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‘A serious venture’: John Rodker (1894–1955) and the
Imago Publishing Company (1939–60)
Re
´my Amouroux
1,2
University of Western Brittany, Faculty of Medicine, Department of Human
Sciences, 22 rue Camille Desmoulins, CS 93837, 29238 Brest Cedex 3, France –
remy.amouroux@univ-brest.fr
(Final version accepted 1 April 2011)
John Rodker (1894–1955) was the founder of the British publishing house – the
Imago Publishing Company – which undertook the republication of the complete
works of Sigmund Freud in German just before World War II. Rodker, himself a
writer as well as a publisher, was initially tempted by a psychoanalytic career;
numerous obstacles, however, lay in his path. War, along with the complicated
management of the royalties from Freud’s writings, compromised the progress of
what seemed to him to be ‘a serious venture’. Besides Rodker, we meet numerous
actors of the psychoanalytic movement: Anna Freud, Marie Bonaparte, Ernest
Jones, James Strachey, all of whom had worked for the dissemination of Freud’s
writings. This paper shows how the English language gradually became the ‘offi-
cial norm’for psychoanalysts. According to the editors of the Standard Edition,
at that time ‘nothing new [was] being written’in German or in French. The fail-
ure of the Gesammelte Werke project signalled the end of an era in which psycho-
analysis was mainly written about in German.
Keywords:history of psychoanalysis, John Rodker, Imago Publishing Company,
Gesammelte Werke,Standard Edition,Complete Works of Sigmund Freud
Introduction
For over 20 years, the Imago Publishing Company (IPC) played a major
role in supporting and disseminating psychoanalysis throughout the world.
The background to the publishing house, however, is not at all well
known. John Rodker, the founder, was a self-taught poet and publisher;
he took over the responsibility for publishing the new German edition of
Sigmund Freud’s writings after the Nazis closed down the Internationaler
Psychoanalytischer Verlag (IPV). Rodker’s aim was profoundly humanistic:
to preserve the memory of Sigmund Freud in spite of the consequences
entailed by the collapse of civilized values at that point in time. In addi-
tion, obtaining the rights to publication of the writings of the founder of
the psychoanalytic movement was quite an achievement in the publishing
world. As regards sales of his books, Freud was a very good author to
have on one’s files. However, contrary to all expectations, the reissue of
the Gesammelte Werke (GW) would turn out to be more of a curse than
1
This paper is based on a research project carried out at the Harry Ransom Centre (HRC) in Austin,
Texas, financed by the C. P. Snow Memorial Fund.
2
Translated by David Alcorn.
Int J Psychoanal (2011) 92:1437– 1454 doi: 10.1111/j.1745-8315.2011.00484.x
Copyright ª2011 Institute of Psychoanalysis
Published by Blackwell Publishing, 9600 Garsington Road, Oxford, OX4 2DQ, UK and
350 Main Street, Malden, MA 02148, USA on behalf of the Institute of Psychoanalysis
e International Journal of
a blessing. The original project could not be carried through, given the
wartime circumstances. A whole series of obstacles increased the time
required for reissuing what theoretically was simply the original German
edition.
In the course of that psychoanalytic publishing adventure, we come across
several important figures in the world of psychoanalysis – Anna Freud,
Marie Bonaparte, Ernest Jones, James Strachey, etc. – who, with John Rod-
ker, did everything they could to make Freud’s writings more widely known.
Unlike these other participants, Rodker was not a psychoanalyst. He had
been psychoanalysed but his application to become a member of the British
Psychoanalytical Society (BPS) was rejected. In this paper, as a parallel to
the history of the Imago Publishing Company, I shall explore the itinerary
followed by that pioneer in the publishing of psychoanalytic writings in the
course of his somewhat atypical life.
The Internationaler Psychoanalytischer Verlag
The story of the publication of psychoanalytic texts begins with the found-
ing of the Internationaler Psychoanalytischer Verlag (IPV) in 1919 (Hall,
1988). At the end of World War I, Hugo Heller’s company was no longer
in a position to continue publishing the two main journals of the psycho-
analytic movement, the Internationale Zeitschrift fr (rtzliche)Psycho-
analyse and Imago. It was in that context that the idea of creating a
publishing house for psychoanalytic literature, independent of commercial
interests, was born. The aim was not only to continue publishing those
two journals and other writings but also to establish some kind of ‘official
norm’. A distinction had to be made between papers that were officially
acknowledged by Freud and his followers to be truly psychoanalytic and
the increasing number of ‘pseudo-psychoanalytic’texts that were appearing
on the market (Marinelli, 2009). That project received important financial
support from Anton von Freund, an industrialist from Budapest who had
been analysed by Freud, and led to the publication of the first edition of
Freud’s complete works, the Gesammelte Schriften (Freud, 1924–34). The
catastrophic state of the world economy at that time, however, meant that
bankruptcy gradually became unavoidable. Although sales of most of
Freud’s writings remained high – some were even bestsellers – the income
from them was insufficient to finance the whole of the planned Verlag
publications (Marinelli, 2009). In addition, every Austrian publishing
house depended for its sales on the German market. When Hitler seized
power in 1933, his aim of ‘purging’anything that contravened the national
socialist ideology had important consequences – the sales of Verlag publi-
cations plummeted as a result of the various measures adopted by the
Nazi administration. The firm officially ceased to exist in 1941, but in fact
from 1938 on it hardly had any ongoing activity as a commercial venture.
In that same year, the catastrophic political situation meant that Freud
had to leave for England. At that point, he began to think about how to
set up another publishing house to continue the work that the IPV had
initiated.
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John Rodker: Writer, translator and publisher
In London, John Rodker, with Barbara Low and Martin Freud, were to be
the directors of the new enterprise. Rodker (1894–1955) was an English wri-
ter and publisher whose ideas were close to those of the French and English
avant-garde movement in literature (Crozier, 1996; Patterson, 2003). The son
of Jewish immigrants, Rodker left school at 14 years of age. He then took
evening classes in German, French and science, while working at various
daytime jobs. At that point too, he spent some time in Paris with a cousin
of his; as a result, his command of the French language was excellent. From
1912 onward, some of his articles, especially those concerning the theatre,
were published in literary reviews such as The Dial,The Egoist and The
New Age. During World War I, he was alternately in prison and on the
run – a convinced anti-militarist, he had decided to desert and to dedicate
himself to his activity as a writer. After the war, some of his writings were
published in The Little Review thanks to the support of his friend, the poet
Ezra Pound. In 1919, with his first wife, Mary Butts, Rodker founded the
Ovid Press, which published his own writings and those of Ezra Pound and
T. S. Eliot, together with drawings done by artists who were close to the
Vorticist movement: Gaudier-Brzeska, Wyndham Lewis and Edward Wads-
worth. At that point, he met Ludmila Savitzky, the mother of Marianne
Ras, who would later become Rodker’s third wife; he married her in 1951,
after divorcing his second partner, the painter Barbara Stanger McKenzie-
Smith. Savitzky would later translate many of Rodker’s writings into French,
and in particular Montagnes Russes and Dartmoor.
Rodker’s career as a publisher continued until his death. In spite of impor-
tant financial difficulties, he founded several publishing houses such as the
Casanova Society in 1923 and the Pushkin Press in 1937. He published
several literary works, including Joyce’sUlysses and his own translations or
editions of Lautramont’sThe Lay of Maldoror, Pound’sCantos 17–26,Le
Corbusier’sToward a New Architecture and Valry’sIntroduction to the
Method of Leonardo da Vinci. In spite of these innovations, the publishing
house was almost £5000 in debt in 1932. Throughout his life, and in spite of
his indisputable talent for discovering avant-garde writers, Rodker was in
financial difficulties and was declared bankrupt on several occasions.
One of Rodker’s favourite themes was his experience as a conscientious
objector. He wrote several papers on the subject, including AC.O.’sWar,
Memoirs of Other Fronts and Twenty Years After (Bell, 1935). His autobio-
graphical account is interspersed with psychoanalytic ideas that are very
reminiscent of self-analysis.
Rodker and psychoanalysis
Rodker was analysed by Barbara Low (1877–1955), probably between 1926
and 1933. There were perhaps some additional sessions, particularly in 1941.
At that time, Low was one of the very few Jewish psychoanalysts in the
British group. She had trained as a teacher, and was also an activist in
the Labour Party. She had been analysed in Berlin by Hanns Sachs and was
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one of the founder members of the British Psychoanalytical Society in 1919.
It was she who invented the idea of the ‘nirvana principle’(King and Stei-
ner, 1991).
From the outset, Rodker’s interest in literature played a major role in his
relationship with psychoanalysis. An exchange of correspondence between
Low and Rodker shows that Low had asked him to find a new publisher for
D. H. Lawrence’s somewhat roguish Women in Love, which had been
banned from publication in Great Britain (Letter from John Rodker to Bar-
bara Low, 25 July 1929; HRC, 7.6). At the end of an analysis which, for
that period, had lasted for quite some time, Rodker even then appeared to
want to continue his relationship with the psychoanalytic world, as is illus-
trated by this reply he received to a letter he wrote to his psychoanalyst:
‘‘ Of course I shall always be glad to see you again if you want more analysis
[…]. My patients are also my friends in a real sense. I shall welcome you as
a friend as well as a patient’’ . (Letter from Barbara Low to John Rodker, 30
October 1933; HRC, 7.6) That seems, however, not to have been enough for
Rodker. Two years later, he informed Low that he had decided to apply for
membership of the BPS. Low replied, saying that she was sure that he had
all the necessary intellectual qualities for becoming a psychoanalyst. A very
pragmatic person, she went on to say that his many contacts in the world of
the intelligentsia would no doubt ensure that he would not be at a loss for
patients. She did, however, feel that his application would probably not be
successful: ‘‘ The difficulty, to my mind, is not as regards your qualification
but the attitude of the PA Society Institute. At the present time most of the
board (e.g. the two directors of the Institute – Jones and Glover) are dis-
tinctly anti the lay-analyst’’. (Letter from Barbara Low to John Rodker, 19
January 1936; HRC, 7.6) That warning, however, did not in the least put
Rodker off, and he wrote to Edward Glover. A few years before, Rodker
had reviewed Glover’sWar, Sadism and Pacifism (Glover, 1933), and Glover
was particularly appreciative of the fact that Rodker had spoken very highly
of that work (Letter from Edward Glover to John Rodker, 15 August 1933;
HRC, 7.6). The encounter between Glover and Rodker seems to have been
quite a positive one, because Low wrote to Rodker to let him know that
Glover intended to support Rodker’s application (Letter from Barbara Low
to John Rodker, 17 February 1936; HRC, 7.2). After several weeks of wait-
ing, during which Rodker seems to have had further interviews, Glover
wrote to him informing him of the official response to his candidature:
The training committee considered very carefully the situation with regard to your
candidature but considered it best to let you know that they could not accept your
application. I shall be very happy to discuss with you some time, personally, their
reasons for arriving at this decision, and also if you care to do so, go into the mat-
ter of your future plans.
(Letter from Edward Glover to John Rodker, 8 October 1936; HRC, 7.2)
What, then, were those ‘‘ future plans’’ of which Glover wrote? From
about the end of 1936, since he was not admitted to the BPS, Rodker was
already thinking about publishing psychoanalytic texts. At the beginning of
1937, he wrote to Ernest Jones about this idea and suggested the setting up
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of a publishing house for the BPS Institute (Letter from John Rodker to
Ernest Jones, 15 February 1937; HRC, 7.2). Once again, however, the reply,
although polite in tone, was negative:
I should be glad indeed to enlist your cooperation if it proves feasible at any time.
Actually I started a publishing firm myself many years ago; I found the detailed
work so arduous that I had to get all our publishing transferred to professional
firms – a system which seems to work pretty well.
(Letter from Ernest Jones to John Rodker, 20 February 1937; HRC, 7.2)
The firm that Jones mentions in that letter was the Hogarth Press.
The Hogarth Press: The rival
Founded in 1917 and directed by Leonard and Virginia Woolf (Woolf,
1975–80, 1977–84), the Hogarth Press was an English publishing house
well-known among the literati (Willis, 1992). They were the publishers of
just about all of the psychoanalytic literature that appeared in Britain before
World War II. In the early 1920s, Ernest Jones and Otto Rank think about
of creating an English branch of the Verlag in London. The aim was to
publish an English-language journal and translate major texts for the
English-speaking readership. It was thanks to these proposals that the Inter-
national Journal of Psychoanalysis and the International Psycho-Analytical
Library series came into being. In 1924, James Strachey contacted Leonard
Woolf, who was involved with the Bloomsbury group (Glendinning, 2006).
Lytton Strachey, James Strachey’s brother, was one of the foremost mem-
bers of that group of British intellectuals and artists (Holroyd, 1973). James
Strachey, on behalf of Jones, asked Woolf whether the Hogarth Press would
be interested in publishing works from the International Psycho-Analytical
Library series. At about the same time, Freud had authorized Jones to pub-
lish an English edition of the four volumes of his Collected Papers (Freud,
1924–50). The publication of those books by Freud immediately gave the
Hogarth Press international status. They were able not only to reimburse
the money invested in the project but also to make a substantial profit out
of the whole venture. Between 1927 and 1937, psychoanalytic publications
brought in more than £4700, almost 40% of the entire profits – and this in
spite of the fact that they represented only a small proportion (6.1%) of the
books published by Hogarth between 1917 and 1941. Sales of those books
were therefore substantial – for example, each of the four volumes of
Freud’sCollected Papers sold more than 6000 copies (Willis, 1992). In spite
of their selling power, the financial straits in which the IPV found itself led,
from the early 1930s on, to a series of difficult discussions between Martin
Freud, Ernest Jones and the Woolfs. In addition, the development of the
American market, which until then had seemed unimportant, added to an
already complicated situation. The Woolfs persuaded the executors of
Freud’s will that the texts that had been translated in Britain should be
published in the United States by W. W. Norton.
In 1937, the Woolfs planned to sell off their publishing house. They were
contacted by John Lehmann, then by John Rodker. At the end of the day, it
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was Lehmann who went into partnership with Leonard Woolf, who had
decided after all that he would continue the publishing venture. After Freud’s
death in 1939, Leonard Woolf suggested to Ernest Jones that Freud’s com-
plete works be published. However, there was a major problem: Freud had
transferred translation rights into English to his nephew Edward Bernays and
to Abraham Brill. Brill was an Austrian psychiatrist who had emigrated to
the United States; he was the initiator of the first translations of Freud’s
works into English and played a major role in making psychoanalysis more
widely known in the USA. Jones and Strachey needed all the resolve they
could gather in order to set aside Brill’s translations (Steiner, 1987, 1991).
