Irma Dream Intro

My purpose is to outline a new approach to dream analysis, one based on Weiss's concept of unconscious planning. My take on Weiss's concept is that our unconscious thought processes are rationally superior to our conscious ones, not inferior to them, as Freud supposed.

Why We Sleep and Dream

We sleep, in part, to successfully meet life situations we face in the present. We have four to five rapid eye-movement (REM) dreams during a night of sleep to broaden the adaptations we will use in meeting these situations. This broadening is accomplished by dreaming each REM dream with the motive of confirming the validity of our adaptations. Dreaming a REM dream means experiencing it in the real world of our memory. Although our motive is to use dream experiences to merely confirm our adaptations, each dream evokes lessons derived from past experience that have not been included in the adaptations. Including these lessons leads to another REM dream, which because it is more encompassing leads to different evoked memories containing more excluded lessons. In this way, our adaptations are honed and broadened to contain all of the wisdom we possess as it relates to meeting our current life situations. Dreaming is a form of reality testing.

Dreams Focus on What Our Behavior Should Be

The foregoing statements contain two logical consequences. One is that in analyzing a dream we should look for the lessons that past memories contain with regard to how the dreamer should behave. The second logical consequence is that flimsy rationalizations cannot be allowed in one's interpretations of the lessons memories contain. In terms of the Irma dream that means we should start by disallowing all of the transparently fallacious rationalizations Freud offers in interpreting the Irma dream. Here are two examples from the "analysis" portion of his discussion. The following quotes are based on A.A. Brill's translation merely because I have so marked up Strachey's text that scanning it is impossible.

Freud says, "I note that in the speech which I make to Irma in the dream I am above all anxious that I shall not be blamed for the pains which she still suffers. If it is Irma’s own fault, it cannot be mine. Should the purpose of the dream be looked for in this quarter?

"I am startled at the idea that I may have overlooked some organic affection. This, as the reader will readily believe, is a constant fear with the specialist who sees neurotics almost exclusively, and who is accustomed to ascribe to hysteria so many manifestations which other physicians treat as organic. On the other hand, I am haunted by a faint doubt--I do not know whence it comes--whether my alarm is altogether honest. If Irma’s pains are indeed of organic origin, it is not my duty to cure them. My treatment, of course, removes only hysterical pains. It seems to me, in fact, that I wish to find an error in the diagnosis; for then I could not be reproached with failure to effect a cure."

There is a bit more here than meets the eye at first glance. On the surface, it is nonsense, because it is part of Freud's job as a practitioner to arrive at a correct diagnosis. Therefore, if he based his treatment plan on an erroneous diagnosis of his own making, he certainly cannot escape blame for Irma's pains.

Notice, however, that Freud does not say that it was his diagnosis. That's probably because it wasn't. Many of Freud's patients came from his friend Josef Breuer, one of Vienna's finest physicians and Dr. M. in the dream. In normal course, Breuer would find nothing physically wrong with a patient, diagnose the case as hysteria, and refer the patient to Freud for treatment on this basis. Freud then would take Breuer at his word and begin treatment without seeking an organic cause. If Irma does have an organic problem, Freud is of course not exonerated, but his culpability is limited to placing blind faith in the infallibility of an authority figure. As we will see, Freud's dealings with authority figures play a large part in this dream.

Freud continues: "The way in which Irma stands at the window suddenly reminds me of another experience. Irma has an intimate woman friend of whom I think very highly….Now it occurs to me that during the past few months I have had every reason to suppose that this lady too is hysterical. Yes, Irma herself betrayed the fact to me. But what do I know of her condition? Only the one thing, that like Irma in the dream she suffers from hysterical choking. Thus, in the dream I have replaced my patient by her friend. Now I remember that I have often played with the supposition that this lady, too, might ask me to relieve her of her symptoms. But even at the time I thought it improbable, since she is extremely reserved. She resists, as the dream shows.

