AFasia Freud
AFasia Freud
Aphasiology
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To cite this article: ClausW. Wallesch (2004) History of Aphasia Freud as an aphasiologist, Aphasiology,
18:4, 389-399, DOI: 10.1080/02687030344000599
To link to this article: http://dx.doi.org/10.1080/02687030344000599
History of Aphasia
Freud as an aphasiologist
Claus-W. Wallesch
Sigmund Freud was born on 6 May 1856, in Freiberg/ Moravia to Jewish parents. His
grandfather and great-grandfather were rabbis, Freud's own father was a merchant. The
family moved to Leipzig, when Sigmund was 2, and settled in Vienna when he was 4. As
a pupil and student, Freud excelled. In 1873, he started to study medicine in Vienna.
In an autobiographical sketch (quoted after Schultz, 1970), Freud wrote later:
Neither as a youth nor later, had I a special vocation for the position or profession of a
physician. Rather, my motive was a kind of curiosity [Wissbegierdeliterally: craving for
knowledge] that aimed more at human conditions than on objects of science, and I had not
realized the value of observation as a major instrument for its satisfaction. However, the then
recent theory of Darwin attracted me greatly, because it promised extraordinary advances of
the understanding of the world.
His curiosity led him into the laboratory of the physiologist Ernst Brucke. Freud's first
publications concerned invertebrate embryology, histology, and pharmacology. At 29
years, he was awarded a private docenture in Neuropathology. This title and unpaid
position allowed him to teach the subject at Vienna university. Neuropathology at that
time encompassed the clinical, topological, and functional analysis of neurological
Address correspondence to: Claus-W. Wallesch, Department of Neurology, Otto-von-Guericke University,
Leipziger Str.44, 39120 Magdeburg, Germany. Email: wallesch@medizin.uni-magdeburg.de
This is a written version of a Luncheon Talk given at the 41st Annual Meeting of the Academy of Aphasia,
Vienna, 1921 October 2003.
# 2004 Psychology Press Ltd
http://www.tandf.co.uk/journals/pp/02687038.html
DOI:10.1080/02687030344000599
390
WALLESCH
symptoms and syndromes. Freud's first bid for fame, the investigation of the clinical
effects of cocaine, failedits most important clinical use as a local anaesthetic, first in
ophthalmology, was discovered and described by Carl Koller.
From July 1882 onwards, Freud received clinical training in surgery (under Billroth, 3
months), internal medicine and neurology (under Herrmann Nothnagel, 6 months),
psychiatry (under Theodor Meynert, 5 months), dermatology (3 months), in the
Department for Nervous Diseases (14 months), and finally in ophthalmology (3 months)
(Sulloway, 1979).
On the strong recommendations of Brucke, the medical faculty of the University of
Vienna awarded Freud a travel grant, which enabled him to spend 5 months with Jean
Martin Charcot at the Salpetriere in Paris from autumn 1885 to February 1886. Charcot
was probably the most influential neurologist of the 1880s. For a time, Freud became
immensely attracted to Charcot's teachings and even translated his lectures into German.
When Freud was in Paris, Charcot's focus of interest lay in the analysis (and demonstration in world-famous lectures) of hysteria (conversion or dissociative symptoms).
Freud took up this interest and when, after returning to Vienna, he went into private
practice, he found that the treatment of psychogenic symptoms was soon to be a pillar of
his practice. Consequently, he translated the Nancy neurologist Hippolyte Bernheim's
standard textbook on hypnosis, and applied the technique in his practice with varying
results. His older friend, Josef Breuer MD, had already specialised in the treatment of
hysteria (besides performing his duties as a regular physician). In 1895, Freud and Breuer
together published Studien uber Hysterie [Studies on Hysteria].
Freud's practice flourished (although his soon growing family caused him financial
concerns), and in 1891 he was able to buy the now famous house in Vienna, Berggasse 10.
J. M. Charcot: Neue Vorlesungen uber die Krankheiten des Nervensystems insbesondere uber
Hysterie [New Lectures on Diseases of the Nervous System, Especially on Hysteria]. Translation
S. Freud with a translator's preface and additional footnotes.
H. Bernheim: Die Suggestion und ihre Heilwirkung [Suggestion and its Curative Effects].
Translation S. Freud with a translator's preface and additional footnotes.
