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Although Sigmund Freud’s theories may seem outdated in today’s context, his profound impact on the evolution of psychology and psychoanalysis remains undeniable. We’ve all heard the tales of Freud’s obsession with linking everything to sexuality, but it’s definitely worth exploring some of his most intriguing patients in greater detail.
10. Mathilde Schleicher
Mathilde Schleicher was one of Freud's earliest patients when he began his practice as a 'nerve doctor' in 1886. Her case is particularly tragic. A musician by profession, her difficulties started in earnest when her fiancé left her. Prone to migraines, her mental health rapidly deteriorated, eventually leading her into a profound depression. Referred to Freud for treatment, he began a series of hypnotherapy sessions with her starting in April 1886. By June 1889, she had emerged from her depression and was so thankful for his assistance that she presented him with a textbook, inscribed with her gratitude for his help.
However, within a month, her depression transformed into mania and insomnia. She began incessantly talking about the fame and wealth she would soon achieve with her musical career, while also experiencing frequent convulsions. Freud referred her to Dr. Wilhelm Svetlin's private clinic, where she was diagnosed with manic depression, later known as bipolar disorder. She was also identified as a nymphomaniac, given that she would frequently undress and call out for Freud. Further notes suggested that her problems went even deeper, as she believed that every bowel movement she had was a 'birth' and would attempt to hide her 'children' under her pillow.
For the next seven months, Schleicher was subjected to a continuous regimen of sedatives, including opium, morphine, chloral hydrate, and cannabis. Over time, and not unexpectedly, her manic episodes subsided, and she was released in May 1890. Sadly, she passed away in September, with Freud still treating her recurring depression with chloral hydrate and a new drug called sulfonal. Tragically, no one noticed that her urine had turned bloody—a sign of liver damage caused by the medication—until it was too late.
9. Little Hans
Freud worked with a young boy, only five years old, known as 'Little Hans,' who was brought to him by his father seeking help for Hans’s intense fear of horses. Living near a busy coach inn, it’s understandable that Hans, at his age, would develop a fear of these large, intimidating animals. Particularly traumatic for him was witnessing a horse collapse and die in front of him while pulling a wagon full of people.
As you might expect from Freud, his explanation for Hans’s fear wasn’t as simple as just the traumatic incident. Freud suggested that Hans’s fear was tied to the horses’ black muzzles, which he associated with his father’s mustache. He also feared horses wearing blinders, which Freud interpreted as a connection to his father’s glasses.
Ultimately, Freud concluded that Hans’s fear of horses was a manifestation of his Oedipus complex. The horses symbolized his father, primarily because of the mustache-and-glasses analogy, and because male horses are notably well-endowed. Freud believed that Little Hans, in the midst of developing intense, sexual feelings for his mother, viewed his father as a rival for her affections. Given his father’s greater size and strength, this dynamic led to Hans’s fear—not just of his father, but also, symbolically, of horses.
Much of Hans’s therapy involved his father acting as an intermediary, but Freud soon realized that Hans’s fear wouldn’t be easily resolved, as the therapy was tied to the very person he feared. When Freud personally met with the boy, he reported that everything that occurred in the session only confirmed his existing theories about the Oedipus complex.
As for Little Hans’s later life, there’s no need to worry—Freud followed up with him when he was 19. Hans had grown into a perfectly normal young man and, remarkably, he couldn’t remember any of the beliefs he held as a child at five years old.
8. Bertha Pappenheim (also known as Anna O)
For many years, the patient treated by Dr. Josef Breuer and Freud was known by the alias 'Anna O' to preserve her true identity—Bertha Pappenheim. Pappenheim sought help from Breuer for a peculiar form of hysteria that began when her father became ill and worsened with his eventual death. She exhibited a wide variety of symptoms, including mood swings, hallucinations, a persistent cough, outbursts of destructive behavior, and partial paralysis. On occasion, she even lost the ability to speak German, communicating only in English and French.
Breuer dedicated hundreds of hours to helping her explore the root causes of her distress. Initially, she communicated her thoughts and feelings through fairy tales, inventing stories as part of what she termed 'chimney sweeping.' Over time, Breuer was able to hypnotize her, guiding her back to the traumatic moments that troubled her the most and encouraging her to speak about them. This process formed the foundation for a therapeutic method that remains in use today.
