Medicine: The Last Days of Freud

Just before his 67th birthday, a bearded, scholarly-looking man suffering from leukoplakia appeared at the clinic of Vienna Rhinologist Marcus Hajek. The patient had a group of hard, smooth white spots on the inside of the jaw; expecting a trivial operation, he had not mentioned the visit to his family. But the operation went badly—the growth proved cancerous. In response to an alarming phone call, the patient’s wife and daughter rushed to the clinic, found him seated on a kitchen chair with blood all over his clothes. He was too ill to go home.

There was no free room or even bed at the clinic, but a bed was improvised in a room already occupied by a cretinous dwarf. While his family was out at lunch, the patient suffered a hemorrhage. He could not call out, but the friendly dwarf noticed his condition and rushed for help. After desperate efforts, the bleeding was stanched. Thus, writes Britain’s Dr. Ernest Jones, a hitherto unhonored and still unnamed dwarf probably saved the life of Sigmund Freud.

Medical History. Much of the third and final volume of Analyst Jones’s painstakingly researched, lovingly written biography* is taken up with an extraordinary account of Freud’s illness and its effects on his last years. The effects, never before described in such detail, were painful, profound and sometimes bizarre.

After the first operation, daughter Anna broke hospital rules and spent the night at her father’s bedside, thus beginning a 16-year vigil during which, often for months at a time, she was always within call. Freud himself was not told that examination of the removed tissues revealed cancer, although more surgery was soon necessary for “an unmistakably malignant ulcer in the hard palate which invaded … the upper part of the lower jaw and even the cheek.” First, a carotid artery was tied off, and glands beneath the upper jawbone (some of them already suspiciously enlarged) were removed. In the second stage of the operation, after slitting the lip and cheek wide open, the surgeon removed the whole upper jaw and palate on the right side, which threw the nasal cavity and mouth into one. “These frightful operations were performed under local anesthesia.”

To shut off the mouth from the nasal cavity and make speech and eating possible, Freud had to wear a “huge prosthesis, a sort of magnified denture or obturator.” This instrument, says Jones, was a horror that Freud and family nicknamed “the monster.” It was painful and difficult to get in or out. In one nightmare scene, neither Freud nor the hovering Anna nor a physician could get it into his mouth, and the surgeon who devised the monster had to be called. When it fitted tightly enough to fulfill its purpose, it caused recurring sores. When it was comfortably loose, Freud sat with his thumb to his face, holding the monster in place.

His speech became nasal and thick, like a cleft-palate victim’s. Damage to the Eustachian tube and repeated infections left him almost deaf on the right side, where he had been accustomed to placing patients, so that his chair and analytic couch had to be transposed. Hardly intelligible in German, he could not surmount the added difficulties of a foreign tongue (though he had spoken English and French fluently), observed to famed Singer Yvette Guilbert: “Meine Prothese spricht nicht französisch [My prosthesis does not speak French].”

Exhaustive Author Jones counts no fewer than 33 operations (plus endless Xray, radium and diathermy treatments) over the next 16 years. One of the more unusual operations: Freud had himself sterilized (by tying off the major sperm ducts) on the chance that a changed hormone production might retard the growth of the cancer. There is no evidence that it had any such effect.

Financial Troubles. Immediately after World War I, Freud had virtually no income. His savings (about $30,000) were swept away by inflation. He was grateful for two patients, one American, one British, sent by Jones; though they paid only the half-rate fee of $5 a session, he admitted that without them he could not make ends meet. There were times when Freud could have made big money easily. In 1920 he had an offer of $1,000 each for articles in Cosmopolitan, huffily turned it down because the editors told him what they wanted him to write about: “The Wife’s Mental Place in the Home.” In 1924 Colonel “Bertie” McCormick cabled Tribune Staffman George Seldes:

OFFER FREUD 25,000 DOLLARS OR ANYTHING HE NAME COME CHICAGO PSYCHOANALYZE LEOPOLD AND LOEB. For the same purpose, Hearst also offered Freud “any sum he cared to name” and also “was prepared to charter a special liner so that Freud could travel quite undisturbed by other company.” Freud’s refusals were chilling.