Zur Auffassung der Aphasien [On the Interpretation of the Aphasias].
Studien uber Hysterie [Studies on Hysteria] (with Josef Breuer).
Die infantile Cerebrallahmung [Infantile Cerebral Palsy].
Cerebrale Kinderlahmung (III) [Cerebral Palsy of Childhood (III)].
Die Traumdeutung [The Interpretation of Dreams].
Zur Psychopathologie des Alltagslebens [Psychopathology of Everyday Life].
FREUD AS AN APHASIOLOGIST
391
The central target of the present analysis is Freud's book on aphasia. It was published
at a time when Freud was established as a physician in private practice with a neurological focus (that included ``functional'' disorders). The book has been regarded as a
``radical and revolutionary criticism'' (Jones, 1953) of contemporary theories of brain
function, as a final statement of 19th-century neurology (Marx, 1967), but also as ``the
foundation of the entire building of psychoanalysis [. . ., and] a major and lasting contribution to the understanding of speech as an indicator that each person is constituted as
an exclusively particular being'' (Rizzuto, 1977).
Freud seemed to differ from the two latter views, as he did not include the aphasia
book in his Complete Works. The book did not have a great impact on the development of
aphasiology until the 1950s, when psychoanalysis had become more widely accepted and
an English translation was available (Stengel, 1953). In modern neurolinguistics, Caplan
(1997) especially discusses Freud's position in some detail (Wallesch & Bartels, 1996).
What were the motives for Freud's interest in aphasiology? His clinical work in
(neuro-)psychiatry has been meticulously analysed. Although he treated at least one
patient who was aphasic, a systematic investigation is not documented (Hirschmuller,
1991). When he wrote the book, Freud detached himself from his former career and from
his former mentors, among them Theodor Meynert, a leading neuroanatomist of his time,
who was the pallbearer of the concept of association as a guiding principle of the
organisation of higher functions and head of one of the two psychiatric departments of
Vienna university. It was with Meynert that Freud had gained most of his psychiatric
training.
On the Interpretation of the Aphasias (1891, p. 1) starts with the following statement:
When I, without my own new observations, attempt to address a topic, which has already
been treated by the best heads of the German and international neuropathology, such as
Wernicke, Kussmaul, Lichtheim and Grashey, Hughlings Jackson, Bastian and Ross, Charcot
and others, then I am well advised to name those few aspects I hope to advance by my
consideration.
1. The first addresses the differentiation of aphasia by lesion of centres from those by lesion
of pathways. [. . .]
2. The second addresses the interaction of the respective assumed centres for language
functions.
Meynert is not mentioned here, although his theory is a major target of Freud's criticism.
Of 850 copies printed, only 257 were sold (Jones, 1953). Recently, a copy was offered
in e-bay for $7500. Zur Auffassung der Aphasien is rather a booklet than a book, as it
contains only 107 pages. Freud dedicated his aphasia book to Josef Breuer, his friend and
later co-author of Studies on Hysteria (who was, however, critical of the aphasia book;
Vogel, 1973/1992).
Freud had high hopes for the book's success. He wrote to his friend Wilhelm Fliess,
a Berlin ENT specialist, on 2 May 1891: ``In a few weeks I shall afford myself the
pleasure of sending you a small book on aphasia for which I myself have a great deal of
warm feeling. In it I am very impudent, cross swords with your friend Wernicke, with
Lichtheim and Grashey, and even scratch the high and mighty idol of Meynert'' (quoted
after Greenberg, 1997).
Wilhelm Fliess is an interesting figure in Freud's biography. More from theoretical
reasoning than from observation, Fliess came to the conviction that the nose and especially the olfactory epithelia were an organ with sexual functions. Although Freud
remained sceptical after early sympathy for this theory, Fliess's influence may have
392
WALLESCH
This position implies that the modules of brain function duplicate observable behaviour,
probably a misleading concept (compare Fodor, 1983) which was also taken for granted
by authors such as Gall earlier and Kleist (1934) later.
Wernicke (1874, p. 4) was more prudent in his groundbreaking doctoral dissertation:
The surface of the forebrain is a mosaic consisting of simple elements that are characterized
by their anatomical links with the bodys surface. All [properties] that exceed these basic
functions, linking various impressions to form a concept, thought, consciousness, are
achievements of the fibre systems that connect various cortical regions which have been
termed association systems by Meynert.