The outcome of that long-term undertaking was the 24 volumes of the
Standard Edition of the Complete Psychological Works of Sigmund Freud [SE],
published between 1953 and 1974 under the general editorship of James
Strachey, in collaboration with Anna Freud, Alix Strachey and Alan Tyson
(Freud, 1953–74).
The Imago Publishing Company
Towards the end of 1938, Rodker spoke of his plans to various people
whom he knew in an attempt to raise the necessary finance. In a letter to a
friend, the managing director of an advertising agency, Rodker explained
that he had many contacts in psychoanalytic and literary circles. In addition,
he said that he had learned that: ‘‘The Institute of Psycho-Analysis is not
altogether satisfied with its present arrangement with the Hogarth Press’’
(Letter from John Rodker to J. P. McNulty, 5 October 1938; HRC, 16.3).
He felt therefore that there was a clear opportunity to be grasped:
This work is being constantly extended, and is assured of a certain, if moderate sale
to specialists, professional men, general and instructional libraries. I do not think
we could necessarily count on these books making large profits, but a number of
standard works selling moderately over some years would show a profit and estab-
lish the concern as a serious venture.
(ibid.)
Full of enthusiasm but nonetheless a realist, Rodker thought that he
would have to raise about £7000 in order to finance the project. In a letter
to his former analyst, he wrote that this new publishing house might publish
the Internationale Zeitschrift fr Psychoanalyse in London, take over the
rights to the International Journal of Psychoanalysis and perhaps even create
another English-language review (Letter from John Rodker to Barbara Low,
5 October 1938; HRC, 16.3). Rodker met Martin Freud at the end of Octo-
ber 1938 in order to discuss with him the planned creation of a publishing
house. Martin was an acquaintance of the wife of Rodker’s advertising
agency friend. From then on, things moved very quickly. Early in December,
Rodker met Marie Bonaparte and Anna Freud in order to discuss his plans
with them. In February 1939, Martin Freud gave his authorization for the
Internationale Zeitschrift fr Psychoanalyse und Imago to be published by
the new firm (Letter from John Rodker to Barbara Low, 3 February 1939;
HRC, 16.3). The name was declared on 17 February and officially registered
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on 20 February 1939. The firm itself was founded on 16 May 1939. The
good news kept coming in – Rodker managed to persuade Marie Bonaparte
to put up £1300; in addition, he obtained £700 from Andr Germain (a wri-
ter friend of his who was in analysis and happened to be the son of the
founder of the French bank, the Crdit Lyonnais), £500 from a Mrs Saye
and £300 from Barbara Low (Letter from John Rodker to Ernest Rawlin-
son, 2 April 1939; HRC, 16.3). It would seem that Rodker himself did not
put up any of his own money, but in an earlier letter he wrote that he had
£1000 at his disposal (Letter from John Rodker to Andr Germain, 25
November 1938; HRC, 16.3). In addition to these sums, he received £140
from William Hoffer and £1700 from the Sigmund Freud Company (Letter
from John Rodker to Martin Freud, 22 December 1949; HRC, 28.12).
The Gesammelte Werke: An impossible project
Very soon after setting up the Imago publishing house, Rodker ran into
several difficulties. In the contract signed between Freud and the Imago
Publishing Company (IPC) on 16 May 1939, the project is very clearly
stated: ‘‘Whereas the Author’s literary and scientific work consisting of 12
volumes entitled Gesammelte Schriften has been destroyed, the Publishers
desire to republish it’’ (Grubrich-Simitis, 1996, p. 40). That new edition was
to be called Sigmund Freud Gesammelte Schriften. Preparations for the new
edition, which would in the end carry the title Gesammelte Werke, had
begun in the autumn of 1938. The editorial committee was composed of
Anna Freud, Edward Bibring and Ernst Kris. Bibring and Kris emigrated
to the United States in the early 1940s and were replaced by William Hoffer
and Otto Isakower. In recognition of the considerable financial support that
she contributed, Marie Bonaparte’s name was to appear on each of the vol-
umes. Grubrich-Simitis (op. cit.) points out that there is very little difference
between the Gesammelte Schriften, i.e. the 1934 German edition (Freud,
1924–34), and the Gesammelte Werke, i.e. the publication in England of the
German text, the final volume of which appeared in 1952 (Freud, 1940–52).
To a considerable extent, indeed, the English edition is simply a photome-
chanical reproduction of the German one. The editorial committee did
make some additions, particularly with respect to what Freud wrote after
1934. Of course, the English edition runs to 17 volumes whereas the Ger-
man edition has only 12, but this is a purely mechanical difference, given
that other writings have been included. In addition, unlike the Gesammelte
Schriften, each volume of the Imago edition carries a more or less complete
index. In the 1950s, it was decided that these indexes should be brought
together in a more systematic manner and published separately as volume
18. It was due to be published to mark the centenary of Freud’s birth, but
it was not until many years later that it saw the light of day, published by
Fischer. Rodker came up against some very important problems concerning
the Gesammelte Werke – indeed, on several occasions he almost abandoned
the whole idea of publishing them. Why were there so many problems?
After all, what Rodker set out to do was simply to reproduce the original
German text.
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In spite of his enthusiasm, he did have to deal with several issues. Accord-
ing to the agreement between the IPC and Freud, in addition to taking over
publication of the two reviews, the Internationale Zeitschrift fr Psycho-
analyse and Imago, under the title Internationale Zeitschrift fr Psycho-
analyse und Imago, six volumes of the Gesammelte Werke were to be
published each year. The entire reprinting should not have taken more than
three years – yet, in actual fact, an additional ten years were required. Six
months after signing the contract, Rodker wrote to Martin Freud, informing
him that as yet he had received no volumes to print, in spite of the fact that
he was due to receive one volume every two months. The editorial committee
was taking much longer than planned to do its work of rereading and indexing:
Had I known that the editorial committee would only be able to treat this matter of
the index and corrections as a spare-time job, I very much doubt whether I should
ever have entered into these agreements.
(Letter from John Rodker to Martin Freud, 5 September 1939; HRC, 28.10)
That, of course, meant that no new money was coming in. As for the
Zeitschrift, it was at that time in deficit. In addition to the delays that Rod-
ker continued to complain about, there was the increase in the cost of paper
and printing brought about by the war; and – for the same reason – there
was also a significant fall in the market for German-language publications.
The publishers therefore had to find a way of losing less money since there
seemed to be no way in which they could earn any. At an IPC directors’
meeting on 5 April 1940, Rodker gave a very disturbing account of the com-
pany’s financial situation:
I am sorry to say that the past year which opened so promisingly, has proved very
disappointing. […]. Although the coming year will be difficult, we shall do our best
to keep the firm in existence, in the hope of better conditions.
(Imago directors’minutes, 5 April 1940; HRC, 17.5)
The Gesammelte Werke are thus not simply a reissue of the Verlag text.
Editorial modifications, various additions and the Index demanded more
work than had initially been thought. According to Rodker, the Gesammelte
Werke were not one of the editorial committee’s priorities. The war, too, of
course, made matters even more complicated. All things considered, revenue
was inexistent for several years. Rodker’s main difficulty, however, had to do
with the fact that he was sharing the management of Imago with Martin
Freud.
Imago: A company difficult to manage
In his will, Freud had designated three of his children – Anna, Ernst and
Martin – as his executors. In 1946, they set up the Sigmund Freud Copy-
rights Limited, a company to which, in 1947, was transferred the copyright
of all of Freud’s writings. In the early 1940s, it was mainly Martin who dealt
with issues involving royalties. Rodker and Martin Freud did not get along
well. Rodker was worried about going bankrupt while Martin Freud, who
himself was in some financial difficulty, demanded that the agreement
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already reached be honoured. According to the terms of that contract,
Martin was to be paid 25% of the net profits, in addition to his salary as
associate director of the IPC. That 25%, however, was absolutely crucial to
the company if it was to go on publishing the remaining volumes. The
money that Rodker had accumulated was sufficient only for the first few
volumes. The profits made from those first sales ought to have made it
possible to finance subsequent spending.
This arrangement as you may remember was made before we had lost our Euro-
pean markets and before the sales of our edition of your father’s works had almost
completely stopped. The result is that we are not making enough profit to cover
our overhead expenses […].
(Letter from John Rodker to Martin Freud, 23 January 1941; HRC, 28.10)
The discussion between the two men became more heated. Martin agreed
to take only a ‘‘modest percentage’’, but refused to accept ‘‘ less than noth-
ing’’ (Letter from Martin Freud to John Rodker, 2 February 1941; HRC,
28.10). In the end, they decided to refer the matter to Ernst, who would
make a decision as to what was best. Somewhat unexpectedly as far as
Martin was concerned, both Ernst and Anna Freud went along with what
Rodker proposed. They felt that the terms of Martin’s contract were ‘‘very
excessive’’ given the work that he was doing for the company:
The suggestion now made by your brother is that this arrangement as such be can-
celled, in favour of a ‘commission’of 5% payable to you at the same time as royal-
ties etc. are paid.
(Letter from John Rodker to Martin Freud, 8 February 1941; HRC, 28.10)
That was quite a setback for Martin. There was apparently no further
exchange of letters between the two men all through the 1940s. It does seem
that Ernst and Anna were able to tone down to some extent their brother
Martin’s financial aspirations.
Martin’s counter-attack
At the end of 1949, however, Martin again demanded that he be paid what
was owed him. He asked Rodker to let him examine all the financial state-
ments of the IPC concerning his father’s writings. Rodker replied that no
profit had been made at all; worse than that, indeed, because, given that
the company had not reimbursed any of the money that had been lent to
it – in particular by Marie Bonaparte, the Sigmund Freud Copyrights Ltd
and William Hoffer – there was a deficit of £4008. Rodker went on to say
that he did not see how he could possibly calculate a ‘profit’– indeed, he
could not see how Imago could possibly pay Martin according to the
terms of his contract. Rodker felt that the contract itself was no longer
valid because it stipulated that the reissue of the Gesammelte Schriften was
to be carried out in one year using a litho-photographic process based on
the Viennese edition. [It should be pointed out that in another letter a
three-year period is mentioned, hence an apparent contradiction here.]
Rodker’s main criticism was that the editorial committee had given him a
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new, modified edition which they called the Gesammelte Werke: this
required many modifications to be carried out and as a result production
time increased by another ten years at least. All of this had cost Imago
thousands of pounds more than had initially been budgeted for – even
without taking into consideration the fact that the cost of binding, paper
and printing had increased twofold since the signing of the contract (Letter
from John Rodker to Martin Freud, 22 December 1949; HRC, 28.12).
Martin’s reply was scathing:
For legal reasons I have to reply to your letter of 22.12 in which, in reply to my
request for some generous and helpful gesture, you grant me nothing for the past,
nothing for the present and nothing for the future.
(Letter from Martin Freud to John Rodker, 2 January 1950; HRC, 28.10)
In the rest of that letter, Martin Freud went on to make clear – although
without saying so in quite so many words – that he too might well break
the terms of the contract and sell some of Freud’s writings to German pub-
lishers. All of this involved finance, and therefore the survival – or otherwise
– of Imago. Rodker, however, was still angry: he felt that it was extremely
unfair of Martin to demand that he explain himself as regards the figures
while his company was in the grip of such financial difficulty. He warned
Martin that he would discuss the situation again with Ernst and Anna. A
few days later he struck the final blow:
Since it appears that you wish to use your position as a director of Imago only for
your own advantage without any regard for our difficulties, past, present and future,
or for the work we are doing, I think it would be best if you resigned your position
as director since no good can come to us from your continuing in that capacity.
(Letter from John Rodker to Martin Freud, 25 January 1950; HRC, 28.12)
Rodker had negotiated with Ernst to secure Martin’s eviction. Neverthe-
less, the financial situation that Imago found itself in was extremely worry-
ing. The sums required to pay the royalties to the Sigmund Freud
Copyrights Ltd were such that the idea of making any kind of profit from
the Gesammelte Werke had to be abandoned (Letter from John Rodker to
Ernst Freud, 1 May 1950; HRC, 28.10). The terms of the contract would
have to be revised downwards.
Initially, Ernst tried to ease the situation but Rodker was having none of
it. He wrote to Anna Freud and to Marie Bonaparte to inform them of the
situation and he explained to Ernst Freud that he was suspending any pay-
ment of royalties until the overall position became clearer (Letter from John
Rodker to Ernst Freud, 5 May 1950; HRC, 28.10). Rodker’s manoeuvre
paid off because after a meeting on 9 May between him and Ernst Freud,
and thanks to Anna Freud’s support, he got what he wanted. The royalties
for the Gesammelte Werke would be examined each year in terms of how
the volumes had sold, and Martin was to relinquish his position as director
of Imago and give up his contractual claims. In addition, the money that
had been advanced with a view to publishing the Gesammelte Werke was to
be looked upon as a donation, not as a loan that would have to be repaid
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(Letter from John Rodker to Ernst Freud, 10 May 1950; HRC, 28.10). It
took several months before Martin’s resignation arrived on John Rodker’s
desk but by September 1950 everything was settled. Martin still received,
however, some cheques and letters from Rodker until 1953.
That was not the only change that occurred in the IPC board of directors.
In 1953, Barbara Low was too ill to carry out her functions even though
these were not particularly demanding. Marianne Rodker, Joan Rodker and
Edward Glover took over those functions with John Rodker – at least this
would seem to be the case because their names appear on the firm’s headed
notepaper. Everything else points to the fact that the IPC was the work of
one man alone.
The end of the Gesammelte Werke and the rapid development
of the Standard Edition
At the end of the war, the IPC was still in a very difficult financial situation.
Sales of the Gesammelte Werke fluctuated between 1500 and 3000 copies,
depending on the volume concerned (Grubrich-Simitis, 1996; see Table 1);
given the high production costs, this made them hardly a viable proposition
from a financial point of view. Although the Gesammelte Werke collection
was still incomplete, Rodker had to find new material to publish or a new
project to carry out. Imago published not only Sigmund Freud’s writings
but also those by his daughter Anna, Marie Bonaparte and several other
psychoanalysts: none of these, however, were particularly profitable. Marie
Bonaparte’s papers were published at her expense but sales of her work were
poor. That said, by contributing the necessary finance for her own work to
be published, she to a very real extent helped Imago to survive. In addition,
Rodker tried to be the authorized distributor of Ferenczi’s writings in
Germany and suggested that they be translated into English. Those two
projects, however, came to nothing because not enough people were pre-
pared to buy Ferenczi’s work (Letter from John Rodker to Robert Brunner,
5 June 1951; HRC, 3.10). Only a few papers – in particular those by Anna
Freud – were financially profitable.