"I have thus compared my patient Irma with two others, who would likewise resist treatment. What is the meaning of the fact that I have exchanged her for her friend in the dream? Perhaps that I wish to exchange her; either her friend arouses in me stronger sympathies, or I have a higher regard for her intelligence. For I consider Irma foolish because she does not accept my solution. The other woman would be more sensible, and would thus be more likely to yield."

In the course of a few sentences, Freud does a complete flip-flop. At first, Irma's friend resists Freud, then suddenly for no apparent reason she would be more likely to yield. In plain fact, the woman was resisting Freud, and that fact alone should be used in the interpretation of this dream.

We analyze the few dreams that have become accessible to consciousness. Most of the dreams of a night of sleep and most of the associations to even the dreams we can remember remain unconscious. That's because dreams are meant to provide the unconscious underpinning of our subsequent waking behavior. We remember dreams usually when we awake while they were ongoing, and then only fleetingly unless we make a special effort to remember them. Another instance when we remember dreams is when dreams were constructed so as to be remembered. That was the case with the Irma dream. Freud gave himself a dream he could easily analyze in detail in terms of his conception of dreams, and the content of the dream instructed him to focus on the dream and analyze it in detail.

Dreams and Pathogenic Beliefs

Before commenting further, perhaps it's best that I explain in more detail about what I mean when I say that unconscious mental processes such as dreams are more rational than conscious ones. A person saddled with a pathogenic belief while awake certainly will not become free of that belief during a dream. On the contrary, the pathogenic belief will operate as one of the foundations of the dream. The lessons that gave rise to the belief will shape the person's adaptations.

This is not to say that pathogenic beliefs are impervious to experience. Were a person to muster the courage to test the validity of his pathogenic beliefs with contradicting experiences while awake, these waking experiences will have an impact on the beliefs through the agency of his dreams. When I say dreaming is reality testing, I don't mean it in some phony-baloney sense. I mean literally. We try the best we can to base our lives on reality as contained in our life experiences. At times we make mistakes--particularly in childhood--and those mistakes can lead to pathogenic beliefs. But if we dare to give ourselves the experiences we need to combat those beliefs, our rational processes as represented by our dreams will overcome the beliefs. The whole point of therapy is to help a patient to dare to remain open to disconfirming experiences long enough to have an impact on crippling beliefs.

Looking for the Lessons Dreams Teach

One of the fundamental distinctions I make when assessing a person's associations to a dream is whether the memories that participate in the dream refer to situations that are unresolved in the present or to past situations that came to a definite conclusion. I take the currently unresolved situations as the situations the dreamer is attempting to deal with better. The way he does that is by bringing to mind similar situations whose outcomes are known. These then become models of what may happen as a result of the behaviors used in the past. In this way, memories offer the dreamer advice about how to handle the situations he is currently facing.

The situation with Irma's friend is unresolved in several respects. Freud suspects that she is hysterical, but he doesn't know for sure. And he has no real indication that she will ever accept him as her therapist. Because the situation is unresolved, it cannot act as a reality principle, which is what Freud's analysis attempts to make of it. Freud's analysis is therefore invalid, from my point of view, as is his use of it in arriving at the conclusion that the Irma dream has a wish-fulfillment purpose.

I will analyze the Irma dream on two levels. First, I will examine the memories of concluded events found in Freud's associations to the dream to get a general sense of the lessons the dream contained. I will then use this information to attempt a moment-by-moment analysis from the point of view of dream structure. I hope in this way to show how the various meanings of the dream unfold in parallel. That is, I hope to show why dreams take on a nonsensical character while remaining exquisitely rational. REM dreams are examples of our ability to process various sorts of information simultaneously. I will begin showing this by examining some of the lessons the Irma dream provides.

Freud writes, "What I see in the throat: a white spot and scabby turbinal bones. The white spot recalls diphtheria, and thus Irma’s friend, but it also recalls the grave illness of my eldest daughter two years earlier, and all the anxiety of that unhappy time."