This is not a localisationist view (this Wernicke took up later under the influence of
Lichtheim). Interestingly, Wernicke regarded association fibres as highly important, but
had no role for association cortex (which, according to Meynert, was considered possibly
functionless until a function was established).
TABLE 2
Some page headings in Zur Auffassung der Aphasien
Page
Heading
2
3
4
5
6/7
8
9
10
11
12
13
14
17
19
22
24
28/29
30/31
32
34
46
47
49
50/51
52
53
54
55
56/57
58
59
60
61
62
64
65
67
68
69
80
90/91
98
100/101
393
394
WALLESCH
Both Broca and Freud attempted to provide a formula to solve the classical (and still
unresolved) mind/matter problem. A very thoughtful statement on this issue by Henry
Maudsley had already been published in the Lancet in 1868 (quoted after Marx, 1967,
p. 126):
Its study . . . brings us at once to that unknown region which lies between what we call mind
and what we call matter. [. . .]
Our available methods of inquiry are indeed as completely divided as are the subject matters
with which they deal:
the objective or physiologic method of direct observation is concerned with the clinical
phenomena of aphasia and the pathological appearances which have been found to accompany it;
the subjective or psychological method of introspection is applicable only to the observation of the mental processes, and to the part words or names have in them.
Later, however, Freud would write: ``The deficiencies in our description would
probably vanish, if we were already in a position to replace the psychological terms by
physiological or chemical ones'' (Beyond the Pleasure Principle, 1920; quoted after
Sulloway, 1979).
FREUD AS AN APHASIOLOGIST
395
cular cortical sites which are to be called centers, while their association is provided
exclusively by subcortical white-fibre tracts [Wernicke's view 1874, CW]. After that, it only
remains for us to state the view that the language area of the cortex is a coherent cortical
region within which the associations and transmissions upon which the language functions
are based take place with a complexity that is beyond comprehension.
The associative language region that integrates optic, acoustic and motor (or kinesthetic)
elements is situated between the primary sensory regions and the motor areas. [. . .] If a lesion
lies adjacent to one of these areas, it will cut off the associative region and the language
mechanism will lack the optic, acoustic etc. element [. . .]. If a lesion is situated more
centrally in the associative region, its effect will be more diffuse; it will not destroy all kinds
of possible associations.
One might add: and thus render partial function (paraphasia, context dependent anomia)
possible (Wallesch & Bartels, 1996).
For Freud, association was a cortical property and not a function of sub- and transcortical fibres. This was the major difference from Meynert and Wernicke. Freud wrote
(1891, pp. 5455):
When we realize, how during individual development myelination affects grey matter piece
by piece, and how for one afferent pathway three or more efferents arise from grey matter
structure, then the grey matter and not the fibre bundles appears as the principal organ of the
brain [. . .]. We see only so much that after passing grey matter fibres homing in the cortex
have some relation to the periphery, but no topic resemblance. They contain the periphery
such as a poem contains the alphabet, in reorganization for another purpose.
Here, Freud proposed an important theoretical innovation, namely that the association
cortex processed its input into a reshaped output.
It is interesting to note that Freud's theoretical position on language representation had
a number of forerunners (Wallesch & Bartels, 1996), among them Adolf Kussmaul,
professor of medicine at the universities of Freiburg and Strassburg, who had written a
book on aphasia in 1877. Kussmaul (1877, p. 32) stated:
There is no single language center or a seat of language in the brain, as there is no seat of the
soul in a simple center. Instead, the central organ of language consists of a large number of
spatially distinct, interconnected ganglionic apparatuses, that interact for mental, sensory and
motor functions. None of these is entirely devoted to language processes, only specific action
produces the connections between neurons that make language [. . .] possible.
396
WALLESCH
Freud's linguistic theory focused on the word. He shared with Wernicke the opinions
(1) that the word is the psychological and developmental unit of the language function,
(2) that the individual evolution of the lexicon is the key to the individual structure of
disintegration, and (3) that the word's meaning is derived from its association with the
object association.
Accordingly, the three types of aphasia postulated by Freud are defined by the relations between and among word and object representations (Freud, 1893):
. Verbal aphasia, in which the associations among the elements of the word representation are damaged.