Aside from lack of money, the deprivation that most troubled Freud in postwar Vienna involved cigars. Imported ones were unobtainable in near-bankrupt Austria, so visiting analysts smuggled them in. Though he knew that his jaw cancer might have been caused by smoking, Freud would not quit on that account. With his shrunken tissues and “the monster” interfering, he sometimes had to pry his mouth open with a clothespin to get the cigar in. Even so, he enjoyed up to four a day. At one time, when he had heart trouble marked by anginal pain, he quit smoking and boasted of this “act of autotomy,” but he stuck it out only 23 days. Disciple Sandor Ferenczi, a Hungarian analyst who was in the process of losing his own mind, offered to go to Vienna to psychoanalyze Freud out of his angina—which, Ferenczi was sure, was merely psychosomatic. Freud was touched by the offer but declined it.

Breaking Ranks. As Freud’s fame grew and his basic ideas came to be ever more widely accepted, he collected some minor honors, but time and again influential friends failed to get him the Nobel Prize, and he soon urged them to stop chasing “the Nobel chimera.” He remained fanatically convinced that he had discovered absolute truths, and excoriated the defectors from his ranks.

The two greatest defectors, Alfred Adler and Carl Gustav Jung, had left him long before, along with Wilhelm Stekel. In the 19203 they were followed by Otto Rank (who proved to be suffering from manic-depressive psychosis that had gone unsuspected in the inner circle of analysts), by Wilhelm Reich, and finally by the fawning Ferenczi, whose lifelong emotional troubles were compounded at the end by pernicious anemia and organic brain damage. Through it all, Freud held firmly to the line he had laid down: “We have only one aim and one loyalty—to psychoanalysis.” When Stekel big-heartedly attempted a late reconciliation, Freud turned a stony face to him. And when Adler died, the unforgiving Freud so far forgot his own Jewishness as to remark: “For a Jew boy out of a Viennese suburb, a death in Aberdeen is an unheard-of career in itself and a proof of how far he had got on. The world really rewarded him richly for his service in having contradicted psychoanalysis.”

Freud made few contributions in later life to the actual practice of psychoanalysis or its adaptation in more conventional psychiatric treatment. While he wrote abundantly, much of his output dealt with analytic trivia, and the rest was in sweeping, philosophic terms—despite his prejudice against “philosophical convolutions.”

Among his principal works in his last two decades were Civilization and Its Discontents, a rambling, chatty discourse on everything from man’s place in the universe to the fear of losing love, and Moses and Monotheism. Freud was convinced that Moses was no Jew, but a highborn Egyptian who chose the Jews (hence “the chosen people”) as the instrument for perpetuating Akhnaton’s monotheism, which had just been swept out of Egypt in a religious counterrevolution. Freud, who regarded religion as a “universal obsessional neurosis,” was at pains to explain the acceptance of Moses and of his one God in terms of the “father figure.” Comments Author Jones: “Freud had always asserted the psychological truth in religion, i.e., that it was concerned with real unconscious conflicts present in everyone. In this book he laid special stress on the historical truth in religion, i.e., that it was concerned with the unconscious memory of actual happenings.” The intriguing point (not acknowledged by Loyalist Jones) about Freud’s religious theorizing: it is reminiscent of the “archetypes” in Jung’s psychology, which is roundly denounced by most Freudians.

Flight to Freedom. Long after the Nazis had attained power in Germany, Freud refused to consider moving from Vienna. Not until after the 1938 Anschluss, when Brownshirts clomped into his apartment and Jones, thanks to extraordinary maneuvering, appeared by chartered plane from Prague, did Freud agree to go to England. To arrange the trip it took three months and all of Jones’s influence with highly placed Britons, plus an assist from U.S. Ambassador to France William C. Bullitt and possibly a word from Franklin Roosevelt and Mussolini as well. Freud’s ailing heart, buoyed by nitroglycerin, stood the journey well, and he was received in London like a conqueror—as befitted a man who during the trip had dreamed that he was landing at Pevensey, where William the Conqueror landed in 1066. Later Freud was so delighted with his new home and garden that he told Jones: “I am almost tempted to cry out ‘Heil Hitler!”

