The Young Suffragist’s Diagnosis

In the spring of 1913, nearly a decade ago, I was asked by a colleague to undertake the analysis of his niece, a young lady of 19 years, whom he described as suffering from neurasthenia complicated by chronically recurrent dyspepsia of an hysterical origin. My acquaintanceship with my referring colleague, a prominent Pest physician specializing in disorders of the kidney and urethra, was of long standing and fair intimacy. He was a fellow member of the board of governors of the Magyar Israelite Medical Association and also a fellow alumnus of the Medical Faculty of the University of Vienna. My final year at that august institution was Herr Dr. S.’s first, and we both lodged at the Pension Wettendorfer, which had the distinction of being one of the few pensions serving Jewish medical students to be furnished with an indoor commode. I was less well acquainted with Herr Dr. S.’s brother, though we traveled in similar social circles. Prior to assuming her treatment, I had on a few occasions the privilege of meeting the charming young Nina S. She had impressed me as a psychically normal girl, though perhaps inclined by virtue of her high intelligence to neurotic excitability when in stimulating company. The S. family is of fine reputation, possessing among its members a number of wealthy financiers, attorneys, and at least one court councillor. It was thus with great interest, even pleasure, that I anticipated Nina S.’s arrival in my surgery on the morning of May 5, 1913.

I wish I could say that Miss S. greeted our appointment with similar optimism and good cheer. On the contrary, when she entered the room, she was irritated, even angry. Her dress, of the reform style, uncorseted and loose flowing, was of winter wool, gray and gloomy in color, matching her demeanor. The day itself was fine, a harbinger of what I hoped would be an especially pleasant spring, and I could not help but notice that her attire stood in marked contrast to the sprightly floral muslins that my own daughters wore that day. Though Miss S. denied being warm, I nonetheless opened a window to give her the benefit of the pleasant lilac-scented breeze.

Miss S. refused to take her place on the analysand’s couch, despite the cheerful nosegay of the season’s last violets that my wife had thoughtfully placed on the small table by the head. Instead she perched stiffly on a chair, her mouth drawn into a thin line, quite a feat considering the generosity of her plump lower lip.

“How can I help you, my dear?” I said, my tone far more avuncular than forensic. Over the previous few years, as I had progressed in my own analysis with the brilliant Sándor Ferenczi and learned from him the utility of empathic reciprocity in the analyst/analysand relationship, I had begun to treat my patients with the love and affection they often lacked and craved. Though I know the S.’s to be devoted, even overindulgent, parents of their three children, I was confident that Miss S., like all my patients, would respond better to affection than to formality. However, my concern aggravated rather than consoled her, and she bristled.

“I am afraid, Dr. Zobel,” she said, “that you have been misled by my father and my uncle. I am not, in fact, in need of your assistance, at least not medical.”

“Ah!” I said. “But you are in need of another kind of assistance?”

“The only thing I need is for you to convince my father that I am not in the early stages of dementia praecox.”

“Surely your father has no fear of such a drastic diagnosis. You uncle certainly expressed nothing of the kind to me.”

Miss S. was fair, with yellow hair and a porcelain complexion uncommon in people of our race. Her delicate skin showed her every mood, and her cheeks and throat now blushed pink. “Do you know what inspired my father to insist on this appointment?” she asked.

“Your uncle raised the possibility of neurasthenia.”

“Do I seem neurasthenic to you?”

She was hardly enervated; rather she radiated energy. This alone did not, however, disprove her uncle’s diagnosis. Fatigue, though generally a primary symptom of the disorder, is not always present. Depression and anxiety can and often are expressed as precisely the kind of agitation and irritability that Miss S. was now exhibiting.

In a soothing voice, I said, “Your uncle also told me that you suffer from a pain in your stomach.”

“He told you that this pain was dyspeptic and recurrent?”

“You are well versed in the terminology, I see.” I was not surprised at Nina’s facility. Familiarity with medical jargon is characteristic of a certain kind of hypochondriacal patient.

“I should hope so,” Miss S. said. “I am preparing to enter medical college next year.”

“Are you? I was not aware.”

“Yes, I am, despite the fact that neither my father nor my uncle approves of women physicians.”

Since the ministerial statute of 1895 allowed for women to enter the Faculty of Medicine here in Budapest, there had been a great influx of female students, though I myself had not yet been forced to confront them in my neurology and psychiatry lectures. Though I did not confess as much to my patient, I am obliged to admit to having possessed an ambivalence about the presence of young lady students in my chosen profession. There are areas, such as the fields of hygiene, pediatrics, and even obstetrics, that are in many ways suited to the female mind and sensibility. Women are naturally predisposed to care for the family, children, and the means of reproduction, and there are certain classes of women who can perform these functions competently and perhaps even more sensitively than men. However, I had concerns about exposing young ladies of class and discernment both to the rigors and to the harsh physical realities of modern medicine. Many of the common and necessary parts of a student physician’s training would be offensive and disturbing to such young ladies. I think I can be forgiven for rebelling against the image of girls like Miss S. or my own daughters, girls from conservative and proper Jewish homes, examining the pustulating papules of a patient suffering from secondary-stage syphilis.