. Asymbolic aphasia, in which the associations between word and object representation
are impaired.
. Agnostic aphasia, in which the object representation itself is involved.
Freud thus did not follow Hughlings Jackson's insight into the importance of the
proposition. This is remarkable, as the only contemporary linguist whom Freud quotes,
Jena professor Berthold Delbruck, stressed the importance of both phonology and syntax
for linguistic content (Greenberg, 1997). Word and object representations were to
become central issues in psychoanalytic theory. Freud himself called psychoanalysis a
``talking cure''.
FREUD AS A NEUROLINGUIST
David Caplan (1987) has produced a masterful analysis of Freud's neurolinguistic theory,
and I will briefly sketch his interpretation. Caplan accepts as valid Freud's criticism of
connectionism and the value of his falsifying a strong theory (the Wernicke-Lichtheim
theory) on the basis of single case observations (compare Caramazza, 1984; Schwartz,
1984). One of these problems was the frequent co-occurrence of motor aphasia and
alexia, which was proven to be possible without an additional posterior lesion. The other
was a classic case of situation-dependent anomia, who may have been a malingerer
(Bartels & Wallesch, 1996). Caplan (1987, p. 83). concludes that Freud's view came
close to a neuronal network theory:
He pointed out that any neuron which was involved in the joining up of the sound and
association properties of a word must somehow represent both the words sound properties
and its associations within itself. [. . .] These neurons might be localized, just as those only
representing the sound or the associations; in this case the complex function would be
localized. Alternatively, each neuron representing a words sound could be linked to neurons
FREUD AS AN APHASIOLOGIST
397
representing its association. In this case, all these neurons would accomplish complex
functions. Freud suggested that it would be reasonable to assume that each word was
represented in a sort of `net' of neurons.
Psychoanalytic authors have linked Freud's theory with the later positions of Kurt
Goldstein, Aleksandr Romanovich Luria, and, most recently, Harold Goodglass
(Greenberg, 1997). Although an analysis would be interesting in Luria's case, who for a
time in his youth was a devoted psychoanalyst, I feel that the similarities mainly rest on
parallels without connections.
398
WALLESCH
This interpretation could also be used for an explanation of hysterical symptoms, and
later (1905: Bruchstucke einer Hysterie-Analyse [Fragment of an Analysis of a Case of
Hysteria] ) Freud (quoted after Sulloway, 1979) gives reference to his earlier aphasiological work:
We must recall the question which has so often been raised, whether the symptoms of
hysteria are of psychical or of somatic origin. [. . .] As far as I can see, every hysterical
symptom involves the participation of both sides. It cannot occur without the presence of a
certain degree of somatic compliance offered by some normal or pathological process in or
connected with one of the bodily organs.
Freud (1891, pp. 1314). assumed that dysfunction in pathology and normality
resulted from the same mechanisms: ``Paraphasia in patients in no way differs from
mistaking and mutilating words in healthy persons under conditions of tiredness, distraction or under affect. It might well be regarded as a purely functional symptom.'' He
wrote (1891, p. 29): ``We must understand paraphasia to be a language disturbance
whereby the appropriate word is replaced by a less appropriate one that always maintains
a certain relationship, however, to the correct one.''
Of special importance for the future development of psychoanalysis was Freud's
increasing interest with the functional structure of word and object representation: ``A
word . . . acquires its meaning by being linked to an `object representation', at least if we
restrict ourselves to a consideration of substantives. The object presentation itself is once
again a complex of associations made up of the greatest variety of visual, acoustic,
kinaesthetic and other representations'' (Freud, 1891, pp. 8081).
The concepts of word and object representations found their way into psychoanalytic
theory: ``The peculiarity of this case lay only in the emergence of isolated key-words we
had to work into sentences. . . . When these are followed up, it invariably turns out that the
apparently disconnected reminiscences are closely linked in thought and that they lead
quite straight to the pathogenetic factor we are looking for'' (Freud & Breuer: Studien
uber Hysterie [Studies on Hysteria], 1895, p. 4).
Paraphasias of medically normal persons became prominent examples in Freud's
Psychopathology of Everyday Life (1901). Thus, key words and concepts of psychoanalysis were first developed in Freud's aphasia book. Later, they acquired new
connotations in his psychoanalytic work.