The extent to which Pappenheim’s mental illness was authentic, and how much of it may have been a tactic to retain the attention of her therapist, remains a topic of debate. Freud, who had been both a close friend and colleague of Breuer (even naming his first daughter after Breuer’s wife), criticized him for missing the sexual aspect of Pappenheim's case. Freud believed that Pappenheim’s issue was her intense infatuation with Breuer. His outspoken views on the matter caused a sharp and bitter end to his friendship with Breuer.
Freud publicly used Pappenheim’s case as a foundation for his psychoanalytic therapy work. Yet, he simultaneously criticized Breuer in front of his students, using the case as an example of the dangers of ignoring clear sexual fantasies in therapy. Freud suggested that Pappenheim’s grief over her father’s death was not simply sorrow but the result of incestuous fantasies she harbored toward him. She transferred these feelings to Breuer, seeing him as a new authority figure. Freud also claimed that Breuer recounted a moment during treatment when he fled Pappenheim’s home after she became convinced she was giving birth to Breuer’s child. After Pappenheim’s death, when her real identity was revealed, her estate denied the truth of these claims.
7. Irma’s Injection
Freud was not above analyzing his own dreams, especially when they helped support his theories. One such dream he explored was ‘Irma’s Injection.’ In the dream, his patient Irma appears at a party, looking even sicker than usual. Freud chastises her for not heeding his previous diagnosis. Other doctors in the dream confirm Freud’s diagnosis after examining her. Freud realizes the cause of her illness is an injection administered by another doctor, which he believes was careless and irresponsible. He even notes that the needle probably wasn’t sterile.
The dream seemed to fulfill all of Freud’s deepest desires and wishes. He confessed that one of his most significant wishes was to prove that an illness could be caused by someone else. In this case, he could blame the other doctors for treating the patient improperly (using unclean needles), and he could also blame the patient for not following medical advice. Freud claimed that he was satisfied with his findings and felt that her continued suffering was not his fault. Some have analyzed this self-reflection, suggesting that Freud’s guilt over Emma Eckstein’s case might be directly connected to the ‘Irma’s Injection’ dream.
6. Ernst Lanzer (Rat Man)
Ernst Lanzer represented a crucial case for Freud, offering him a chance to see if his psychoanalytical methods used to treat hysteria could also help patients with different psychological conditions. Lanzer’s condition was rooted in obsessive thoughts, which was the central issue in the case of the ‘Rat Man.’
When Lanzer first sought Freud’s help, he was suffering from a wide array of obsessive thoughts. Lanzer was consumed by the fear that he would act on his impulses to harm himself, specifically by cutting his own throat. He also experienced crippling anxiety about something terrible happening to his father or a young woman he had feelings for. Additionally, Lanzer had an intense fear of rats, stemming from a traumatic story he overheard while in the army about a brutal form of torture. This torture involved placing rats in a bucket, inverting the bucket, and pressing it against the accused person’s buttocks, allowing the rats to gnaw their way through the person’s body. The image was deeply disturbing, leading to Lanzer’s fear that it could happen to him, his father, or the woman he cared about.
Freud’s initial observations of the Rat Man revealed an expression that suggested he was disturbingly intrigued by the idea of rats entering through the anus. Freud diagnosed him with an Oedipus complex, leading to a complex emotional mix of love, hate, and fear, directed toward his lady, his father, and, notably, his rats. Freud also discussed what he saw as the symbolic power behind the rats and the anus. He believed that the fear and obsession with rats reflected anxieties about cleanliness, a connection between money and waste, and that the rats symbolized children, which tied into the childhood myth that babies were ‘born through the anus.’ Freud also noted that the one time Lanzer’s father had spanked him coincided with an event where a governess allowed Lanzer to touch her naked body, intertwining these incidents in his psychological development.
Lanzer’s case is especially unique because it is the only one where both Freud’s detailed case notes and his official report are available. These notes reveal aspects of the case that were omitted from the final published work, such as Freud’s lack of impartiality in matters like sending postcards to his patients while on holiday, which became a notable point of personal behavior during treatment.