This is an experience where a definite conclusion was reached. For what that conclusion may have meant to Freud, we turn to his biographer Ernest Jones (Vol. 1, p. 152-153). "Freud was not only a loving but also an indulgent father, as one might expect from his general principles. The numerous illnesses of the children naturally caused him much concern. When his eldest daughter was five or six years old she nearly died of diphtheria, the 'dangerous illness' to which Freud refers in his writings. At the crisis the distracted father asked her what she would like best in the world and got the answer 'a strawberry.' They were out of season, but a renowned shop produced some. The first attempt to swallow one induced a fit of coughing that completely removed the obstructive membrane and the next day the child was well on the way to recovery, her life saved by a strawberry--and a loving father."

So far as I know, Freud never spoke of what this experience meant to him beyond the obvious. As we will see, however, Freud's behavior with regard to authority figures is a subject that preoccupies him throughout this dream. With that foreknowledge and a bit of hindsight, I interpret the incident as indicating to Freud that good consequences can sometime flow unexpectedly from measures taken that lie at variance with accepted medical practice. No medical authority would have advocated using a strawberry to dislodge the membrane, yet that was what was called for in this case.

Let's now look at another past experience where the lesson is clearer. Freud writes, "I quickly call Dr. M., who repeats the examination. This would simply correspond to the position which M. occupied among us. But the word 'quickly' is striking enough to demand a special examination. It reminds me of a sad medical experience. By continually prescribing a drug (sulphonal), which at that time was still considered harmless, I was once responsible for a condition of acute poisoning in the case of a woman patient, and hastily turned for assistance to my older and more experienced colleague.

"The fact that I really had this case in mind is confirmed by a subsidiary circumstance. The patient, who succumbed to the toxic effects of the drug, bore the same name as my eldest daughter. I had never thought of this until now; but now it seems to me almost like a retribution of fate—as though the substitution of persons had to be continued in another sense: this Matilda for that Matilda; an eye for an eye, a tooth for a tooth. It is as though I were seeking every opportunity to reproach myself for a lack of medical conscientiousness."

Freud was responsible for the woman's death, but what was the extent of his culpability? Did he defy accepted medical practice? No indeed, she died precisely because of Freud's blind faith in accepted procedures. This faith, which was a detriment in this instance, is what Freud refers to as his lack of medical conscientiousness.

So far we have come upon two lessons contained within the Irma dream: one of a happy outcome that arrived unexpectedly as a result of a novel medical approach and of a sad outcome that resulted from following accepted procedures to the letter. I believe that Freud applied these lessons to the Irma situation and saw them as forming the context for lessons he derived from a more recent, more relevant episode bearing a strong resemblance to Freud's dealings with Irma as depicted in the dream. Freud does not mention this episode in his associations. Max Schur brought this episode to light through an examination of Freud's then unpublished letters to his friend Wilhelm Fliess.

Fliess was an ear and nose specialist in Berlin and a man much given to imaginative theorizing. Fliess's theories emphasized three main points: that there was a correspondence between nose mucosa and the genital organs, that human beings were fundamentally bisexual, and that human physiology was ruled by a double periodicity--a feminine cycle of twenty-eight days and a masculine cycle of twenty-three days.

At the beginning of 1894 Freud treated Emma, a woman patient, for hysteria. During the course of her treatment, Freud called Fliess to determine whether there was a connection between her symptoms and a possible nose condition. Fliess said there was, operated on Emma’s nose (the turbinal bones in the dream) and returned to Berlin. The patient, however, suffered from severe postoperative complications, and another specialist found that Fliess had accidentally left a long piece of iodoform gauze in the cavity. Weeks later the patient had a hemorrhage of such severity that her condition remained critical for quite some time.

Schur argued that memories of this episode participated in the Irma dream by pointing to many striking correspondences between the two as found in Freud's letters. I'll quote from a portion of Freud's March 8, 1895, letter.