The psychoanalysist Schoenwald summarized Freud's aphasia book as follows (1954,
p. 124):
In its pages rests the evidence of Freud's first extended wrestling with the relation to the
psychological and the physiological [. . .]. Here, then is a real turning point. Leaving demands
for absolutely anatomical-physiological explanations behind, at least for the time being,
turning to the actuality of the behavior anatomy and physiology made possible, Freud managed
to create a new conceptual scheme for everyday use in his own thinking and practice.
FREUD AS AN APHASIOLOGIST
399
REFERENCES
Bartels, C., & Wallesch, C. W. (1996). Nineteenth century accounts of the nature of the lexicon and semantics:
Riddles posed by the case of Johann Voit. In C. Code, C. W. Wallesch, Y. Joanette, & A. R. Roch Lecours
(Eds.), Classic cases in neuropsychology (pp. 5368). Hove, UK: Psychology Press.
Caplan, D. (1987). Neurolinguistics and linguistic aphasiology. Cambridge: Cambridge University Press.
Caramazza, A. (1984). The logic of neuropsychological research and the problem of patient classification in
aphasia. Brain & Language, 21, 920.
Freud, S. (1891). Zur Auffassung der Aphasien. Eine kritische Studie. Leipzig/ Vienna: Deuticke.
Freud, S. (1893). Aphasie. In A. Bum & M. T. Schnirer (Eds.), Diagnostisches Lexikon. Leipzig/ Vienna:
Deuticke.
Freud, S. (1901). Zur Psychopathologie des Alltagslebens. Monatsschrift fur Psychiatrie und Neurologie, 10 (1
32), 95143.
Freud, S., & Breuer, J. (1895). Studien uber Hysterie. Vienna: Deuticke.
Fodor, J. A. (1983): The modularity of mind. Cambridge, MA: MIT Press.
Greenberg, V. (1997). Freud and his aphasia book. Ithaca and London: Cornell University Press.
Jackson, J. H. (1879/ 1931). On affections of speech from disease of the brain. In Selected writings of John
Hughlings Jackson, Vol. 2 (pp. 155204). London: Hodder & Stoughton.
Jones, E. (1953). The life and work of Sigmund Freud. New York: Basic Books.
Hirschmuller, A. (1991). Freuds Begegnung mit der Psychiatrie. Tubingen: Discord.
Kleist, K. (1934). Gehirnpathologie. Leipzig: Barth
Kussmaul, A. (1877). Die Storungen der Sprache. Leipzig: Vogel.
Marx, O. M. (1967). Freud and aphasia: An historical analysis. American Journal of Psychiatry, 124, 123133.
Maudsley, H. (1868). Concerning aphasia. Lancet, 2, 690ff [quoted after Marx, 1967].
Rizzuto, A. M. (1997). Reflections about Freud's on aphasia and contemporary science. www.psychomedia.it/
pm/science/psybyo/rizzuto.htm
Schiller, F. (1979). Paul Broca founder of French anthropology, explorer of the brain. Berkeley, CA: University
of California Press.
Schoenwald, R. L. (1954). A turning point in Freud's life. Osiris, 7, 119126.
Schultz, J. H. (1970). Sigmund Freud. In K. Kolle (Ed.), Grosse Nervenrazte (2nd ed., pp. 99114). Stuttgart:
Thieme
Schwartz, M. F. (1984). What the classical aphasia categories can't do for us, and why. Brain & Language, 21,
38.
Solms, M., & Saling, M. (1986). On psychoanalysis and neuroscience: Freud's attitude to the localizationist
tradition. International Journal of Psycho-Analysis, 67, 397416.
Stengel, E. (1953). S. Freud: On aphasia [translation]. New York: International Universities Press.
Sulloway, F. J. (1979). Freud biologist of the mind. London: Burnett.
Vogel, P. (1992). Editorische Vorbemerkungen. In P. Vogel (Ed.), Sigmund Freud: Zur Auffassung der Aphasien
(pp. 3638). Frankfurt: Fischer. (Original work published 1973)
Wallesch, C. W., & Bartels, C. (1996). Freud's impact on aphasiology, aphasiology's impact on Freud. Journal
of the History of the Neurosciences, 5, 117125.
Wernicke, C. (1874). Der aphasische Symptomencomplex. Breslau, Poland: Cohn & Weigert.