5. Ida Bauer (Dora)
Ida Bauer’s struggles began long before her father brought her to Freud in an attempt to cure her hysteria. Her issues became severe when her mother, after discovering she had contracted a venereal disease from her husband, became obsessively focused on cleanliness. This obsession caused Ida to experience a breakdown at just seven years old, which was treated through hydrotherapy and electric shock treatments.
Years later, Ida was approached by a family friend—the father of the children she had once babysat, and the husband of her father’s mistress. She rejected his advances, which sent her into a deep spiral of depression, even contemplating suicide. Freud, who had previously treated her father for his venereal disease, was asked to assist Ida with her emotional struggles.
Freud diagnosed Ida (referred to as Dora in his published work) not as a victim of unwanted advances from a trusted family friend, but as someone suffering from repressed lesbian feelings toward her would-be suitor’s wife. This attraction was complicated by the fact that the woman was also her father’s mistress, thus intensifying the already strained, competitive dynamic between Ida and her father. Freud interpreted a dream for Ida in which her family’s house was burning down. While her father was focused on getting them out, her mother was more interested in finding a jewelry case. Freud suggested that the case symbolized Ida’s genitals, which her father had failed to protect.
Ida ultimately ended her treatment with Freud. She continued to battle mental health issues throughout her life, which ended in 1945. Despite her efforts to avoid becoming like her father, she ironically became more like her mother, developing a compulsive obsession with cleanliness. Curiously, she maintained relationships with the very family that had caused her distress, particularly with her father’s mistress, who became her preferred bridge partner.
4. Fanny Moser
At first glance, Fanny Moser seemed to have everything anyone could wish for. She was happily married, had two children, was an heiress to an esteemed, aristocratic family, and had married into a renowned family famous for their exquisite Swiss watches. However, just days after the birth of her second daughter, her husband passed away from a heart attack. To make matters worse, his son from a previous marriage began to spread rumors that Fanny had been responsible for his death. After a long, public court battle to clear her name, Fanny sold the Moser watch company, donated a significant sum to build and support several hospitals, and became increasingly known for her nervous condition. She sought help from numerous doctors, but nothing seemed to alleviate her symptoms.
Fanny first consulted with Josef Breuer, and Freud was soon involved when she was transferred to a sanatorium in Vienna. Struggling with severe depression and debilitating nervous tics, she was hypnotized by Freud, who encouraged her to recall and confront every painful memory in hopes of erasing them from her consciousness. Her traumatic experiences ranged from the death of her husband to a distressing encounter with a toad. While her condition seemed to improve temporarily, it didn't last long. Less than a year later, she was back in treatment at another clinic. Despite claiming to harbor a strong dislike for Freud (blaming both him and Breuer for damaging her relationship with her daughters, especially due to her outrage that one of them aspired to be a scientist), she repeatedly returned for treatment.
Despite receiving treatment, Fanny continued to relapse. Estranged from her younger daughter, whom she despised, and refusing help from her older daughter (who became a successful zoologist), Fanny instead turned to a lover who extorted millions of dollars from her. She passed away in 1925. Freud later wrote to her daughter, expressing regret for his failure to properly diagnose the nature of their troubled relationship and estrangement.
3. Sergei Pankejeff (Wolf Man)
Born in 1886, Sergei Pankejeff's life was marked by a constant battle with death, depression, and thoughts of suicide. Mental illness ran through his family, with his sister taking her own life in 1906, followed by his father's suicide in 1907. Even his wife would tragically end her life in 1938. As Pankejeff himself began experiencing depression, he sought professional help.
Freud treated Pankejeff from 1910 to 1914, focusing particularly on a dream that Pankejeff recalled having as a child. In the dream, Pankejeff would be lying in bed and, upon waking, would gaze out of an open window. Outside, a walnut tree grew, and perched in its branches were six or seven giant white wolves, watching him intently. Although initially diagnosed by Dr. Emil Kraeplin as having 'manic-depressive insanity,' Freud disagreed, diagnosing him with 'obsessional neurosis.' Freud believed this stemmed from anxiety episodes in Pankejeff's youth, influenced by his mother's religious teachings.
Freud believed that the wolf dream held the key to understanding Pankejeff's unconscious mind. He suggested that animals in dreams often serve as substitutes for father figures. The open window and the watchful wolves represented a sexual fantasy Pankejeff had repressed, where his father played the role of the predator, and he, the prey. This was linked to a repressed memory, where Pankejeff, at the age of 18 months, believed he had witnessed a violent encounter between his parents that he would later interpret as a pleasurable act.