"I wrote you that the swelling and the hemorrhages would not stop, and that suddenly a fetid odor set in, and that there was an obstacle upon irrigation. (Or is the latter new [to you]?) I arranged for Gersuny to be called in; he inserted a drainage tube, hoping that things would work out once discharge was reestablished; but otherwise he was rather reserved. Two days later I was awakened in the morning—profuse bleeding had started again, pain, and so on. Gersuny replied on the phone that he was unavailable till evening; so I asked Rosanes to meet me. He did so at noon. There still was moderate bleeding from the nose and mouth; the fetid odor was very bad. Rosanes cleaned the area surrounding the opening, removed some sticky blood clots, and suddenly pulled at something like a thread, kept on pulling. Before either of us had time to think, at least half a meter of gauze had been removed from the cavity. The next moment came a flood of blood. The patient turned white, her eyes bulged, and she had no pulse. Immediately thereafter, however, he again packed the cavity with fresh iodoform gauze and the hemorrhage stopped. It lasted about half a minute, but this was enough to make the poor creature, whom by then we had lying flat, unrecognizable. In the meantime--that is, afterward--something else happened. At the moment the foreign body came out and everything became clear to me and I immediately afterward was confronted by the sight of the patient I felt sick. After she had been packed, I fled to the next room, drank a bottle of water, and felt miserable. The brave Frau Doktor then brought me a small glass of cognac (the liquor in Freud's associations) and I became myself again….

"Rosanes stayed with the patient until I arranged, via Streitenfels, to have both of them taken to Sanatorium Loew. Nothing further happened that evening. The following day, that is, yesterday, Thursday, the operation was repeated with the assistance of Gersuny; [the bone was] broken wide open, the packing removed, and [the wound] curetted. There was scarcely any bleeding. Since then she has been out of danger, naturally very pale, and miserable with fresh pain and swelling. She had not lost consciousness during the massive hemorrhage; when I returned to the room somewhat shaky, she greeted me with the condescending remark, 'So this is the strong sex.'

"I do not believe it was the blood that overwhelmed me--at that moment strong emotions were welling up in me. So we had done her an injustice; she was not at all abnormal, rather, a piece of iodoform gauze had gotten torn off as you were removing it and stayed in for fourteen days, preventing healing; at the end it tore off and provoked the bleeding. That this mishap should have happened to you; how you will react to it when you hear about it; what others could make of it; how wrong I was to urge you to operate in a foreign city where you could not follow through on the case; how my intention to do my best for this poor girl was insidiously thwarted and resulted in endangering her life--all this came over me simultaneously. I have worked it through by now."

I have bolded the two phrases by way of anchoring a moment in the dream as referring to the Emma episode at least partially. I am speaking of the moment when Freud looks at Irma and finds that she is pale and puffy. I see this moment as being evoked by another reference to the Emma episode at the manifest level, when Irma said, "It's choking me." I believe that's possibly what Emma said either on this occasion when a torrent of blood flowed from her nose and mouth or during another such incident that occurred a few weeks later.

Why would Freud ask Fliess to travel to Vienna from Berlin to see Emma? The obvious answer is that he was having trouble curing her, and thus was led to doubt himself. Possibly Emma was resisting his therapeutic interpretations, just as Irma would later do. So he called for Fliess, who was serving as his medical authority at the time, just as he called for Breuer (Dr. M.) in the dream.

So the Emma episode was an occasion when trouble with a patient caused Freud to doubt himself, and thus turn over his patient to an authority, leading to disastrous consequences. Freud had Fliess examine Irma too. It is not known what Fliess suggested, but he probably suggested a similar operation. I say this because both men treated many of the same symptoms and because Fliess was surgically a one-trick pony. He had already operated on Freud's nose and was scheduled to do so again in two months. That this was on Freud's mind during the Irma dream can be inferred from his associating turbinal bones to concerns about his own health. Who wouldn't be concerned after witnessing what Emma went through?