Video Column

Donald C. Fidler, M.D. Video Column Editor

Videos of Sigmund Freud's Most Famous Cases

Dr. Lesley Dicksen has provided us with two wonderful videotape versions of

Sigmund Freud's treatments of "Dora" and "Wolfman." Each video is approximately an hour in length and each is faithful to the recollections of Freud as evidenced by fre­quent verbatim quotes from therapy notes, reported dreams, letters, and speeches re­counted in "The Complete Psychological Works of Sigmund Freud."

The videos tell the stories of Dora and Wolfman by showing Freud interviewing these two historically famous patients as they describe dreams, associations, and memories of childhood. Freud is often shown proposing his theories to the patients and making interpretations as he explores data and hypotheses. Other data and ideas are presented by showing Freud talking with patients' families; reading letters to col­leagues; having discussions with doctors Fleiss, Frerenczi, and Jung; and making speeches to the International Psychoanalytic Association's annual meetings. Freud's data and theories are presented within the context of his personal life as he formed friendships and had disagreements with col­leagues. Even Freud and Fleiss's uses of co­caine is briefly presented.

Both videos are well designed for educa­tion; each pauses to propose questions for audience discussion. Questions ask viewers to think about how differently these two famous patients would now be treated with our more advanced knowledge. Questions also ask viewers to discuss the psychody-

namics of both patient and therapist and to think about how Freud's personal life influ­enced his goals for the therapies, thus exam­ining countertransference issues.

What cannot be accurate is the dialogue between patients and Freud. The video pro­ducers had access to the written notes of Freud's thoughts about patients, but could not have detailed process notes of Freud's words to patients and could have no vide­otapes or films of Freud's affects and tones of voice when talking with patients. Thus, out of necessity, the producers created dialogue and affects that mayor may not be faithful to the actual sessions. The bias chosen presents Freud as quite intellectualizing and forcing treatment to progress rapidly by making in­terpretations in almost every sentence. This video technique of condensing allows much material to be collapsed into brief video seg­ments, but how accurately the script and actors portray the mood and attachment be­tween therapist and patient should be ques­tioned.

The video and audio qualities of both videotapes are excellent. The camera angles, sets, props, and acting are often simple and stilted, and in "Dora" the actors often cheat and read from their scripts; however, it is important to not let these latter qualities dis­tract from the overall value of these educa­tional videotapes. Often big money productions are done about historically im­portant people, impressing audiences with high-tech aspects, but leaving little content to be remembered. In contrast, these two

low-tech videotapes provide content in a manner that can be well remembered.

In earlier years I read about Dora, Wolf­man, and other famous cases of Freud. After having observed these two videos, I was sig­nificantly intrigued to reread the cases. I was able to develop much more appreciation for the difficulties in developing initial psycho­analytic theories after I had been visually stimulated by the videos. I believe the same will be true of residents, but will be less true for medical students. Neither video can be used to teach how to do therapy because both show Freud bludgeoning his theories into the heads of his patients; however, both videos can be used to discuss how psycho­analysis has advanced from a search for un­conscious truths to being a respectful discovery of subjective experience within our patients.

I believe these videos can promote dis­cussion among residents as they learn about the history of psychoanalysis and psychody­namic psychotherapies. They are valuable as history lessons because they offer us with overall contexts to understand whence we came and perhaps where we shall journey. I am uncertain how successful these videos will be with medical students, but I certainly

encourage teachers to experimentally pre­sent these videos to selected groups of medi­cal students in psychiatric clubs. I believe the videos will be useful to validate the disen­chanbnent and dissatisfaction that many of our students have expressed toward psy­chiatry. As psychiatric educators we should be strong enough to accept that in its early stages of development, psychiatry often was overly intellectual and lacking empathetic attachment. In accepting and owning this history, we can also explain how psychiatry now encompasses more ideas about attach­ment and neuropsychiatric development. By doing this I believe we can win over more medical students to psychiatry. These videos can certainly help us toward these worthy goals.

These two videos offer visual reinforce­ments for well-read audiences and offer stimulating introductions for beginning stu­dents learning about the beginnings of psy­choanalysis and the pioneers who pursued the science and art of these controversial theories and techniques.

"Dora" and "What Means the Dream: Wolfman" are available from Health Sci­ences Consortium, 201 Silver Cedar Court, Chapel Hill, NC 27514, (919)942-3689.