dream.

     Artemidorus observes that we dream the future for others as well as ourselves. Sometimes we receive a dream message for someone else. “Many dreams come true for those whose characters are similar to the dreamer’s and for his relatives and namesakes.” Artemidorus gives the example of a woman who dreamed she was married to a man who was not her husband. He observed that work with this dream could proceed in several directions, including exploring the possibility that it warned of death; “marriage and death signify each other because the circumstances surrounding a marriage and a funeral are similar.” This association, it turned out, was on the right track, but it was the dreamer’s sister, not the dreamer herself, who “married death” after the dream.   

     Artemidorus kept in touch with his clients after consultations, and apparently believed that divination through dreams is for the benefit of the whole community. This carries a burden. “If a man dreams that he has become a prophet and has been celebrated for his predictions, he…will take upon himself, in addition to his own anxieties, those of others.” 

      He wanted to raise dream divination to the level of an applied science. In the view of one modern scholar, Christine Walde, he succeeded. “The more complex aspects of divination – which is the attempt to investigate the connections underlying fate and the cosmos through natural and artificial means – constituted both an ancient mode for mastering life and a way of gaining knowledge or insight that, in the context of its time, can in no way be dismissed as irrational; at most, it might be considered extrarational.” Artemidorus devised a “demystified” approach to divination that “provides the standardized conditions that scientific distance requires” and “an imposing reservoir of knowledge about things in the world and their interdependence.” [2] 

REFERENCES

1. All quotations from Artemidorus are from, Oneirocritica: The Interpretation of Dreams. Trans. Robert J. White. Torrance CA: Original Books, 1990.

2. Christine Walde, “Dream Interpretation in a Prosperous Age? Artemidorus, the Greek Interpreter of Dreams” in David Shulman and Guy G. Stroumsa (eds) Dream Cultures: Explorations in the Comparative History of Dreaming. New York: Oxford University Press, 1999, pp. 126, 128.

This article is adapted from The Secret History of Dreaming by Robert Moss. Published by New World Library. All rights reserved.

Photo: Medusa at Ephesus (c) Robert Moss