Summary
In his “Prefatory Remarks,” Freud gives a brief outline of his research methodology and addresses the concerns that some readers may have with his conclusions. Freud first takes on the view that a patient’s most intimate secrets should not be divulged without their consent. He acknowledges that most patients would not undergo psychoanalytic treatment if they suspect that confidentiality may be broken. He also concedes that the psychoanalyst should take every possible measure to protect his patient. However, Freud argues that the psychoanalyst must balance the needs of the patient with the needs of science. Freud suggests that he has a duty to share his findings for the sake of the patients who suffer from the same disorder. He hopes that they will benefit from a study of its symptoms, causes and solutions.
Freud then goes into his treatment of sex in the case study. He asserts that the “causes of hysterical disorders are to be found in the intimacies of the patients’ psycho-sexual life.” Given the importance of sex to neurotic behavior, Freud argues that frank discussion of sex is necessary in his case study.
Freud then goes on to emphasize the importance of dream analysis to revealing the unconscious. Freud believes that dream interpretation is particularly well-suited to clarifying hysterical symptoms. As such, Freud argues that the analysis of dreams has been a fundamental part of this case study and emphasizes that the reader should be aware of this system of dream interpretation as presented in The Interpretation of Dreams.
Finally, Freud seeks to manage the expectations of his readers. Because “Dora” is the case study of a single person, Freud acknowledges that it cannot offer a complete understanding of hysteria. Even the case study itself is a fragment, as Dora walked out of treatment before she was cured. Freud says that some readers may be surprised that Dora's hysterical symptoms were not resolved within the three month duration of her treatment. He attributes this delay to a change in his psychoanalytic technique. Whereas before he started from the patient's symptoms, working until each one was resolved, in this case study he has allowed the patient to determine the course of therapy. He refers to this technique as "free association," in which the patient says whatever comes to mind, allowing unconscious thoughts to rise to the surface.
Analysis
In his "Prefatory Remarks," Freud addresses concerns of doctor-patient confidentiality and privacy, two issues that weighed heavily on his mind. Freud waited for four years to to publish Dora: An Analysis of a Case of Hysteria, partly for fear of divulging his patient's secrets and damaging her reputation. In this first section, Freud acknowledges his responsibility to honor doctor-patient confidentiality, but argues that he will be benefiting all hysterics by publishing Dora's case. Freud makes every effort to protect Dora's identity, including using pseudonyms and fake town names.
Freud also attempts to explain his treatment of sex in the case study. In most of Europe at the turn of the century, the thought of a middle-aged man talking to an eighteen year old girl about sex would have been considered highly inappropriate. Freud asserts that sex plays a fundamental role in the development of hysterical symptoms, a point which he first makes in Studies on Hysteria, published in 1895. He thus argues that candid discussion of sex is necessary to finding a cure and emphasizes that he has no prurient interests in the case study.
In addition to stressing the importance of sex, Freud argues for the value of dream analysis in psychotherapy. Dora: An Analysis of a Case of Hysteria works off of many the assertions made in The Interpretation of Dreams. In that work, Freud famously called dream interpretation "the royal road to the understanding of unconscious mental processes." According to Freud, all dreams try to fulfill an unconscious wish. Thus to the psychoanalyst,skilled in demystifying dream content, dreams can provide an incredible opportunity to delve into the patient's unconscious.