I could not help but sympathize with Mr. S.’s antipathy to his daughter’s choice of profession and was relieved that my own daughters had shown no such inclinations. In fact, on that very morning, my wife and I had determined to accept on behalf of our eldest daughter, Erzsébet, the marriage suggested by an elderly relative who made her living facilitating such arrangements. The young man in question was himself a student of medicine, and while considering Miss S.’s ambitions, I for a moment entertained the ludicrous notion of Erzsébet meeting her intended for the first time not in her mother’s parlor but rather in the autopsy theater, their hands mutually immersed in the viscera of a diseased corpse.

I determined, however, not to alienate my young patient by allowing her to see my doubts about the suitability of her ambitions. I said, “Do you, as a fledgling physician, agree with your uncle’s diagnosis of your symptoms?”

“No. The pain, while recurrent, is not dyspeptic. Nor do I suffer from abdominal ulcers. I suffer from” — here she hesitated and flushed but continued — “I suffer from nothing more than severe menstrual cramping.” I could see that she was doubly embarrassed, both by the topic and by her own shame in discussing it, and this affirmed my feelings about elegant and cultured women and the medical profession. A young girl’s pretty flush when referring to such matters is understandable, even desirable, but a doctor can feel no such compunctions.

Miss S. rushed on, “It’s only that my father does not understand that most women experience these symptoms. It’s not a disease. It’s normal.”

Maintaining a dry and direct tone of voice in order to assure her that I found our conversation to be utterly benign—an analyst, after all, must speak without indignation or revulsion on all topics, even the most bizarre of sexual perversions, and certainly something as commonplace as menstruation—I said, “Some cramping is normal, I agree. However, it is not uncommon for intense pain during the menstrual period to be hysterical in nature, not physical, and thus resolvable with treatment and analysis.” I refrained at this moment from addressing the most likely source of her pain, excessive masturbation and a consequent shame response. There would be time, once she grew trusting of me, to lead her toward this logical conclusion. I continued, “How intense is your pain?”

For a moment Miss S. did not reply, but then, grudgingly, she said, “Very.”

“Wouldn’t you like it to be less so?”

“Of course.”

“Well, then perhaps I can help you. Here is what I suggest. Let us meet a few times to explore this pain of yours, to consider if it might have a genesis traumatic rather than physical. If we are successful in ameliorating it, then that will be wonderful. If not, then what will we have lost but a few hours of time, time spent in one another’s surely not-unpleasant company?”

She frowned and said, “I won’t be hypnotized.”

“Why not?”

“I don’t wish to be.”

“Well, then I shall not hypnotize you. Though I must say, by precluding hypnosis you do remove one of the analyst’s most artful tools. Perhaps you’ll change your mind.”

“I won’t.”

“There are many other means to our mutual end of relieving your pain. Conversation, exploration, massage.”

“Massage?”

“Dr. Sigmund Freud has had marvelous results with gentle massage in the treatment of hysteria. This is something we might explore together. Again, only if you are willing.”

She was silent for a few moments, weighing, I imagined, the unpleasantness of her monthly pain against the indignity of ceding to her father’s insistence on treatment.

Finally, she said, “Dr. Zobel, there is one thing I ask of you.”

“What is that, my dear?”

“I ask only that if you determine that there is no psychical remedy for my symptoms, but that they are, rather, purely physical and normal, in short, if you find me to be sane, you tell this to my father.”

“Of course. It is my obligation as your physician to inform your father of my diagnosis. I would do nothing else.”

“Good.”

“Earlier you mentioned that you believe your father to fear that you suffer from dementia praecox. Why is that?”

“My father is a great reader.”

“Is he? He has this trait in common with his brother, then. Your uncle and I have often shared books with one another.”

“Recently he received a book by someone named Alexander Pilcz.”

Miss S. said, “Pilcz’s book has convinced Papa that I, like so many Jewish women, am doomed to fall ill with dementia praecox and spend my life wound up in restraining sheets in an insane asylum, screaming obscenities and tearing out
my eyelashes.”

I laughed at the hyperbole of her image, and she graced me with a small smile. I was delighted to see how easily Miss S. adopted my own playful attitude. Despite herself, the young lady was enjoying our conversation. Though modesty usually prevents me from saying so quite so blatantly, I would be remiss in not alerting the reader to my facility with this kind of patient. Young women have always responded well to treatment with me. They flourish under my care because I am comfortable with them, having daughters of my own. I have a natural affinity for the young of the gentler sex, and they for me.

