The dream of Irma’s injection: Freud reinterpreted

It has been possible to unravel Freud’s dream because, fortunately, the relevant historical evidence about the traumatic events in his life during the months preceding it, and the reactivation of concerns about these events by the remarks of a visiting friend on the evening before, are available to us.

This evidence provides the key to understanding his dream in the light of Joe Griffins's findings about the purpose of dreams. And, as we shall see, this explanation is far removed from the one arrived at by Freud himself. His dream was, in fact, a precise metaphorical re-enactment of specific historical events in his life that were still troubling him greatly. The dream was described by him as follows:

The dream of Irma’s injection

A large hall — numerous guests, whom we were receiving — among them was Irma. I at once took her on one side, as though to answer her letter and to reproach her for not having accepted my solution yet. I said to her: If you still get pains it’s really your own fault! She replied: if only you knew what pains I’ve got in my throat and stomach — it’s choking me — I was alarmed and looked at her. She looked pale and puffy. I thought to myself that after all I must be missing some organic troubles. I took her to the window and looked down her throat, and she showed signs of recalcitrance like women with artificial dentures. I thought to myself that there was really no need for her to do that — she then opened her mouth properly and on the right I found a big white patch: at another place I saw extensive whitish grey scabs upon remarkable curly structures which were evidently modelled on the turbinal bones of the nose — I at once called Dr M and he repeated the examination and confirmed it. Dr M looked quite different from usual, he was very pale, he walked with a limp and his chin was clean shaven … My friend Otto was now standing beside her as well, and my friend Leopold was percussing her through her bodice saying: She has a dull area low down on the left. He also indicated that a portion of the skin on the left shoulder was infiltrated (I noticed this as he did), in spite of her dress … M said "there's no doubt about it, it's an infection, but no matter, dysentery will supervene and the toxin will be eliminated" … We were directly aware, too, of the origin of the infection. Not long before, when she was feeling unwell, my friend Otto had given her an injection of a preparation of propyl propyls, … propionic acid … trimethylamin (and I saw before me the formula for this printed in heavy type) … Injections of that sort ought not to be made so thoughtlessly … and probably the syringe had not been clean.

From Freud's discussion of the background to the dream, which on first inspection appears to be about one of his patients, Irma, we know that, on the previous day, he had received a visit from an old friend who was also the family paediatrician, Dr Oskar Rie. Earlier in his career Rie had been Freud's assistant and collaborated with him on a scientific paper. In the dream of Irma’s injection Freud calls him Otto. That evening Rie had come directly from Irma’s home where he had been staying with her and her family. Freud asked him how Irma was and he replied, "she"s better but not quite well". Freud was annoyed by his reply as he fancied that he detected a reproof in it to the effect that he (Freud) had promised the patient too much. He gave no indication to Rie of his feelings but that night he worked late, writing out her case history to give to Dr M (subsequently identified as Dr Josef Breuer, a senior colleague and a collaborator with Freud on a book about hysteria).

In The Interpretation of Dreams Freud proceeds to give lengthy associations for each element in the dream and, finally, concludes that the main instigating force for the dream was a wish to exonerate himself from any blame for the lack of complete success in the treatment of Irma’s condition. This is achieved by (a) blaming Irma herself for not accepting his solution, (b) pointing out that, because the pains were organic in nature, they were not treatable by psychological means, and (c) implying that Otto had caused the pains by giving her an injection with a dirty needle. These reasons are not, however, as Freud himself noted, mutually applicable. The dream also gave him his revenge on Otto, by making Otto responsible for Irma’s condition.

Now that we are aware that all the elements in a dream stand for something else, with the exception of when someone’s presence is felt but not perceived, we can conclude that Freud’s explanation for the dream, based as it is on the manifest characters, is wrong. Furthermore, since the publication in 1966 of a paper by Max Schur[1] in which previously unpublished letters from Freud to Wilhelm Fliess were included, we have had available the means to identify with some certainty the true meaning of Freud’s specimen dream.

We learn from these letters that, in March 1895, Freud had treated a young, single woman of 27, Emma Eckstein, for hysterical nose bleeds. He had called in his friend Fliess, a nose and throat specialist, to examine her to see if there was a somatic basis to her illness. Fliess had not only operated on Freud himself but was also, at this time, Freud's major confidant and had expressed complete confidence in Freud’s theories. Fliess travelled from Berlin to Vienna to examine Emma and operated on her nose on the 4th March. (Fliess had propounded a bizarre theory that the turbinal bones in the nose and the female sexual organs were intimately connected and that somatic symptoms, allegedly arising from masturbation, could be cured through nasal surgery.) Freud subsequently wrote to Fliess telling him that the swelling and bleeding hadn’t let up and that a foetid odour had set in. He went on to say that he had called in another surgeon, G [Dr Gersuny], who inserted a tube to help the drainage.

Four days later he wrote again to Fliess telling him that profuse bleeding had started again and, as Dr G was unavailable, he had called in surgeon R [Dr Rosanes] to examine Emma. While cleaning the area surrounding the opening, Rosanes began to pull at a thread and suddenly at least half a metre of gauze came away from the cavity. This was followed by profuse bleeding. It turned out that Fliess had left a piece of iodoform gauze in the cavity some two weeks earlier, which was interfering with the healing process and was the source of the foetid smell. Freud went on to say that leaving in the gauze was an unfortunate accident that could have happened to the most careful surgeon and he reassured Fliess of his complete confidence in him.

On 28th March 1895 he again wrote to Fliess reassuring him about Emma's condition but, by 11th April, he was writing once more telling Fliess that

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