Even before the Gesammelte Werke series was completed, a new and for-
midable rival came into the picture, making everything look gloomier. After
the success of Freud’sCollected Papers published in the 1920s and 1930s, it
was now the turn of the Standard Edition to see the light of day. These 24
volumes were published between 1953 and 1974. The English-speaking
world was thus able to have at its disposal a new edition of Freud’s writings,
which might well be given priority not only by those German-speaking
psychoanalysts who had emigrated to the United States but also by their
followers. As Rodker put it in a letter to Ernst Freud: ‘‘[In] any case, your
English collected Edition, in my opinion, will oust the German edition from
our best markets soon after it appears’’ (Letter from John Rodker to Ernst
Freud, 1 May 1950; HRC, 28.10). One very important element appears at
this point: the radical change of direction on the linguistic level that was
about to take place within the psychoanalytic movement. That change of
direction would entail many material consequences for the finances of the
Rodker and Imago 1447
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Table 1. Some examples of Imago Publishing Company sales between 1940 and 1960 (HRC).
1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960
Vorlesungen zur Einfhrung
in die Psychoanalyse (1940)
66 ? ? ? ? ? ? ? ? ? ? 107 262 253 150 135 91 79 191 94 157
The Origin and Development
of Psychoanalysis (1954) – – – – – – – – – – – – – – – 1328 177 126 57 50 53
The Question of Lay Analysis
(1948) – – – – – – – – – 986 375 119 69 31 31 37 31 287 43 26 20
Zur Psychopathologie des
Alltagslebens (1948)
– – – – – – – – – 530 158 233 87 144 105 59 18 17 51 53 140
Selbstdarstellung (1948) – – – – – – – – – 134 56 43 35 82 57 25 20 30 26 16 20
Gesammelte Werke
vol. 11 (1940) 66 26 30 70 82 67 232 ? 399 53 413 344 227 205 193 209 191 219 160 127 103
Gesammelte Werkevol. 15
(1940) 62 24 28 51 46 77 202 ? 105 451 219 239 205 205 206 198 197 237 153 107 107
The Psychoanalytic Treatment
of Children (1946)
? ? ? ? ? ? ? – – – 526 ? 876 ? 807 529 400 917 611 ? 140
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IPC. In the post-war period, the English language became the norm for
psychoanalysts. The Standard Edition was therefore not simply a financial
but also a linguistic success. It was probably thanks to that publication that
psychoanalysis in the English-speaking world very quickly took on a
‘‘ distinctive, readily identifiable, technical character’’ (Graham, 2000, p. 204).
The choice of several neologisms and of terms that until then had been little
used was an important factor in creating this new ‘official norm’. Riccardo
Steiner has shown the importance of the part played by political and
national issues in the production of the Standard Edition. In his view, the
creation of the International Journal of Psychoanalysis in 1920, that of the
International Psycho-Analytical Library series by the Hogarth Press in 1924
and, in the same year, the publishing of Freud’sCollected Papers all had the
same aim: that of ensuring the hegemony of the British Psychoanalytical
Society in the English-speaking world (Steiner, 1987, 1991). Having control
over translations of Freud’s writings did indeed constitute a real political
strategy.
Over and beyond these institutional and logistic difficulties, it has to be
admitted that the idea of publishing Freud’s work in German on the eve of
the outbreak of World War II was not a particularly profitable choice.
Psychoanalysis all but disappeared in Germany at that time; the fact that
the majority of German psychoanalysts emigrated to English-speaking coun-
tries led to a sharp reduction in the number of potential readers. The result
was that, by the end of the war, Imago was in a much more difficult situa-
tion than before. Everything seems to point to the fact that the project of
publishing Freud’sGesammelte Werke ended without bringing any real relief
to the publishing house. Furthermore, the fact that English was becoming
increasingly important in psychoanalytic circles meant that the original ver-
sions of Freud’s writings were less of an attraction. One anecdote will serve
to illustrate the point that I am making here. In 1957, Marianne Rodker
wrote to Alix Strachey suggesting that a ‘vocabulary of [psychoanalytic]
terms’be drawn up covering the three main languages (English, German
and French). The Stracheys had indeed contributed significantly to the pub-
lication of the Glossary for the Use of Translators of Psycho-Analytical Work
(Jones, 1928) and of the New German–English Psycho-Analytical Vocabulary
(Strachey, 1943). At about the same time, in France, Daniel Lagache,
Jacques Laplanche and J.-B. Pontalis were thinking about a similar project
which would indeed come to fruition in 1967 under the title Vocabulaire de
la Psychanalyse [The Language of Psychoanalysis] (Laplanche and Pontalis,
1967). At first, the Stracheys were somewhat hesitant:
We want to make a number of emendations or additions to the glossary, largely as
a result of work on SE. We both, however, are rather strongly opposed to any idea
of including definitions of the terms, as this inevitably opens the door to contro-
versy.
(Letter from Alix Strachey to Marianne Rodker, 6 October 1957; HRC, 12.8)
The idea, therefore, was to establish an official work of reference that,
over time, would require few if any changes to be made to it, one that could
be of service to psychoanalysts throughout the world. Such a work must,
Rodker and Imago 1449
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however, have seemed superfluous to the Stracheys, given their commitment
to the Standard Edition; they came to the conclusion that there was no need
for another glossary:
There seems to be a good deal of scepticism as to whether there would be any
demand for such a work – at any rate so far as German or English is concerned. It
is argued that everything worthwhile in psychoanalysis in German has been trans-
lated already and that nothing new is being written in that language.
(Letter from James Strachey to Marianne Rodker, 6 May 1958; HRC, 12.8)
Henceforth, then, the standard work of reference was to be the Standard
Edition. It was not just a matter of ‘the Old World versus the New World’.
Over and beyond the national issues that Steiner highlights, there were some
that were truly linguistic. Had psychoanalysis at that point officially become
an English-language discipline? Perhaps it was the elusive and ubiquitous
nature of psychoanalysis in the 20th century – the ‘whole climate of opin-
ion’(Forrester, 1997) – that freed it from its German linguistic roots? It is
interesting to note that the 11 volumes of the Studienausgabe – the new
German edition published between 1969 and 1975, edited by Alexander Mit-
scherlich, Angela Richards and James Strachey – followed the model laid
down by the Standard Edition. Behind the purely financial considerations
linked to publishing Freud’s writings, there was therefore a whole political
and linguistic project concerning psychoanalysis as such, some 50 years after
it had been created. The future of psychoanalysis lay in Western Europe
and in the United States. It should be pointed out, all the same, that some
psychoanalysts who were not native English speakers – for example, Jacques
Lacan – did play a significant role in the development of psychoanalysis
after World War II.
The death of John Rodker – and that of Imago
‘‘ He [...] died one evening after dinner at the house of a friend, in the pres-
ence of his wife Marianne’’ (Bonaparte, 1956, p. 200). John Rodker died
suddenly on 6 October 1955. His death foreshadowed that of the Imago
Publishing Company. His friend, the psychoanalyst Princess Marie Bona-
parte, wrote a beautiful obituary, published in both French and English. In
it, she praised Rodker’s talent as a poet and a publisher, and paid tribute to
his many English translations of French authors, in particular Jean Giono,
Pierre Jean Jouve, the Count of Lautramont, Henry de Montherlant, Paul
Nizan, Jules Romain, Antoine de Saint-Exupry and Jean-Paul Sartre. The
Princess’s interest in literature (Amouroux, 2010) undoubtedly played a part
in the friendly relationship that existed between her and Rodker. As Ian
Patterson (2003) has pointed out, Rodker’s work as a translator was an inte-
gral part of his achievements. It was Rodker, indeed, who provided the
impetus for translating several of Marie Bonaparte’s writings, such as Myths
of War (1948), The Life and Works of Edgar Allan Poe (1949), Flyda of the
Seas (1950) and Female Sexuality (1951). Edward Glover read the
funeral oration for Rodker, proof if need be of the latter’s involvement in
psychoanalytic circles in Great Britain. Even Ernest Jones, who had
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prevented Rodker from becoming a practising psychoanalyst, described him
warmly – ‘‘a friendly, intelligent and enterprising publisher’’ (Jones, 1957, p.
249) – in his biography of Freud. Some months before Rodker died, his
friend Andr Chamson, the French writer, nominated him for the Lgion
d’honneur, the highest honorific award that exists in France (Letter from
Marianne Rodker to Marie Bonaparte, 22 February 1955; Bibliothque
Nationale de France, Marie Bonaparte archives). That award was indeed
conferred on him posthumously.
Thereafter, his wife, Marianne Rodker, took over the management of
Imago. She had an Arts degree and in Paris had run a bookshop specializ-
ing in French and English psychological literature before rejoining her
husband in London. It was as early as 1959 – despite all her enthusiasm,
the profit that the company was in fact making (see Table 2) and her desire
to continue the work that her husband John had initiated – that Marianne
Rodker seriously began to think about closing down the publishing house.
One indication of the fragile foundations of the business was that, when it
was put up for sale, in spite of its worldwide reputation, Imago had only
one employee. Buyers quickly appeared on the scene – Fischer in Germany
and the Hogarth Press in Great Britain.
It was with some reluctance that Marianne Rodker let Fischer take over
the publication of the Gesammelte Werke. Shortly after John Rodker’s
death, Fischer had entered into negotiations with Imago concerning the
publication of some of Freud’s writings in less expensive editions. Those
books sold remarkably well: 76,000 copies of the Abriss der Psychoanalyse
and 112,000 of Zr Psychopathologie des Alltagsleben (Letter from Gottfried
Bermann Fischer to Ernst Freud, 31 May 1956; HRC, 26.5). Those figures
go to show the extent to which Rodker’s project might well have proved
successful. When she realized that a whole new market was slipping away
from her, Marianne Rodker refused to grant to Fischer the rights to reissue
some of Freud’s writings – in particular Zr Psychopathologie des Alltagsle-
ben. At the same time, Fischer went very much on the attack on the com-
mercial front with an eye to the English market, even though the German
firm was theoretically prohibited from so doing (Letter from the Rubinstein
law firm on behalf of Imago to Gottfried Bermann Fischer, 9 May 1956;
HRC, 26.5). Under pressure from Anna Freud, Marianne Rodker did in the
end agree to give up her rights to part of her catalogue of works in favour
Table 2. Imago revenues in GBP between 1954 and 1959 (HRC).
Sale of Books Foreign Rights
(general)
Foreign Rights
(Fischer Verlag)
1954–5 £6468 £824 £85
1955–6 £5603 £478 £85
1956–7 £7005 £520 £255
1957–8 £5712 £334 £270
1958–9 £6081 £225 £95
Rodker and Imago 1451
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of the German publisher. That publishing house, of course, was mainly
interested in Freud’s writings since the other authors on Imago’s files would
be much more difficult to sell. Considering all the work that John Rodker
had put into Imago, the sale of the firm did not bring in much money:
£1750 for Freud’s writings in English translation (Letter from Piers Ray-
mond to Marianne Rodker, 1 January 1960; HRC, 5.3) and £9300 for the
entire German edition (Letter from Marianne Rodker to Ernst Freud, 17
March 1960; HRC, 11.9).
Conclusion
As we come to the end of this account, we cannot but be struck by the
tragic and even absurd nature of Rodker’s project. For more than
13 years, he did everything he could to have Freud’s writings reissued
without making any real financial gain, given the near disappearance of
the German market during the war. He witnessed the rapid success of the
Standard Edition after the war was over. His untimely death prevented
him from realizing that the German readership that had been initially so
lacking did in fact exist. In the 1950s, Fischer, the German company,
successfully published less expensive editions of Freud’s writings in the
original German. Rodker’s project was therefore a disappointment not
only financially, in spite of all the work and single-mindedness that he
had put into it, but also from the editorial point of view. Paradoxically,
the English-language edition became the norm throughout the world. It is
the only one that has a critical edition; in Germany, Rodker’s edition was
never revised and the one published by Fischer (Freud, 1969–75), in spite
of its editorial qualities, remains incomplete.
Implicit in this account is the fact that English gradually became the
‘official norm’for psychoanalysts. According to the editors of the Standard
Edition,‘nothing new [was] being written’in German or in French. Mutatis
mutandis, the Gesammelte Werke version almost certainly seemed to them to
be very much in second place compared to the Standard Edition. The failure
of the Gesammelte Werke project was thus not entirely attributable to the
vagaries of history linked to the war. It was a powerful indication of the
profound changes that were about to take place in the psychoanalytic move-
ment after World War II. The emigration of the first generation of German-
speaking psychoanalysts to the United States, plus the extraordinary success
that psychoanalysis was to have in that country, changed forever the linguis-
tic landscape of the potential readership. Thereafter, the development of
psychoanalysis was not simply a matter of preserving Freud’s writings; it
involved how these could be circulated, as well as the language in which
they would be made available.
Acknowledgements
I would like to express my sincere gratitude to Professor John Forrester and
to Ian Patterson.
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Translations of summary
,,Ein betra
¨chtliches Wagnis’’ : John Rodker (1894– 1955) und die Imago Publishing Company
(1939– 1960). John Rodker (1894–1955) war der Grnder des britischen Verlagshauses Imago Publishing
Company, das kurz vor Beginn des zweiten Weltkriegs den Nachdruck von Sigmund Freuds Gesamtwerk
in deutscher Sprache bernommen hatte. Rodker, selbst Schriftsteller und Verleger, war zunchst geneigt,
selbst den beruflichen Werdegang eines Psychoanalytikers einzuschlagen, jedoch gab es zahlreiche Hinder-
nisse auf dem Weg zur Verwirklichung seines Vorhabens. Der Krieg, zusammen mit der komplizierten
Verwaltung der Tantiemen von Freuds Schriften, gefhrdeten den Fortschritt dessen, was ihm als ,,ein
betrchtliches Wagnis’’ erschien. Neben Rodker begegnen wir zahlreichen Akteuren der psychoanalytis-
chen Bewegung: Anna Freud, Marie Bonaparte, Ernest Jones, James Strachey, die alle an der Verbreitung
von Freuds Schriften mitgearbeitet hatten. Dieser Aufsatz zeigt, wie die englische Sprache allmhlich die
,,offizielle Norm’’ fr die Psychoanalytiker wurde. Laut Herausgebern der Werkausgabe wurde zu dieser
Zeit weder in Deutsch noch in Franzçsisch ,,etwas Neues geschrieben’’. Das Scheitern des Projekts
Gesammelte Werke markiert das Ende einer ra, in der ber Psychoanalyse hauptschlich in deutscher
Sprache geschrieben wurde.