“Would you like to know what evidence he has for this?”
she continued.

“I would.”

She ticked them off on her fingers. “Number one, that I insist on studying medicine, a sure sign of pending insanity, don’t you think? Number two, and this is probably an even-greater offense in his mind, that I refuse to consider marrying the boy he and my mother chose for me when I was still in swaddling clothes.”

I interrupted. “You are betrothed?”

“No, I am certainly not betrothed. It is only that Mama and one of her cousins have been scheming since we were babies for their children to marry, and Papa is, if anything, even more eager for the alliance.”

“Do I know this young man?”

“Probably. It’s Ignác E.”

“The son of Baron Móric E.?”

“No. The son of Jene and Berta E. of Nagyvárad. A lesser cousin of the baron’s. Though they are certainly wealthy enough, as my mother never tires of telling me. Shall I continue presenting my father’s evidence for my dementia, or has my refusal of the proposal of a member of the illustrious E. family, no matter how minor a branch from how minor a distant city, convinced you that my father is right?”

I could sympathize with her father’s frustration at his daughter’s refusal to acquiesce to the match. The object of my Erzsébet’s pending betrothal, while a fine young man from a family in good standing in the community, was nowhere near as illustrious as Nina’s potential husband, yet were Erzsébet to take against him, I would be most annoyed. Still, dementia praecox? Hardly.

“I will reserve judgment on the suitability of the young E.,” I told her. “Pray continue.”

“The third evidence of my supposed insanity is that I refuse to lace my corsets so tightly that my eyes bug out from my head, like other girls my age. The fourth is that I spend my own allowance to subscribe to the journal Women and Society. The fifth, that I not only attended a lecture by Mrs. Rózsa Schwimmer but dared to suggest to my father that he might consider joining the Men’s League for Women’s Suffrage . . .”

At this I could not restrain a bellow of laughter. The idea of the pontifical fogy Marcus S., vice president of the Israelite Congregation of Pest, a man ever attired in sober black, never plaid, morning coats, who’d sooner wear a boot on his head than replace his top hat with a stylish bowler, petitioning the king to give the women of Austria and Hungary the vote was, perhaps, the most amusing idea I’d heard in months.

“And finally,” Miss S. said, acknowledging my laughter with a raised eyebrow, “number six, that I have befriended Gizella Weisz, who is not merely a feminist and disciple of Mrs. Rózsa Schwimmer but also a dwarf.”

“A dwarf?”

“Yes, a dwarf. And what of it? Half of my father’s own friends are certified imbeciles, so why should he view my friendship with a dwarf as a sure sign of insanity?”

“You’re being a bit harsh on your parents’ society, are you not? Though not a friend, I certainly consider your father a fond acquaintance. Perhaps I am an imbecile, too?”

“Perhaps you are, Dr. Zobel. I’m afraid I don’t know you well enough to say yet.”

The clock in the hall chimed. “And I’m afraid our time together is up,” I said. “But we shall continue this discussion tomorrow, yes? Shall we say ten o’clock?”

She sprang to her feet. “All right. Yes. We can meet again. But I have an appointment with my tutor to prepare for my matura in the morning, so it must be in the afternoon.”

How well I remembered the strain I underwent during my own final examinations from gymnasium. No fewer than three young boys in my class attempted suicide in the days immediately before. Given that she was in the midst of this arduous preparation, Miss S. struck me as remarkably composed. And though I knew neurosis to be an expert masquerader, still for a moment I could not help but think that the girl, though probably neurasthenic, was as sane as I.

“Of course,” I said. “I will have to adjust my calendar, but I shall send word first thing in the morning.” Though my afternoon clients, women of leisure, would not object overmuch to being shuffled around, I would refrain from telling them that it was for the sake of a busy young girl studying for her final exams. That they might not have tolerated so willingly.

Miss S. extended her hand, and I kissed it.

“Thank you, Herr Dr. Zobel,” she said. “This was not as miserable an experience as I had expected it would be.”

“My dear, Nina . . .” I waited for a moment to gauge whether she would take insult at the familiar use of her given name. As she appeared unoffended, I continued, “If we accomplish nothing more than alleviating such unpleasant expectations, then I will consider our time together to be well spent.” 

Ayelet Waldman is the author of the novels Red Hook Road, Love and Other Impossible Pursuits and Daughter’s Keeper, as well as of the essay collection Bad Mother: A Chronicle of Maternal Crimes, Minor Calamities and Occasional Moments of Grace, and the Mommy-Track Mystery series.

Excerpt from Love and Treasure by Ayelet Waldman. ©2014 by Ayelet Waldman. All rights reserved. Reprinted by arrangement with Mary Evans Inc.