Two years before his flight, Freud had undergone two more exceptionally painful operations. But in London, at 82, Freud had so far recovered as to be doing four analyses daily. In February 1939 unmistakable cancer was again found, and this time the surgeons labeled the case “inoperable, incurable.”

Freud hated to take drugs, and had rarely used them throughout his years of pain. Now he consented to take aspirin occasionally. On Sept. 21 he asked his physician, Max Schur, for a sedative: “It is only torture now and it has no longer any sense.” Two days later, aged 83, he was dead.

Magic & Death Wishes. Biographer Jones, for all his hero worship, belongs to the warts-and-all school, and notes some strange quirks in Freud’s character: ¶ Despite his insistence that he was a scientist first and last, Freud clung stubbornly to Lamarck’s idea that acquired traits can be inherited—which to serious scientists now makes no more sense than the notion that the earth is flat. ¶ Throughout his life, Freud dabbled with occultism and telepathy. He narrowly avoided publishing acceptance of some weird, spiritistic rigmarole, but he made it plain in private that he believed there was a good deal in it. ¶ Freud believed in the magic of numbers. In early life he greatly admired the theory of a close friend, Wilhelm Fliess, that important things happened to men in cycles of 23 and 28 days, kept harking back to this even after he had broken angrily with Fliess. He was obsessed with the numbers 61 and 62, was long convinced that he would die at one of those ages. After he passed 62 he raised it to 85½, the age at which his father and half-brother had died.

Says Jones: “The theme of death, the dread of it and the wish for it, had always been a continual preoccupation of Freud’s mind as far back as we know anything about it.” Freud’s reactions to his mother’s death at 95 were unusual. She had been in great pain, so he was glad of her release. Beyond that, he was relieved that now he was free to die without causing her grief—he had always, he said, been afraid that he might die first and cause her suffering. Freudian Jones sees in this an unanalytic rationalization, suggests that unconsciously Freud could not bear the possibility of death unless through it he could rejoin his mother, to whom he was deeply and Oedipally attached.

A Summing Up. When it comes to assessing Freud’s influence on his fellow men, Jones sees a snag. “What chiefly impresses [a psychoanalyst],” he says, “is the shallowness of so much of what passes as acceptance of Freud’s ideas, and the superficiality with which they are treated. They are so often bandied about lightly as a form of lip service that one cannot help suspecting that much of the so-called acceptance is really a subtle form of rejection, a protection against assimilation of their profound import.”

Jones has no hesitation in claiming for Freud a major contribution to psychiatry by bringing the neuroses out of the limbo of “imaginary” complaints and into treatment, and by laying the foundation for the recent development of psychosomatic medicine. Also to Freud’s credit he lays much of the greater tolerance now shown by laymen toward severe mental illness and more humane ways of treating it. In psychology itself, Jones holds, Freud’s investigative method compares in importance with the discovery of the microscope—”in both cases a hitherto invisible world was revealed.”

It is in social life that Jones sees the most widespread change. “Most important,” he says, “is the increasing sense people have of being moved by obscure forces within themselves which they are unable to define. Few thinking people nowadays would claim a complete knowledge of themselves, or that what they are consciously aware of comprises the whole of their mentality. And this recognition, with all its formidable consequences for the future of social organization, we owe above all to Freud . . . Man’s chief enemy and danger is his own unruly nature and the dark forces pent up within him. If our race is lucky enough to survive for another thousand years the name of Sigmund Freud will be remembered as that of the man who first ascertained the origin and nature of those forces, and pointed the way to achieving some measure of control over them.”

* The Life and Work of Sigmund Freud, Vol. III: The Last Phase, 1919-39 (537 pp.); Basic Books; $7.50.