‘Una empresa seria’: John Rodker (1894– 1955) y la Imago Publishing Company (1939–
1960). John Rodker (1894–1955) fue el fundador de la editorial britnica – la Imago Publishing Com-
pany – que emprendi la reimpresin de las obras completas de Sigmund Freud en alemn justo antes
de la Segunda Guerra Mundial. Rodker, que era escritor adems de editor y que en un momento se
haba visto tentado de seguir la carrera psicoanaltica, debi enfrentar gran cantidad de obstculos para
llevar adelante este proyecto. La guerra, sumada a la compleja administracin de los derechos de autor
de la obra de Freud, comprometi seriamente el avance de lo que era para l ‘una empresa seria’.
Adems de Rodker, nos encontramos con numerosos actores del movimiento psicoanaltico – Anna
Freud, Marie Bonaparte, Ernest Jones y James Strachey – todos los cuales se esforzaron por divulgar los
textos de Freud. Este trabajo muestra la manera en la que el ingls se fue convirtiendo en la ‘norma ofi-
cial’del psicoanlisis. Segffln los editores de la Standard Edition, en esa poca ‘‘ no se escriba nada nuevo’’
en alemn ni en francs. El fracaso editorial del proyecto de las Gesammelte Werke indic el final de una
era en la cual el psicoanlisis se publicaba principalmente en alemn.
«A Serious Venture»: John Rodker (1894-1955) et l’Imago Publishing Company (1939-
1960). John Rodker (1894–1955) est le fondateur de la maison d’dition britannique – Imago Publishing
Company – qui va entreprendre la rimpression en allemand des œuvres compltes de Sigmund Freud
l’aube de la Seconde Guerre mondiale. Cet diteur et crivain, tent un temps par une carrire de psych-
analyste, va se heurter une foule de difficults dans la ralisation de ce projet. La guerre et la difficile
gestion des royalties de l’œuvre de Freud vont en effet srieusement compromettre le bon droulement de
ce qui lui apparaissait comme « a serious venture ». Outre Rodker, on croise de nombreux acteurs du
mouvement psychanalytique – Anna Freud, Marie Bonaparte, Ernest Jones, James Strachey …– qui
ont tous œuvr pour la diffusion des textes de Freud. En filigrane de ce rcit on voit comment petit
petit la langue anglaise devient la « rfrence officielle » pour les psychanalystes. Pour les auteurs de la
Standard Edition, « nothing new is being written » en allemand ou en franÅais. L’chec ditorial du projet
des Gesammelte Werke marque la fin d’une poque o la psychanalyse s’crivait principalement dans la
langue allemande.
‘Un’impresa importante’: John Rodker (1894– 1955) e la casa editrice Imago (1939–1960). John
Rodker (1894 –1955) stato il fondatore della casa editrice Imago – casa editrice che intraprese la ripubb-
licazione dell’opera completa di Sigmund Freud in tedesco, alle soglie della Seconda Guerra Mondiale.
Scrittore oltre che editore e inizialmente tentato dalla carriera psicoanalitica, Rodker dovette confrontarsi
con vari ostacoli. La guerra, nonch le complicazioni connesse alla gestione dei diritti di autore dell’opera
freudiana compromisero la possibilit di portare a compimento quella che lui stesso defin ‘un’impresa
importante’. Oltre a Rodker, si annoverano numerosi artefici del movimento psicoanalitico: Anna Freud,
Marie Bonaparte, Ernest Jones, James Strachey, tutti psicoanalisti che avevano contribuito alla diffusione
dell’opera freudiana. Questo lavoro dimostra come la lingua inglese sia gradualmente divenuta la norma,
la lingua di riferimento per gli psicoanalisti. Secondo gli editori della Standard Edition, in quell’epoca
non fu pi scritto nulla di nuovo n in tedesco n in francese. Il fallimento del progetto delle Gesammelte
Werke segn la fine di un’era in cui il tedesco aveva rappresentato la lingua nella quale si esprimeva il
mondo psicoanalitico.
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1454 R. Amouroux
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Marie Bonaparte, her first two patients and the literary
world
Re
´my Amouroux
1
Unite
´Douleur, Ho
ˆpital Trousseau, 26 av. Du Dr Arnold Netter, 75571 Paris,
France – amouroux.remy@gmail.com
(Final version accepted 1 December 2009)
Marie Bonaparte (1882–1962) played a critical role in the development of
psychoanalysis in France. Her clinical activity is not well known yet she was one
of the first female French psychoanalysts. The journalist–writers Alice and Valerio
Jahier were Bonaparte’s first two patients. She conducted this dual analysis with
Rudolph Loewenstein (1898–1976). Alice and Valerio exchanged analysts on sev-
eral occasions. During his analysis, Valerio began corresponding with Italo Svevo
(1861– 1928), the author of La Coscienza di Zeno, who imparted his doubts on
the therapeutic merits of psychoanalysis. Valerio described his difficult analysis in
his letters to Svevo. Bonaparte consulted Freud on the subject, but was not able to
prevent Valerio’s suicide in 1939. The Princess of Greece encouraged Alice in her
vocation as a writer and enabled her to benefit from her connections in literary cir-
cles. On the margins of this unpublished story of the two analyses, which is based
on archived documents recently made available, we discover the importance of the
links which were formed – around Marie Bonaparte – between psychoanalysis and
literature. In addition to Italo Svevo, we come across the acerbic writer, Maurice
Sachs, as well as the famous novelist, Stefan Zweig.
Keywords:history of psychoanalysis, Italo Svevo, literature, Marie Bonaparte
Marie Bonaparte, who was analysed by Freud and a patron of the French
psychoanalytic movement, played a cardinal role in the development of
psychoanalysis in France (Bertin, 1982; Mijolla, 1988; Roudinesco, 1990).
She participated in particular in the creation and financing of the Paris
Psychoanalytical Society (SPP) as well as in the French translation of many
of Freud’s texts. In her scientific work, she was interested in the therapeutic
perspectives of psychoanalysis as well as its applications in diverse domains
such as ethnology, sexology, or literature (Ohayon, 1999). She had no uni-
versity qualifications and supported Laeanalyse, that is, psychoanalytic
treatment practised by a non-medical practitioner (Amouroux, 2008). She
was also a controversial character, whose biologizing vision of psycho-
analysis was at the origin of an oeuvre which did not survive her
(Thompson, 2003). Her taste for surgery led her, during her analysis with
Freud, to theorize and undergo a troubling intervention aimed at obtaining
sexual satisfaction (Appignanesi and Forrester, 2000), the interpretation of
which is particularly difficult (Moore, 2009).
1
Translated by Andrew Weller.
Int J Psychoanal (2010) 91:879– 894 doi: 10.1111/j.1745-8315.2010.00278.x
Copyright ª2010 Institute of Psychoanalysis
Published by Blackwell Publishing, 9600 Garsington Road, Oxford, OX4 2DQ, UK and
350 Main Street, Malden, MA 02148, USA on behalf of the Institute of Psychoanalysis
e International Journal of
Valerio and Alice Jahier were Marie Bonaparte’s first two analysands. It
is rare to have access to the account of the ‘first steps’of a psychoanalyst.
These analyses are all the more interesting in that they were ‘supervised’by
Freud himself. Valerio was, moreover, close to Italo Svevo, the author of La
Coscienza di Zeno (Svevo, 1930[1923]), with whom he kept up an interesting
correspondence. A study of the correspondence between Valerio and Italo
on the one hand, and the unpublished correspondence between the Jahiers
and Marie Bonaparte
2
on the other allows us to form a picture of the
practice of psychoanalysis and its links with literary circles in the inter-war
period.
Valerio and Alice Jahier
Born in Aoste, in North-West Italy, in 1899, Valerio Jahier was a Franco-
Italian who originally came from the Vaudois valleys. At the end of World
War I, anticipating the arrival of fascism which was soon to establish itself
in Italy, he emigrated to France. Notably, he was an editor at the Institute
of Intellectual Cooperation, the ancestor of UNESCO, where he was in
charge of cinema. Between 1934 and 1939, he contributed to the journal
Esprit. He wrote more than 30 articles for the cinema section, either under
his Gallicized name Valry Jahier or under the pseudonym Bernard Valdo.
In the 1930s, cinema was considered as a minor art. Jahier’s articles were
thus exceptional and forerunners of the development of film criticism after
World War II (Hughes, 1997). Moreover, he won renown by participating in
a collective book entitled Le role intellectuel du cinma (Jahier, 1937). Vale-
rio also wrote several novels and plays which he did not publish. He was in
psychoanalysis with Marie Bonaparte, which was frequently interrupted,
between 1928 and 1934. Valerio Jahier also had some analysis with Rudolph
Loewenstein around 1931 and consulted other psychoanalysts of the SPP.
We have very little information about the circumstances that led him to
commit suicide in 1939. On his death, Emmanuel Mounier, the director of
Esprit, wrote the obituary himself where he refers to the exchanges he had
with Valerio and to the importance of his column on cinema in the journal.
But he also mentions the moral wound inflicted on him by World War I:
The wearing effects of the war were aggravated by those of semi-exile far from the
Italy he loved and which he did not wish to see again while it was subjugated. These
burdens weighed more heavily on him than some may have suspected: when he was
in bad shape, he went to ground …Among all the circumstances that pushed him
towards death, we find the merciless inevitabilities of life which we come up against.
And the image emerges of hands, already considerably weakened, which let go of
the lifeboat too soon. Perhaps we didn’t know how to hold on to them? How
terribly helpless friendship can be …
(Mounier, 1939, p. 654)
2
The correspondence between Valerio and Alice Jahier and Marie Bonaparte is part of the Marie
Bonaparte heritage of the Bibliothque Nationale de France (BNF) which corresponds to the
classification mark NAF 28230. The origin of the letters that do not come from the BNF is stated in the
body of the text.
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Alice Jahier was the author of several articles in different journals. In Note
sur la presse fminine (Jahier, 1936), published in Esprit in 1936, she
denounces the mediocrity and frivolity of a certain kind of women’s press. In
her articles for Le Flambeau,‘the Belgian journal of political and literary
questions’, she wrote short essays of literary criticism, sometimes psycho-
analytically inspired, notably on FranÅoise Sagan (Jahier, 1957, 1959, 1965).
Following her husband, she began an analysis, first with Loewenstein
between 1929 and 1931, and then with Marie Bonaparte. Her analysis with
the Princess took place mainly between 1931 and 1933, then between 1935
and 1937. It is very likely that she subsequently underwent other periods of
analysis. Shortly before World War II, Marie Bonaparte helped the couple to
obtain French citizenship. Valerio’s death made this invalid and the Princess
was obliged to intervene once again. In May 1940, in view of her Jewish ori-
gins and on Marie Bonaparte’s advice, Alice took refuge in England. She
worked at the headquarters of the Free French Forces for the department of
protocol and wrote a regular column for the newspaper France. Her style
met with some success and she said that General de Gaulle had invited her
to lunch one day. She declined because he had only informed her of his invit-
ation two hours in advance (Mann, 1981). In 1944, she also published a
book, France Inoubliable [France Remembered] (Jahier, 1944) in which she
speaks of her nostalgia for France. It comprises 42 texts, illustrated with as
many photos, which treat of places and monuments representing French
culture, such as the Eiffel Tower, Notre Dame Cathedral, Avignon or Saint-
Tropez. This book, published in a bilingual edition, was prefaced by the poet
and Nobel Prize winner for Literature, Thomas Stearns Eliot. It is dedicated
to Marie Bonaparte, her analyst, with whom she kept up a significant corre-
spondence throughout her life. In fact, she became one of the Princess’s
‘close relations’and even kept company with Anne Berman for a while. Once
she was back in France, she continued to write articles for various news-
papers, translated a novel (Ralph, 1958), and worked for the cinema. She
attended a few of Marie Bonaparte’s courses at the Institut de Psychanalyse
in Paris at the end of the 1950s, as well as a psychoanalytic congress in 1957.
In 1986, Alice Jahier was interviewed by Michel Colle and Nicole Humbr-
ech for the journal Frnsie (Jahier, 1986). It was there that Jahier revealed
in particular that she and her husband had been in analysis with Marie
Bonaparte. She had never wanted to become a psychoanalyst but, at the end
of her life, this enthusiast for writing turned her interest towards graphology.
Svevo and the Jahiers
Apart from a few acquaintances in the French-speaking Swiss
psychoanalytic world, that the Jahiers seem to have come into contact with
psychoanalysis through the work of Italo Svevo. Alice relates she had
become accustomed to reading some of the books that her husband received
via the press service:
Among them, I noticed an Italian book by a then unknown author, Italo Svevo,
entitled La Coscienza di Zeno. Even though I hadn’t studied this language much,
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I forced myself to read it, and discovered a highly talented author. Reading this
book made me understand that only psychoanalysis could be of real help in resolv-
ing the problems with which I was wrestling.
(Jahier, 1986, p. 118)
So Alice recommended it to her husband. Both of them succumbed to the
charm of La Coscienza di Zeno. Published in Italy in 1923, this novel was
then translated into French in an abridged version in 1927. After reading it,
Valerio began a correspondence with the author of the novel and they met
in Paris in March 1928. In the first letter that Valerio Jahier sent to Svevo,
he spoke of the shock that reading the novel had had on him:
I belong to the generation which the war tore away from studies before abandoning
it subdued and irresolute, almost without prospects, in the midst of a humanity in
which all the values had been turned upside down. After leaving Italy in 1920, I
only returned there for a few weeks per year. Abroad, I looked to other cultural
movements, to other literatures for the spiritual food which I felt I could not find
for the moment in my own country. And with regard to the proposition to intro-
duce the public to modern Italian writers, to translate them, to speak about them, I
sidestepped impolitely, not daring to reveal that I couldn’t see any who really
seemed worthy of becoming Europeans. It was with this idea in mind that I had
lived until a month ago, that is, until the appearance of Zeno in the French version.