Freud also explored the influence of Pankejeff's religious and maternal role models, particularly his mother and his beloved nurse, Nanya. Despite his efforts to be obedient and follow their guidance, Pankejeff's primal urges would eventually break through, often resulting in violent outbursts. Freud interpreted his sister's suicide as symbolizing unresolved sexual issues, particularly incest, that could never be addressed. For Freud, Pankejeff's case served as a perfect example of the psychological damage that unresolved sexual conflicts during infancy could inflict.
Pankejeff eventually sought a new path and became an insurance lawyer.
2. Daniel Paul Schreber
Freud analyzed the case of the German judge, Daniel Paul Schreber, using only Schreber’s own memoirs as his source. Intrigued by terms like “soul murder,” Freud found in Schreber’s account a compelling and complex story of psychosis.
The story began in Schreber's childhood. His father, a doctor, believed children should never be allowed to cry and should be punished until they stopped. He also insisted on cold baths to toughen them up and forced children to wear an orthopedic device from ages two to eight to ensure proper posture. The daily routine was highly structured, and if a child missed a scheduled activity, they would be left hungry. Any punishment or beatings had to be administered by the punisher, so the child wouldn't harbor resentment.
Schreber’s father passed away when he was 19, and when he turned 35, his older brother took his own life. After suffering a breakdown following a failed political campaign, Schreber was hospitalized. There, he was diagnosed with an extreme sensitivity to stimuli (especially sounds), intense emotional reactions, hypochondria, and speech problems. He was discharged after six months.
He spent eight years living relatively normally before experiencing a relapse that led to another eight years in the hospital. During this time, he wrote the memoir that Freud would later study with such interest. It was also during this period that Schreber believed his body was being transformed into that of a woman, assisted by tiny men residing in his feet who operated pumps that removed his old organs and inserted new ones. He also became convinced that his purpose in life was to become pregnant with God’s child.
Freud concluded that Schreber’s delusions were centered first around his physician, Professor Flechsig, and later around God. Schreber’s belief that he had to become a woman in order to give birth to a new race of men reflected deep-seated fears of his father. Freud saw these fears manifesting as a fear of castration, which Schreber symbolized by believing he was turning into a woman. When God became the focus of Schreber’s delusions, Flechsig took on a hated role, suggesting that Schreber harbored a strong sexual attraction to him. Unable to fulfill this attraction, the role of Flechsig morphed into God, positioning Schreber in the passive, female role that his father's abuse had pushed him toward.
1. Hilda Doolittle (H.D.)
Hilda Doolittle, a poet and writer, provided the most thorough documentation of Freud’s analytical methods through letters she wrote while under his care, as well as a follow-up book she published later.
In 1915, Doolittle experienced the heartbreak of giving birth to a stillborn child. She later had a daughter in 1918. After recovering from childbirth and a prolonged illness, she traveled with her companion, Winifred Ellerman (Bryher), to Greece for further recuperation. During the journey, she briefly had an affair with a man aboard their ship. (Her husband, who wasn’t the father of her child, had long since departed.) Doolittle played an active role in the marriage of Bryher and Robert McAlmon, but when McAlmon could no longer tolerate the dynamic, he left, and Kenneth Macpherson took his place. Bryher and Macpherson married, adopted Doolittle’s daughter, and formed a three-way partnership with Doolittle. Freud must have enjoyed hearing about this unconventional relationship.
One surprising omission in Freud’s case studies of Doolittle (known as “H.D.”) is the topic of her sexuality. Despite her complex personal life, Doolittle sought Freud’s help because she was suffering from writer’s block. His therapy proved effective, and she went on to write Tribute to Freud, a memoir detailing their sessions and their personal connection. Her work following therapy often explored Freud’s theories, such as parent-child relationships and gender identity, using a literary format.
Doolittle's letters also mention the presence of Freud's dogs during their therapy sessions. Described as chows resembling little bears, these dogs were always there, often causing distractions. Doolittle recalls incidents where the dogs fought, and on one occasion, two puppies were added to the mix, creating a chaotic atmosphere—certainly an unusual setting for a therapy session.