(Letter from V. Jahier to I. Svevo dated November 1927 [Svevo, 1978, p. 233])
In October 1954, Alice Jahier informed Marie Bonaparte that she had
been asked to write about her encounter with the writer Italo Svevo (letter
from A. Jahier to M. Bonaparte dated 18⁄10 ⁄1954, BNF). Alice then pub-
lished an article on the subject with a few letters that Svevo had exchanged
with her husband Valerio (Jahier, 1955). The totality of these letters was
published in Italian in 1978 (Svevo, 1978). In Alice’s article, she mainly
speaks about psychoanalysis, but the name of Marie Bonaparte is not
mentioned. She refers again to her encounter with Svevo which she describes
fervently:
In spite of the tragic facts – my husband committed suicide on June 23, 1939 –
with which …my memories of Svevo are, for me, inevitably associated, everything
in my memory which relates to him remains unalterably sunny. I will never cease to
be astonished by this and to attribute it all the more to his extraordinary and extre-
mely powerful personal radiance.
(Jahier, 1955, p. 26)
Italo Svevo, whose real name was Ettore Schmitz, was the author of
several other novels – including Una vita [A Life] in 1892 and Senelit [As
A Man Grows Older] in 1898 – which, even more than the one that inter-
ested the Jahiers, went relatively unnoticed by his contempories. It was only
a short time before his accidental death in 1928 that his work was recog-
nized. Real success only came many years later. Svevo was notably the
friend of James Joyce and had even started to translate Freud’sThe Inter-
pretation of Dreams into Italian, but this was never published. A friend of
Eduardo Weiss, he was one of the first novelists to have deliberately drawn
inspiration from psychoanalysis. In France, at the same period, writers like
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Paul Bourget and Andr Gide were also giving prominence to psycho-
analysis in their novels. Thus Gide immortalized the figure of Eugnie
Sokolnicka in the guise of the doctor Madame Sophroniska in The Counter-
feiters (1925). In La Coscienza di Zeno, Svevo relates the life of a man, Zeno
Cosini, who decides to undergo psychoanalysis. This treatment failed and
Zeno finally broke off the relationship with his doctor. Admittedly, the
vision of psychoanalysis developed in his novel can easily be qualified as
‘wild’(Ardolino and Druet, 2005), but Zeno Cosini’s setbacks were to have
an undeniable echo for Valerio Jahier.
Can psychoanalysis provide a cure for psychical suffering? Valerio, Zeno
and Italo would be led, in turn, to ask this question. Around 1912, Bruno
Veneziani, Svevo’s brother-in-law, had begun an analysis with Freud which
did not have the hoped-for success. ‘‘Freud himself,’’ Svevo writes to Jahi-
er, ‘‘after years of treatment involving great expenses, dismissed his patient,
declaring him incurable’’ (letter from Italo Svevo to Valerio Jahier dated
27 ⁄12 ⁄1927 [Jahier, 1955, p. 29]). According to Svevo, the latter was suf-
fering from ‘benign paranoia’and emerged from the treatment ‘completely
destroyed’. Bruno Veneziani was equally a friend of Eduardo Weiss. In
addition to Freud, he also consulted Viktor Tausk and George Groddeck.
All these treatments failed (Weiss, 1970). At the same period, Svevo began
a‘self-analysis’:‘‘It was out of this experience that the novel emerged in
which, if there is a character I have created without having had a model
for it, it is definitely that of Dr S. …’’ (Letter from Italo Svevo to Valerio
Jahier dated 10 ⁄12 ⁄1927 [Jahier, 1955, p. 29]). In the novel, ‘Dr S.’is a
psychoanalyst. When he published his novel, Weiss told him that it was
not psychoanalysis. If Svevo remained convinced that he had done a self-
analysis, he confided to Valerio that he nonetheless regretted not having
done his analysis directly with Freud. It is safe to say that the quality of
his novel would have been enhanced by it. Yet he was very circumspect
concerning the eventual therapeutic virtues of psychoanalysis. Thus, when
Valerio told him that he was interested in psychoanalysis, Svevo advised
him against it. He seemed much more enthusiastic about suggestion and
the work of the Nancy School, about which he spoke to him on several
occasions:
Try autosuggestion. You mustn’t laugh at it because it is simple. The cure that you
should obtain is simple, too. They will not change your personal ‘ego’.
(Letter from Italo Svevo to Valerio Jahier dated 27 ⁄12 ⁄1927 [Jahier, 1955, p. 30])
The day Valerio confessed to Svevo that he had already done ‘sixty
sessions of analysis’, the latter is said to have replied to him: ‘And you are
still alive?’Zeno, but also Svevo and his brother-in-law, indeed came up
against the therapeutic limits of psychoanalysis. Valerio did, too, but in a
more dramatic manner, since he chose to commit suicide. Perhaps Svevo
had sensed the importance of the hidden weaknesses in his interlocutor. In
their correspondence, Svevo seemed to recognize himself in Jahier’s suffer-
ings. But, unlike him, he rejected the interest of a treatment which involved
‘changing the ‘‘personal’’ ego’:
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And anyway, why wish to be cured? Really, must we wrench from humanity what is
best in it? I firmly believe that the real success which has brought me peace resides
in this conviction. We are a living protest against the ridiculous conception of the
superman, as they have tried to impose on us (especially on us Italians).
(Letter from Italo Svevo to Valerio Jahier dated 27 ⁄12 ⁄1927 [Jahier, 1955, p. 30])
Going against that would, according to him, boil down to reproducing
the scorn of the swan in Andersen’s fairy-tale, who thought he was
deformed because he had been hatched by a duck. Svevo distinguishes the
suffering from which one can recover with the help of suggestion from that
which is part of the subject and which nothing – neither suggestion nor
psychoanalysis – can reach. He explains to Jahier that what he admires
about Freud is his sincerity, that is to say, his capacity to speak about his
inner conflicts in a ‘contemplative’way. In the same letter, he presents Freud
and Schopenhauer as two masters of literature: ‘‘A great man, our Freud,
but more for the novelists than for the patients.’’ He thus expresses serious
doubts concerning Valerio’s‘anxious hopes for cure’. Svevo nonetheless asks
him to keep him informed about his ‘psychoanalytic experience’.
A couple on the couch
In a letter to Svevo prior to his meeting with the Princess of Greece, Valerio
lets it be understood that he has already had a good many sessions with a
psychoanalyst from Geneva (Letter from V. Jahier to I. Svevo dated
21 ⁄12 ⁄1927 [Svevo, 1978, p. 241]). The analyst in question was Charles
Odier, another pioneer of French-speaking psychoanalysis. When presenting
Valerio to the Princess, he took care to summarize the ‘case’for her:
When I saw him, I suspected a powerful repression of aggressivity in him, but the
negative transference was barely elaborated. Was I mistaken? I thought I had also
discovered, perhaps owing to repression of the kast-Angst [sic], quite a strong pass-
ive–anal position, without managing of course to unravel all that from the genetic
point of view.
(Letter from C. Odier to M. Bonaparte dated 21 ⁄04 ⁄1928, Container 6, Princess
Marie Bonaparte Papers, Sigmund Freud Collection, Manuscript Division, Library
of Congress, Washington, DC)
In January 1928, Valerio was pessimistic. He wanted to take up his analy-
sis again. What psychical troubles was he suffering from then? Odier speaks
of ‘Zwangsneurose’; as for his wife, she describes him as ‘cyclothymic’and
refers to several suicide attempts which preceded that of 1939. In his letters
to the Princess, he speaks to her about his ‘nervousness’, about his ‘anxiety’,
or again about ‘aggressivity’and difficulties in relating with his family. In
his correspondence with the writer from Trieste, he explains that he wants
to overcome an ‘inferiority complex’which ‘poisons my existence’and
‘makes life hell’. He wanted to try analysis again but the derisory salary he
was earning prevented him from doing so:
My first visit to a psychoanalyst had a negative result. The price of the treatment
would have obliged me to make a crushing loan and I would never have been able
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to find the sum necessary to begin it. [ …] I was on the point of giving up the idea
for good – if it is possible to abandon such an idea – when I had the opportunity
of meeting the Princess of Greece. When I explained my case to her, she said she
was ready to take me into treatment.
(Letter from V. Jahier to I. Svevo dated 03 ⁄04 ⁄1928 [Svevo, 1978, p. 254])
Once again, the Princess’s money made the difference. We understand
implicitly in this letter that Marie Bonaparte offered him exceptional
financial conditions. Did she allow him to benefit from this ‘reduction’to
compensate for her lack of experience as an analyst? She told him in fact
that she still had to do a ‘control analysis with Freud in Vienna in the
autumn’. Valerio was not the only one, moreover, to appeal to the Princess’s
generosity in order to be able to have psychoanalytic treatment. Roland
Dalbiez – who notably published a thesis on psychoanalytic doctrine and
method in 1936 (Dalbiez, 1936) – also contacted her about this. A qualified
teacher [agrg] in philosophy, he wrote a letter to her in 1933 in which he
explained that he had spent several years working on psychoanalysis. Not
wanting to write a ‘purely speculative’thesis, he had followed several ‘neuro-
paths’who had ‘absolutely exhausted’him. Since then, he had been suffer-
ing for about a year from a ‘syndrome of classical psychasthenia’which had
led him to break off the writing of his thesis. He had already tried several
treatments – in particular ‘soporifics’and autosuggestion – which had
brought him some relief. Until then Dalbiez had not wanted to begin an
analysis in order to preserve the ‘independence’of his university work. He
presented himself, then, to the Princess of Greece as a ‘sick intellectual’
who, in the last resort, wanted to start an analysis:
The difficulty I fear I will not be able to overcome is a material one. An analysis
generally takes a very long time. If I do it, I will have to stay in Paris during the
whole treatment, while my family remains in Rennes. This already represents a seri-
ous increase in expense. If on top of that considerable fees have to be added for the
psychoanalyst, I will find myself faced with a total material impossibility …If I do
not succeed, thanks to you, in obtaining special conditions, I will be unable to have
treatment.
(Letter from R. Dalbiez to M. Bonaparte dated 04 ⁄12 ⁄1933, BNF)
Like Valerio Jahier, Roland Dalbiez had planned to do an analysis with
Codet and Loewenstein. He met the latter on several occasions (Letter from
R. Dalbiez to M. Bonaparte dated 23⁄01 ⁄1934, BNF). He also stayed in
contact with the Princess of Greece at least until he had presented his doc-
toral thesis in 1936 (Letter from R. Dalbiez to M. Bonaparte dated
09 ⁄05 ⁄1936, BNF). Did Dalbiez begin an analysis? Did he break it off?
Nothing allows us to answer these questions. Much more precise informat-
ion is available concerning Valerio’s analysis. His first session took place on
27 March 1928. In the letter which preceded this appointment, we can read
in the Princess of Greece’s handwriting the following inscription: ‘My first
analysand’(Letter from V. Jahier to M. Bonaparte dated 27 ⁄03 ⁄1928,
BNF). It would seem that she saw him several times a week. This was quite
time-consuming for Jahier who had to fit three hours for analysis into a
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time-table that was already very full: two hours for the journey and one for
the session (Letter from V. Jahier to I. Svevo dated 27⁄06 ⁄1928 [Svevo,
1978, p. 257]). This case was to prove an extremely difficult one. Yet every-
thing seemed to go well to start with. Following the experience of her own
analysis, Marie Bonaparte tried to find a screen memory concealing some
primal scene which Valerio might have witnessed as a child. Traces of this
quest can be found in their correspondence. On returning from a trip to
Italy, he wrote to his analyst:
I have tried to find out about the lay-out of my parents’bedroom during my child-
hood. According to what I have been told, it could be that the constant light that
cannot be switched off in my ‘big’dreams is quite simply the light from a window in
which, from my bed, I could see the outline of my parents’bed. Another significant
detail is that at the age of 1 I made terrible scenes if in the evenings my father
would not let me rub his bare back with my hand.
(Letter from V. Jahier to M. Bonaparte dated 12 ⁄08 ⁄1928, BNF)
There is a sort of mirroring here of the quest for the primal scene. Freud
demonstrated the role of this type of fantasy in his analysis of the Wolf Man.
In the Princess of Greece’s analysis, this scene plays a very important role. It
led her, moreover, to question the eventual witnesses of her indistinct memo-
ries. Having become a ‘trainee analyst’, she seems to have oriented her patient
in this direction too. In the letter cited above, we are given to understand that,
when Valerio was visiting his parents, he questioned them at length about his
childhood. He also tells her about some of his ‘anxiety dreams’which he
attributes to the pervasive nature of his castration complex. However, after
one year of ‘periods’of analysis interrupted by the Princess’s numerous trips,
Valerio was in very bad shape. Moreover, he had to leave to live in Italy. After
one of Bonaparte’s trips, he wrote to her saying: ‘‘I am not sure how useful it
would be to continue the analysis, for I feel it will just be a series of blank ses-
sions’’ (Letter from V. Jahier to M.Bonaparte dated 26 ⁄04 ⁄1929, BNF). A
few months later, however, there was quite a long and unexpected period of
improvement which led Valerio to break off the analysis:
I must confess that I often felt some sort of shame towards you for this treatment
which was going on and on without there being the slightest sign of a result either in
the short or long term. I considered this as great impoliteness, as unforgivable ingrati-
tude which compensated you very poorly for all the time you had devoted to me.
(Letter from V. Jahier to M. Bonaparte dated 24 ⁄07 ⁄1929, BNF)
It was now Alice Jahier who needed help: ‘‘You may know that my wife
has decided to do an analysis and that she has just begun one with Loewen-
stein. It seems to be doing her a lot of good’’ (Letter from V. Jahier to
M. Bonaparte dated 07⁄10 ⁄1929, BNF). Alice, however, was to keep a bitter
memory of her analysis with Loewenstein which lasted from 1929 to 1931:
I did two years of analysis with R. Loewenstein, but it was no use. He said he
understood nothing about a woman like me, and as for me, I understood nothing
about a man like him.
(Jahier, 1986, p. 118)
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These difficulties led her to change analyst. There are several conceivable
versions. Even if, as it seems, she had already met Marie Bonaparte, as one of
Valerio’s letters suggests (Letter from V. Jahier to M. Bonaparte dated
20 ⁄10 ⁄1929, BNF), Alice Jahier has written elsewhere that she had consulted
the Princess via her husband (Jahier, 1986, p. 118). In any case, she was
referred to Marie Bonaparte. Alice kept a much better memory of her ‘second’
analytic treatment. This one involved successive periods – sometimes spaced
out by pauses of several years – between 1931 and 1937. After the war, there
were most likely other periods. When she was in France, Marie Bonaparte
received her for one hour, several times a week, and sometimes every day.
Alice Jahier also tells how she would often stay to dinner after the sessions. So
the two women gradually developed an uncommon form of friendship. Alice
considered herself as ‘M.B.’s analytic daughter’(Jahier, 1986, p. 119). More
than 100 letters were exchanged between 1929 and 1962. They bear precious
testimony to a therapeutic relationship which gradually turned into one of
friendship and whose tone resembles a personal diary. Unfortunately, we do
not have the Princess’s replies. Alice Jahier herself wonders on many occasions
about the status of their correspondence: ‘‘Are these letters the remains
of transferences or just the cumbersome signs of my very grateful affection
for you?’’ (Letter from A. Jahier to M. Bonaparte dated ‘Saturday’1946,
BNF). In the interview that she gave for Frnsie, she tells how her analysis
ended:
By common agreement. The end of the analysis was absolutely triumphal. We
understood that I had a very strong attachment to my mother and M.B. …or
rather my mother resembled M.B. enormously. When one puts two photos side by
side one understands better. I really loved my mother entirely. But I was M.B.’s
analytic daughter …My mother was a completely uneducated and cold person;
there was no bond between us, whereas with M.B. I had very deep bonds.
(Jahier, 1986, p. 121)
Valerio, Zeno and Marie
In 1931, Valerio contacted the Princess of Greece. He was once again in
extremely bad shape.So she took him back into analysis for a while, but
then referred him to someone else. But how did this come about? We have
the precious testimony of Alice on this subject:
Before undertaking the treatment, his psychoanalyst [Marie Bonaparte] consulted
Freud: he didn’t believe that a total cure was possible; she, however, placing great
hopes in the very real gifts of her patient, did not let herself be discouraged.
(Jahier, 1955, fn. 1, p. 27)
At the end of 1931, however, Marie Bonaparte referred him to Loewen-
stein because she was convinced – had she asked Freud for his advice
here too? – that ‘‘a few sessions with a man’’ (Letter from V. Jahier to
M. Bonaparte dated 05⁄12 ⁄1931, BNF) would do him a great deal of good.
The ‘exchange’of patients between analysts was quite common at the time,
it seems. Accordingly, in 1933, Ren Allendy wrote to the Princess of Greece
asking her to take into analysis one of his analysands who ‘‘was giving him
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great difficulties with regard to resolving his transference’’ (Letter from
R. Allendy to M. Bonaparte dated 22⁄08 ⁄1933, BNF).
Alice Jahier kept the Princess informed about the progress of her hus-
band’s treatment. Things then went from bad to worse: ‘‘My husband has
not changed. He is still floating between life and death without taking
sides’’ (Letter from A. Jahier to M. Bonaparte dated 28 ⁄01 ⁄1935, BNF).
Like his wife, Valerio did not benefit from his analysis with Loewenstein. It
seems that subsequently he had some more sessions with Marie Bonaparte.
She obtained some success and continued to be ‘supervised’by Freud:
I imagine that you have spoken to the wise man from Vienna about me. I regret
that you were unable to speak to him about many more documents and obsessions,
because the last time you saw me I was just beginning to come back to life again.
(Letter from V. Jahier to M. Bonaparte dated 15 ⁄08 ⁄1935, BNF)
Alongside these different periods of analysis, Valerio consulted a large
number of other therapists. Many years later, in 1946, his wife wrote to Marie
Bonaparte to tell her about an astonishing discovery she had made in her
husband’s papers. In his 1934 diary, she discovered that her husband had not
only seen Marie Bonaparte once a week but had had very many appoint-
ments with a large number of the members of the SPP: Ren Allendy, Charles
Odier, Michel Cnac, Ren Laforgue, Georges Parcheminey, Rudolph
Loewenstein, John Leuba, Eugnie Sokolnicka, Sophie Morgenstern, Adrien
Borel, Paul Schiff, Sacha Nacht and Blanche Reverchon-Jouve!
I apologize for asking you this indiscreet question, but did my husband really go
and see all those people? This seems so crazy to me, so desperate, that I am horri-
fied and filled with immense pity, terrorized pity, if you like.
(Letter from A. Jahier to M. Bonaparte dated 05 ⁄07 ⁄1946, BNF)
She also recalled a meal in London during the war during which Blanche
Reverchon-Jouve had asked her if she was related to ‘a certain Italian writer
who had killed himself’. At the time she thought there must have been some
confusion,and had been unable to accept the invitations received from the
Jouves thereafter. All this suggests, however, that ‘Valerio’s’case must have
been relatively well known at the SPP. We do not know precisely what happ-
ened then to Valerio. Apparently things went from bad to worse and he
committed suicide shortly before the outbreak of war on 23 June 1939. This
failure seems to have saddened the Princess profoundly. But she never wrote
anything on this subject. We can imagine, however, that it was difficult to
see her first patient kill himself. In an interview cited earlier, Alice Jahier
had this to say on the matter:
I know that M.B. has almost never spoken about it because it was a terrible blow
for her. And the last time I saw her she said something to me which I believe is
true: I think my husband wanted to seduce her, and he did not succeed.
(Jahier, 1986, pp. 122–3)
Alice retained no ill feelings towards Marie Bonaparte, quite to the cont-
rary. She was convinced that, thanks to the treatment that he began in 1928,
888 R. Amouroux
Int J Psychoanal (2010) 91 Copyright ª2010 Institute of Psychoanalysis
the remaining years of his life had been much better as a whole than they
would have been without psychoanalytic intervention.
Literature plays an important role in this story. In fact, writing is at the
centre of this ‘double analysis’. Valerio Jahier himself said he had a strong
affinity with Zeno Cosini:
I too I had an analysis that was left high and dry …And I have been living for a
very long time with the belief that only success of a practical kind can save me and
give me the moral security, the balance to which I aspire: Zeno Cosini’s cure result-
ing from the effects of his commercial triumph could not fail to touch me.
(Letter from V. Jahier to I. Svevo dated 10 ⁄12 ⁄1927 [Svevo, 1978, p. 237])
In Svevo’s novel, it is indeed not Zeno’s analysis but the success of his
business venture which helps him recover his health. Valerio Jahier, too,
hoped to achieve professional success which would enable him to overcome
his difficulties. Like Svevo, he was interested in psychoanalysis, but not for
the same reasons. The author of Zeno certainly regrets not having done an
analysis with Freud. He thinks that it would have helped him write a
more ‘complete’novel (Letter from Italo Svevo to Valerio Jahier dated 27
December 1927 [Jahier, 1955, p. 30]). But Svevo remains doubtful about the
therapeutic virtues of the Freudian method. As for Valerio Jahier, he consid-
ers that psychoanalysis is foreign to art. Yet he nonetheless pursued his
analysis relentlessly:
Basically, our positions are quite characteristic: you believe in the literary value of
psychoanalysis and not much in its therapeutic value; I believe more in the thera-
peutic value and not in the literary value.
(Letter from V. Jahier to I. Svevo dated 25 ⁄01 ⁄1928 [Svevo, 1978, p. 245])
Valerio is not always so categorical. The Jahiers were, moreover, partic-
ularly sensitive to their psychoanalyst’s interest in literature. On numerous
occasions, they both attest that, as an analyst and writer, she gave consider-
able support to their literary creativity. Valerio referred to his literary tastes
in his correspondence with Bonaparte. He thus suggested that she read
Thomas Mann’sDeath in Venice and The Fox,‘‘a short English novel by
Lawrence’’ (Letter from A. Jahier to M. Bonaparte dated 12⁄08 ⁄1928,
BNF). He told her that this last book was one of the rare cases in which
psychoanalytic knowledge had been well employed by a writer. Naturally,
Jahier also invited her to read La Coscienza di Zeno. But notwithstanding
Valerio’s intense liking for the book, Marie Bonaparte did not appreciate it.
After Svevo’s unexpected death, he wrote to his analyst about this:
About three weeks ago, I learnt of Svevo’s death. I think this was the biggest
sorrow of my life. The blurred impressions [sic] of psychoanalysis that are contained
in Zeno probably prevented you from sensing the full importance of this work.
(Letter from V. Jahier to M. Bonaparte dated 10 ⁄10 ⁄1928, BNF)
In a letter to Svevo’s widow, Livia Schmiz, he wrote that he even had the
impression he had lost his father (Gatt-Rutter, 1988, p. 359).
Marie Bonaparte, her first two patients and the literary world 889
Copyright ª2010 Institute of Psychoanalysis Int J Psychoanal (2010) 91
Valerio Jahier also discusses his wife’s texts with the Princess. He is partic-
ularly enthusiastic for a short story that she has written which is called The
Bath. In the story, Alice takes a literary approach to the bodily relations
between a mother and her child at wash time. Valerio also discusses with his
analyst the progress of his wife’s analysis: ‘‘I think that this text is equally
very significant at the level of the analysis that has been done. It is perhaps
the first experience of analysis in action in a work of art’’ (Letter from V.
Jahier to M. Bonaparte dated 04 ⁄06 ⁄1934, BNF). In this correspondence,
psychoanalysis and art are interwoven to such a degree that they end up
being confused. Marie Bonaparte had a large part to play in this because
she gave Alice advice on some of her short stories and even suggested titles
for them to her (Letter from A. Jahier to M. Bonaparte dated 03 ⁄11 ⁄1934,
BNF). She sent her patient all her publications, including the most personal
ones such as her Cinq cahiers (Letter from A. Jahier to M. Bonaparte dated
03 ⁄01 ⁄1940, BNF). The Princess of Greece also put Alice in contact with
her editor friend, John Rodker (Letter from A. Jahier to M. Bonaparte
dated 06 ⁄01 ⁄1945, BNF) and the writer Paul Morand (Letter from P.
Morand to M. Bonaparte dated 11⁄04 ⁄1935, BNF). In Valerio’s and Alice’s
letters, the question of the ‘desire to write’is mentioned on several occa-
sions, a desire that comes and goes with the ups and downs of analysis.
Alice’s admiration for Bonaparte nonetheless had its limits. In the interview
for Frnsie, she says that, even if the Princess of Greece was a very interest-
ing person and in love with science, she was never a great writer. Another of
Marie Bonaparte’s female patients, Bethsabe de Rothschild, also sent
her literary writings on several occasions to her analyst in order to have her
opinion (Letter from B. de Rothschild to M. Bonaparte dated 1951, BNF).
The question of the relations between psychoanalysis and literature was in
fact of particular interest to the Princess of Greece. In 1933, she published
Edgar Poe, sa vie, son oeuvre: tude analytique (Bonaparte, 1933), which may
be considered as her major work. It was certainly the book that had the most
impact on her contempories (Amouroux, 2006). Stefan Zweig, for instance,
wrote to the Princess to say that he had particularly liked this book:
The book is absolutely convincing: we understand Poe’s disaster as a necessity and
not, as the Americans always want to portray it, as a case of misfortune.
(Letter from S. Zweig to M. Bonaparte dated 20 ⁄06 ⁄1933, BNF)
Marie Bonaparte’s interpretations, then, seem to have helped Zweig
understand more clearly the reasons which led the genius Poe to sink into
alcohol and madness. The writer Maurice Sachs, who spent some time on
Allendy’s couch, also seems to have been particularly receptive to this text.
We are familiar with his terrible destiny (Raczimov, 1988). A writer who was
close to Jean Cocteau and Max Jacob, Sachs had the reputation of being
venal in character and not someone to associate with. He did not enjoy real
literary success in his lifetime. As a ‘Jewish collaborator’, he emigrated to
Germany in 1942 and became an agent of the Gestapo. He was finally
imprisoned in Flsbuttel and shot by the S.S. in April 1945. A few months
890 R. Amouroux
Int J Psychoanal (2010) 91 Copyright ª2010 Institute of Psychoanalysis
later, one of his novels, Le Sabbat [The Sabbath] (Sachs, 1946) was
published by CorrÞa and became a formidable bookshop success.
In 1937 he wrote a long letter to Marie Bonaparte in which he expressed
his deep admiration for her. The story of the life of the American poet by
Marie Bonaparte resonated with certain aspects of his own history. In a
long letter, Sachs explained how he discovered in her text on Poe an almost
exact description of the periodical return of nervous troubles from which he
himself suffered:
Between these two terrible circles of dipsomaniac cyclothymia and one’s own lack
of success, were one can knows where is the cause and where the effect, how does
one live? How does one break the bad spell and find success, which is there but out-
side? How does one even finish the book one has begun? Sometimes, I tell myself
that it is the present lack of success which brings about those withdrawals of despair
in which posthumous success is elaborated.
(Letter from M. Sachs to M. Bonaparte dated March 1937, BNF)
Sachs asked Marie Bonaparte what psychoanalysis could offer by way of
an answer to his own self-destructive madness. The mention of cyclothymia
may well have reminded Marie Bonaparte of her failure with Valerio Jahier,
who was to commit suicide two years later. Moreover, was not Jahier’s
experience of reading Zeno and Sachs’s experience of reading Poe what
Freud called the Unheimlich? This uncanny feeling of strange familiarity in
reading literary works went as far as to seal their destinies. Valerio Jahier
did not benefit from his analysis any more than Zeno did, and Poe’s descent
into hell very much inspired Maurice Sachs. Was it a case of one of those
‘self-fulfilling prophecies’of the performative power of the literary work or
simply the attraction exerted by certain life-stories when they seem familiar?
It is difficult to know. At the very most, all we can say is that Marie
Bonaparte was a first-rate interpreter of the suffering of some of her con-
temporaries. When Sachs sought information about his disorders, his cyclo-
thymia, she asked her secretary to advise him to see a psychiatrist who was
‘more competent’in this domain (Letter from M. Bonaparte to A. Berman
dated 30 ⁄04 ⁄1927, BNF). At that time, the Princess was still a ‘young ana-
lyst’whose fingers had been burnt by the difficulties encountered with Vale-
rio Jahier. She nonetheless offered to see him but he did not take up the
offer. At this period, things could not be going worse for him and he had
the feeling he was sinking into madness. Allendy sent him to a nursing home
where he was treated for alcohol addiction for several months Three years
later, he wrote again to Marie Bonaparte, explaining to her why he had not
been able to visit her and asking her for help:
…I don’t know which resistance to everything that might have done me some good
prevented me (as strongly as chains) from accepting the audience that your Royal
Highness had kindly offered me. Since then, I have been getting by as best I can,
but have felt a bit calmer. [ …] Mobilization and military life made me fall back
into my old ways. To drink or not to drink; to write or not to write; horror of one-
self; the pursuit of a soul about which one feels that the core is in the grips of a
horde of demons, etc. …[…] It is at the end of a long period of despair that I am
writing to you, Madam. Can one ever escape the cycle? Escape falling back into the
Marie Bonaparte, her first two patients and the literary world 891
Copyright ª2010 Institute of Psychoanalysis Int J Psychoanal (2010) 91
worst aspects of oneself? I think you know what the true remedies are because you
are familiar with the misfortunes.
(Letter from M. Sachs to M. Bonaparte dated 08 ⁄01 ⁄1941, BNF)
In another letter, he sent her the manuscript of Le Sabbat, his future succ-
essful novel, in which he once again describes the ‘terrible circles’of failure
and alcohol. It would seem, as is suggested by a latter from Alice Jahier
(Letter from A. Jahier to M. Bonaparte dated 24 ⁄06 ⁄1947, BNF), that she
never read it. He was mobilized in Caen but then discharged on health
grounds with the help of a medical certificate established by Allendy for
‘acute psychasthenia’, whereupon he returned to Paris. This time, he went to
the appointment fixed for 8 April 1940 by the Princess of Greece. His corr-
espondence with Marie Bonaparte ended at this date.
Conclusion
The analytic treatment of the Jahiers by Marie Bonaparte, a figure of the
French movement, raises many questions. There is something troubling in
this ‘couple’analysis, in which Marie Bonaparte and Rudolph Loewenstein,
who themselves were lovers, exchanged their patients under Freud’s super-
vision – and assent? And what are we to think of the fact that the Princess
of Greece’s money not only permitted her to finance the movement but also
– admittedly, to a much lesser extent – the treatment of her first ‘analy-
sands’?
Marie Bonaparte’s analysis itself was not a model of orthodoxy either.
Her very great closeness with Freud and his family, her taste for sexual
surgery and her extraordinary destiny led her to be an ‘unconventional’psy-
choanalyst. The rules for conducting analysis were, moreover, not completely
fixed for the first disciples of the movement. These elements thus bear
witness to the extraordinary diversity of practices amongst the first Freud-
ians. Beyond the technical aspects, these fumblings also show how much the
enthusiasm of the pioneers of the movement was sometimes sorely tested.
Marie Bonaparte, Valerio Jahier, Maurice Sachs – and even Zeno Cosini to
a certain extent – were all confronted, more or less violently, with the thera-
peutic limits of psychoanalysis.
Translations of summary
Marie Bonaparte, ihre beiden ersten Patienten und die Welt der Literatur. Marie Bonaparte
(1882–1962) spielte in der Entwicklung der Psychoanalyse in Frankreich eine entscheidende Rolle. Ihre
klinische Ttigkeit ist wenig bekannt, jedoch war sie eine der ersten franzçsischen Psychoanalytikerinnen.
Die Schriftsteller Alice und Valerio Jahier waren die ersten beiden Patienten Bonapartes. Sie fhrte diese
doppelte Analyse zusammen mit Rudolph Loewenstein (1898–1976) durch. Alice und Valerio tauschten
ihre Analytiker bei mehreren Anlssen. Whrend seiner Analyse begann Valerio eine Korrespondenz mit
Italo Svevo (1861–1928), dem Autor von La Coscienza di Zeno, der ihm seine Zweifel am therapeutis-
chen Nutzen der Psychoanalyse mitteilte. Valerio beschrieb seine schwierige Analyse in seinen Briefen an
Svevo. Bonaparte konsultierte Freud zu dieser Problematik, war aber nicht in der Lage, Valerios Selbstm-
ord im Jahr 1939 zu verhindern. Die Prinzessin von Griechenland ermutigte Alice, ihren Beruf als
Schriftstellerin auszuben und ermçglichte ihr, von ihren Beziehungen zu literarischen Kreisen zu profiti-
eren. Am Rande dieser nicht publizierten Geschichte der beiden Analysen, die auf krzlich zugnglich ge-
machten Archivdokumenten beruht, entdeckten wir die Bedeutung der Verbindungen, die um Marie
Bonaparte herum zwischen der Psychoanalyse und der Welt der Literatur entstanden. Außer auf Italo
892 R. Amouroux
Int J Psychoanal (2010) 91 Copyright ª2010 Institute of Psychoanalysis
Svevo stießen wir auch auf den beißenden Schriftsteller Maurice Sachs sowie den berhmten Roman-
schriftsteller Stefan Zweig.
Marie Bonaparte, sus dos primeros pacientes y el mundo de la literatura. Marie Bonaparte (1882– 1962)
jug un papel esencial en la evolucin del psicoanlisis en Francia. Su actividad clnica no es muy cono-
cida, pero fue una de las primeras psicoanalistas francesas. Los periodistas y escritores Alice y Valerio
Jahier fueron los dos primeros pacientes de Bonaparte. sta llev adelante este doble anlisis junto con
Rudolph Loewenstein (1898– 1976). Alice y Valerio intercambiaron analistas en varias ocasiones. Durante
su anlisis, Valerio comenz a escribirse con Italo Svevo (1861–1928), autor de La Coscienza di Zeno [La
conciencia de Zeno], quien le expres sus dudas acerca de las bondades teraputicas del psicoanlisis. En
sus cartas a Svevo, Valerio describi su difcil anlisis. Bonaparte consult con Freud acerca de este
paciente, pero no pudo prevenir el suicidio de Valerio en 1939. La Princesa de Grecia alent a Alice en
su vocacin de escritora y le permiti beneficiarse de sus conexiones en los crculos literarios. En los
mrgenes de este relato indito acerca de los dos anlisis, basado en documentos de disponibilidad
reciente, descubrimos la importancia de los nexos que se formaron – a travs de Marie Bonaparte –
entre psicoanlisis y literatura. Adems de Svevo, nos encontramos con el mordaz escritor Maurice Sachs
y el famoso novelista Stefan Zweig.
Marie Bonaparte (1882– 1962) a joue
´un ro
ˆle capital dans le de
´veloppement de la psychanalyse
en France. Son activit clinique est quant elle totalement mconnue. C’est pourtant l’une des toutes
premires femmes psychanalystes franÅaises. Les journalistes et crivains Alice et Valerio Jahier furent ses
deux premiers patients. Marie Bonaparte mena cette double cure avec Rudolph Loewenstein (1898–
1976). Ils s’changrent en effet Alice et Valerio plusieurs reprises sur leurs divans respectifs. Pendant
son analyse Valerio entreprit une correspondance avec Italo Svevo (1861–1928) o l’auteur de La Cosci-
enza di Zeno lui fit part de ses doutes sur les vertus thrapeutiques de la psychanalyse. Valerio lui dcrivit
en retour le droulement de sa cure qui se rvla particulirement difficile. Bonaparte consulta Freud
son sujet, mais ne put l’empÞcher de se suicider en 1939. La princesse de Grce encouragea Alice dans sa
vocation d’crivain et lui fit bnficier de ses relations dans les milieux littraires. En marge du rcit in-
dit de ces deux cures qui s’appuie sur des documents d’archives rcemment mis jours, on dcouvre
l’importance des liens qui se tissent – autour de Marie Bonaparte – entre psychanalyse et littrature.
Outre Italo Svevo, on y croise l’crivain sulfureux Maurice Sachs ou encore le clbre nouvelliste Stefan
Zweig.
Marie Bonaparte, i suoi due primi pazienti e il mondo letterario. Marie Bonaparte (1882–-1962)
ebbe un ruolo complesso nello sviluppo della psicanalisi in Francia. La sua attivit clinica non ben
conosciuta, tuttavia ella fu una della prime psicanaliste donne. I giornalisti–scrittori Alice e Valerio Jahi-
er furono i primi due pazienti della Bonaparte. Ella condusse questa doppia analisi con Rudolph Loe-
wenstein (1898–1976). In diverse occasioni Alice e Valerio si scambiarono gli analisti. Durante l’analisi,
Valerio inizi una corrispondenza con Italo Svevo (1861–1928), l’autore de La coscienza di Zeno, che gli
rivel i suoi dubbi circa i meriti terapeutici della psicanalisi. Nelle sue lettere a Svevo, Valerio gli descrisse
la sua difficile analisi. In merito, la Bonaparte consult Freud, ma non fu in grado di impedire il suicidio
di Valerio nel 1939. La principessa di Grecia incoraggi Alice a seguire la sua vocazione di scrittrice e le
permise di trarre vantaggio dalle sue conoscenze nei circoli letterari. Ai margini della storia inedita di
queste due analisi – storia basata su documenti d’archivio recentemente resi disponibili – veniamo a
conoscenza dell’importanza dei legami che si formarono intorno a Marie Bonaparte tra psicanalisi e let-
teratura. Oltre a Italo Svevo, c’imbattiamo nello sferzante autore Maurice Sachs, cos come nel famoso
romanziere Stefan Zweig.
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Article original
Douleur et troubles comportementaux apre
`s ade
´noı
¨dectomie
et pose d’ae
´rateurs transtympaniques chez l’enfant
Pain and postoperative behavioural changes following adenoidectomy
and ear tube placement in children
R. Amouroux *, D. Cohen-Salmon, R. Gooze, C. Rousseau-Salvador, D. Annequin
Unite
´fonctionnelle d’analge
´sie pe
´diatrique, service d’anesthe
´sie-re
´animation, ho
ˆpital d’enfants Armand-Trousseau,
26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France
Rec¸u le 23 mai 2006 ; accepte
´le 30 octobre 2008
Disponible sur Internet le 10 de
´cembre 2008
Re
´sume
´
Objectifs. – Cette e
´tude avait pour but d’e
´valuer la douleur postope
´ratoire apre
`s ade
´noı
¨dectomie (VG) et/ou pose d’ae
´rateur transtympanique
(ATT) a
`l’ho
ˆpital et au domicile et les troubles comportementaux postope
´ratoires (TCPO) au domicile.
Type d’e
´tude. –E
´tude observationnelle.
Patients et me
´thodes. – Soixante quatre enfants (4,3 2,4 ans) : 28 VG, 16 ATT, 20 VG-ATT. La douleur postope
´ratoire a e
´te
´e
´value
´e (entre
´e
SSPI, sortie SSPI, sortie ho
ˆpital) avec l’Objective Pain Scale (OPS). Les parents ont e
´value
´au domicile pendant sept jours la douleur de leur enfant
avec l’e
´chelle nume
´rique simple (ENS). Les TCPO ont e
´te
´e
´value
´s (24 heures et a
`7 jours) avec le Post-Hospital Behavior Questionnaire (PHBQ).
Re
´sultats. – Entre
´e SSPI, OPS = 3,5 [0–6]. Il existait une diffe
´rence significative ( p<0,05) entre le groupe VG (OPS = 5 [2,25–7,75]) et les
groupes ATT (OPS = 0 [0–5,5]) et VG-ATT (OPS = 2 [0–5,75]). Sortie SSPI, OPS = 1,0 [0–2]. Sortie ho
ˆpital OPS = 0 [0–1]. Tre
`s faibles scores
ENS au domicile. Soixante quinze pour cent des parents a
`24 heures apre
`s la sortie et 40,6 % a
`sept jours rapportent l’existence d’au moins un
TCPO.
Discussion. – Dans les trois groupes, les parents rapportent des TCPO malgre
´une analge
´sie correcte.
Conclusion. – La fre
´quence importante des TCPO implique de les e
´valuer syste
´matiquement pour l’ame
´lioration de la prise en charge globale de
l’enfant.
#2008 Elsevier Masson SAS. Tous droits re
´serve
´s.
Abstract
Objectives. – The purpose of this study was to evaluate postoperative pain in the hospital and at home as well as behavioural changes at home
following outpatient adenoidectomy (VG) and ear tube (ATT) surgery.
Study design. – Prospective cohort study.
Patients and methods. – Sixty-four children (mean age 4.3 2.4 years): 28 VG, 16 (ATT), 20 dual surgeries (VG-ATT). Postoperative pain was
evaluated (arrival in recovery room, departure from wake-up room, departure from hospital) using the Objective Pain Scale (OPS). Parents
evaluated their child’s pain at home over a period of seven days using a numeric pain scale. Behavioural changes were measured with the Post-
Hospital Behaviour Questionnaire (PHBQ).
Results. – At arrival in the recovery room, OPS = 3.5 [0–6]. A statistically significant difference ( p<0.05) was shown between the VG group
(OPS = 5 [2.25–7.75]), and the ATT (OPS = 0 [0–5.5]) and VG-ATT (OPS = 2 [0–5.75]) groups. OPS was 1.0 [0–2] when leaving the recovery
room, and OPS was 0 [0–1] when leaving the hospital. Numeric pain scale scores recorded at home were extremely low. Postoperatively, 75% of
parents at Day 1 and 40.6% at Day 7 reported at least one postoperative behavioural change.
Discussion. – In all three groups, parents reported frequent postoperative behaviour changes despite adequate analgesia.
Annales Franc¸aises d’Anesthe
´sie et de Re
´animation 28 (2009) 11–15
* Auteur correspondant.
Adresse e-mail : remy.amouroux@trs.aphp.fr (R. Amouroux).
0750-7658/$ – see front matter #2008 Elsevier Masson SAS. Tous droits re
´serve
´s.
doi:10.1016/j.annfar.2008.10.017
Author's personal copy
Conclusion. – The relatively high frequency of postoperative behaviour changes in this population demonstrates the need to systematically
evaluate those changes in order to improve overall paediatric care.
#2008 Elsevier Masson SAS. All rights reserved.
Mots cle
´s: Douleur ; Troubles comportementaux ; Enfant ; Ade
´noı
¨dectomie ; Ae
´rateurs transtympaniques
Keywords: Pain; Behavioural problems; Child; Adenoidectomy; Ear tubes
1. Introduction
Dans la chirurgie pe
´diatrique en hospitalisation de jour, la
prise en charge de la douleur de l’enfant au domicile est souvent
inade
´quate [1]. Apre
`s une hospitalisation de jour pour
intervention chirurgicale, des troubles de comportement sont
fre
´quemment rapporte
´s chez les enfants ope
´re
´s. Leur fre
´quence
est tre
`s variable, pouvant aller jusqu’a
`88 % des enfants [2].
L’ade
´noı
¨dectomie et la pose d’ae
´rateur transtympanique
comptent parmi les interventions chirurgicales les plus
fre
´quentes chez l’enfant. Elles repre
´sentent, en France, jusqu’a
`
deux tiers des actes chirurgicaux pratique
´s avant quatre ans [3].
On dispose cependant de tre
`s peu de renseignements sur les
suites ope
´ratoires de ce type d’intervention, en particulier pour
la douleur postope
´ratoire et le comportement de l’enfant.
L’ade
´noı
¨dectomie et la pose d’ae
´rateur transtympanique sont
en effet couramment pratique
´es en hospitalisation de jour. Par
conse
´quent, l’essentiel des suites ope
´ratoires se passe au
domicile, hors de la surveillance des e
´quipes soignantes, et
repose principalement sur la famille.
Cette e
´tude observationnelle a pour but d’e
´valuer la douleur
postope
´ratoire a
`l’ho
ˆpital et au domicile et les troubles
comportementaux au domicile pendant la semaine suivant
l’intervention.
2. Patients et me
´thodes
2.1. Patients
Une se
´rie de 64 enfants ont e
´te
´e
´tudie
´s conse
´cutivement sur
une pe
´riode de quatre mois par deux investigateurs non
implique
´s dans la prise en charge anesthe
´sique et analge
´sique.
Tous les enfants e
´taient classe
´s ASA 1 ou 2. Ils e
´taient admis en
hospitalisation de jour pour ade
´noı
¨dectomie et/ou pose
d’ae
´rateurs transtympaniques. Tous les parents et enfants
sollicite
´s ont accepte
´de participer. Cette e
´tude observationnelle
n’a pas entraı
ˆne
´de modifications par rapport a
`la prise en
charge habituelle.
2.2. Protocole anesthe
´sique et analge
´sique
Tous les enfants ont e
´te
´vus en consultation pre
´anesthe
´sique
plusieurs jours avant l’intervention. Au cours de celle-ci, des
explications sur l’intervention et sur l’e
´tude ont e
´te
´donne
´es aux
parents et a
`l’enfant. Celui-ci a pu essayer le masque
d’anesthe
´sie et a rec¸u un livret de pre
´paration « Je vais me
faire ope
´rer – Alors on va t’endormir » [4]. La pre
´me
´dication
comprenait du midazolam (0,5 mg/kg) par voie rectale
30 minutes avant l’heure pre
´vue de l’anesthe
´sie. L’anesthe
´sie
ae
´te
´induite par le se
´voflurane au masque a
`la concentration de
6 % dans un me
´lange oxyge
`ne–protoxyde d’azote a
`50 %.
2.3. E
´valuation de la douleur et des troubles
comportementaux postope
´ratoires
La douleur postope
´ratoire a e
´te
´e
´value
´e en utilisant une
version modifie
´e de l’e
´chelle Objective Pain Scale (OPS)
comprenant quatre items : pleurs, mouvements, comportement
et expression de la douleur. Les re
´sultats de cette e
´chelle se
traduisent par un score a
`huit points, chaque item pouvant e
ˆtre
cote
´0, 1 ou 2 selon la pre
´sence et l’intensite
´de la
caracte
´ristique e
´value
´e. Les enfants ont e
´te
´e
´value
´sa
`trois
reprises, a
`la sortie du bloc ope
´ratoire, a
`la sortie de salle de
surveillance postinterventionnelle (SSPI), et enfin a
`la sortie de
l’ho
ˆpital. Pour des raisons de commodite
´, l’e
´chelle nume
´rique
simple (ENS) d’autoe
´valuation de la douleur a e
´te
´utilise
´e
quotidiennement en he
´te
´roe
´valuation par les parents pendant la
semaine suivant l’intervention.
Les troubles comportementaux postope
´ratoires ont e
´te
´
recueillis a
`l’aide d’une version simplifie
´e du Post-Hospital
Behaviour Questionnaire (PHBQ) de Vernon et Schulmann [5].
Le questionnaire utilise
´e
´value, a
`l’aide de questions ferme
´es
standardise
´es diffe
´rentes dimensions du comportement de
l’enfant : sollicitation des parents, cole
`res, re
´veils nocturnes,
alimentation, frayeurs, cauchemars, et proble
`mes d’endormis-
sement. Les diffe
´rentes questions sont de
´taille
´es dans le
Tableau 1. Les parents ont e
´te
´contacte
´s par te
´le
´phone a
`
24 heures et sept jours apre
`s l’intervention. Pour chacune des
sept questions, il leur a e
´te
´demande
´d’e
´valuer dans quelle
mesure le comportement de l’enfant avait e
´te
´modifie
´par
rapport a
`son statut habituel, en choisissant entre trois
re
´ponses : « moins qu’avant », « autant qu’avant », « plus
qu’avant ». Le jour de l’intervention, les parents ont rec¸u un
formulaire de recueil de donne
´es sur le PHBQ et l’ENS. Des
explications leur ont e
´te
´donne
´es pour l’utilisation de ces outils.
2.4. Statistiques
Toutes les analyses ont e
´te
´re
´alise
´es avec un programme
statistique (SPSS 13.0 ; SPSS Inc, Chicago, Ill). Les donne
´es
ont e
´te
´analyse
´es avec des tests non parame
´triques ad hoc
(Mann-Whitney et Kruskall-Wallis). On a exprime
´les valeurs
quantitatives par les me
´dianes assorties des percentiles 25 et
75 %. Une valeur de p<0,05 e
´tait conside
´re
´e comme
significative.
Une analyse de re
´gression logistique a e
´te
´mene
´e afin de
de
´terminer l’impact de diffe
´rentes variables explicatives sur les
troubles comportementaux postope
´ratoires. Les relations entre
R. Amouroux et al. / Annales Franc¸aises d’Anesthe
´sie et de Re
´animation 28 (2009) 11–1512
Author's personal copy
les variables inde
´pendantes (l’a
ˆge des enfants, le score de
douleur a
`l’entre
´e en SSPI et une journe
´e apre
`s l’hospitalisa-
tion, le type d’intervention, l’administration de morphine et de
parace
´tamol au bloc ope
´ratoire) et les variables de
´pendantes
(les troubles comportementaux postope
´ratoires a
`24 heures et a
`
7 jours) ont e
´te
´examine
´es en deux e
´tapes. Premie
`rement, toutes
les corre
´lations possibles entre les variables ont e
´te
´analyse
´es en
utilisant le coefficient rho
ˆde Spearman. Deuxie
`mement, a
`
partir des variables corre
´le
´es a
`la variable de
´pendante ( p<0,2)
ou cliniquement pertinentes, on a re
´alise
´une analyse de
re
´gression logistique pas a
`pas descendante.
3. Re
´sultats
3.1. Population
Les 64 enfants e
´taient a
ˆge
´s de 4,3 2,4 ans et se
re
´partissaient de la manie
`re suivante: 28 ade
´noı
¨dectomies
(VG : 3,7 2,4 ans), 16 poses d’ae
´rateurs transtympaniques
(ATT : 5,2 2,6 ans), 20 associations des deux interventions
(VG-ATT : 4,4 2,2 ans). Il n’y avait pas de diffe
´rences
significatives d’a
ˆge entre les trois groupes. Le nombre me
´dian
d’hospitalisations ante
´rieures par enfant e
´tait de 1 [0–2].
3.2. Protocole anesthe
´sique et analge
´sique
Le protocole anesthe
´sique et analge
´sique e
´tait laisse
´au choix
de l’anesthe
´siste et non connu par les investigateurs. L’analge
´sie
postope
´ratoire comprenait du parace
´tamol (15 mg/kg) adminis-
tre
´par voie veineuse ou par voie rectale pendant l’anesthe
´sie.
Environ 40 % des enfants de chaque groupe ont rec¸u de la
morphine comme antalgique de relais en SSPI.
3.3. Modalite
´sdese
´paration et pre
´sence des parents en
SSPI
Les modalite
´sdese
´paration entre l’enfant et ses parents
e
´taient les me
ˆmes dans les trois groupes. Apre
`s la pre
´me
´dica-
tion, les enfants e
´taient accompagne
´s par un aide-soignant
jusqu’au bloc ope
´ratoire. Les parents n’e
´taient pas pre
´sents lors
de l’induction anesthe
´sique. Au moment de cette e
´tude, la
pre
´sence des parents n’e
´taient pas syste
´matique en SSPI, mais
laisse
´ea
`l’appre
´ciation de l’e
´quipe infirmie
`re. Dans 58 % des
cas, un parent (33 me
`res et 4 pe
`res) a e
´te
´admis aupre
`sde
l’enfant en SSPI.
3.4. Scores de douleur a
`l’ho
ˆpital et au domicile
La totalite
´des re
´sultats est pre
´sente
´e dans le Tableau 2.Le
score de douleur me
´dian, e
´value
´a
`l’entre
´e en SSPI a
`l’aide de
l’OPS e
´tait de 3 [0–6]. Il existait une diffe
´rence significative
(p<0,05) entre le groupe VG d’une part (OPS = 5 [2,25–
7,75]) et les groupes ATT (OPS = 0 [0–5,5]) et VG-ATT
(OPS = 2 [0–5,75]) d’autre part. La me
´diane des scores OPS a
`
la sortie de SSPI e
´tait de 1 [0–2]. A
`la sortie de l’ho
ˆpital, il e
´tait
nul (0 [0–1]). Il n’y a pas de diffe
´rences significatives entre les
groupes pour ces deux dernie
`res e
´valuations. Les scores de
douleur recueillis a
`la maison a
`l’aide de l’e
´chelle ENS e
´taient
tre
`s faibles de
`s le premier jour avec une me
´diane a
`1 [0–2,75] et
un score nul pour le reste de la semaine.
3.5. Troubles comportementaux au domicile
Les trois quarts des parents rapportaient l’existence d’au
moins un changement ne
´gatif du comportement 24 heures
apre
`slasortie.Apre
`s sept jours, 40,6 % des parents
mentionnaient la fre
´quence accrue d’au moins un de ces
troubles. Les changements les plus fre
´quemment rapporte
´s
e
´taient la sollicitation parentale accrue et les cole
`res. Les
changements juge
´s positifs ne concernaient qu’un petit
nombre d’enfants. Une analyse sur e
´chantillons apparie
´sa
permis de mettre en e
´vidence une diffe
´rence significative dans
le sens d’une diminution des TCPO entre l’e
´valuation a
`
24 heures et a
`sept jours (Tab lea u 3). Une analyse logistique
multivarie
´eae
´te
´mene
´eafindede
´terminer l’impact de
diffe
´rentes variables explicatives sur les TCPO a
`24 heures et a
`
sept jours. Aucune des variables choisies n’est apparue
de
´terminante (Tablea u 4).
4. Discussion
L’objectif principal de ce travail e
´tait d’e
´valuer les TCPO
dans une population d’enfants subissant des gestes chirurgicaux
ORL en ambulatoire. Il s’agissait aussi d’e
´valuer la douleur
postope
´ratoire et de rechercher d’e
´ventuels facteurs influant sur
l’incidence des TCPO. L’incidence e
´leve
´e des TCPO contras-
tait avec un contro
ˆle satisfaisant de la douleur au domicile.
Nous avons mene
´une analyse multivarie
´e qui n’a pas pu mettre
en e
´vidence de facteur lie
´a
`une plus grande fre
´quence de
troubles comportementaux. De plus, dans notre e
´tude,
l’absence de standardisation du protocole anesthe
´sique et
Tableau 2
Scores douleur mesure
´sa
`l’aide de l’Objective Pain Scale (OPS).
Score OPS Effectif
total
(n= 64)
VG
(n= 28)
ATT
(n= 16)
VG-ATT
(n= 20)
Entre
´e SSPI 3 [0–6] 5 [2,25–7,75]* 0 [0–5,5] 2 [0–5,75]
Sortie SSPI 1 [0–2] 1 [0–2] 0 [0–2,5] 1 [0–2]
Sortie Ho
ˆpital 0 [0–1] 0 [0–1] 0 [0–1] 0 [0–0]
ATT : ae
´rateurs transtympaniques ; OPS : Objective Pain Scale ; SSPI : salle de
soin postinterventionnelle ; VG : ve
´ge
´tations ; VG-ATT : ae
´rateurs transtym-
paniques et ve
´ge
´tations ; * diffe
´rence significative ( p<0,05) entre les groupes.
Tableau 1
Version simplifie
´e du Post-Hospital Behavior Questionnaire.
Questions du Post-Hospital Behavior Questionnaire version 7 items
Est-ce que votre enfant cherche a
`ce que vous vous occupiez de lui ?
Est-ce que votre enfant a un tempe
´rament cole
´rique ?
Est-ce que votre enfant se re
´veille la nuit ?
Est-ce que votre enfant a des difficulte
´s pour manger ?
Est-ce que votre enfant vous a semble
´effraye
´?
Est-ce que votre enfant a fait des cauchemars ou des mauvais re
ˆves ?
Est-ce que votre enfant a besoin d’aide pour dormir ?
R. Amouroux et al. / Annales Franc¸aises d’Anesthe
´sie et de Re
´animation 28 (2009) 11–15 13
Author's personal copy
analge
´sique, ainsi que le faible nombre de sujets inclus limitent
les conclusions de ce type d’analyse statistique.
La version du PHBQ utilise
´eae
´te
´mise au point par
Kotiniemi et al. [6],a
`partir du questionnaire original de Vernon
en 27 items, sur une population d’enfants en hospitalisation
bre
`ve. Cette e
´quipe propose deux versions simplifie
´es
diffe
´rentes du PHBQ [7,8]. Il existe deux modes de recueil
du PHBQ : comparatif avec une seule cotation ou absolu avec
deux cotations a
`deux dates diffe
´rentes. La me
´thode de
passation comparative, qui a e
´te
´employe
´e ici, est conside
´re
´e
comme la plus sensible [9].
Les trois quarts des parents interroge
´sa
`j1, et 40,6 % des
parents a
`j7 signalent au moins un changement ne
´gatif du
comportement. Les changements les plus fre
´quemment cite
´s
sont la sollicitation parentale accrue et les cole
`res. Ils
correspondent aux cate
´gories « anxie
´te
´de se
´paration » et
« agressivite
´envers l’autorite
´» du questionnaire original de
Vernon. Les proble
`mes a
`l’endormissement sont e
´galement
fre
´quents. A
`l’exception des frayeurs et des cauchemars, ces
troubles diminuent de fac¸on marque
´e entre le premier et le
septie
`me jour postope
´ratoire. Cette fre
´quence importante est en
accord avec les donne
´es de la litte
´rature [2,10]. Dans notre
travail, la douleur des enfants subissant une ade
´noı
¨dectomie
seule e
´tait significativement plus importante que celle des
enfants qui subissaient une pose d’ae
´rateur transtympanique,
que celle-ci ait e
´te
´accompagne
´e ou non d’ade
´noı
¨dectomie.
Le lien entre la douleur postope
´ratoire et l’apparition
ulte
´rieure de TCPO reste controverse
´. Dans la se
´rie de
Kotiniemi, la douleur postope
´ratoire a
`j0 est pre
´dictive de
TCPO jusqu’a
`la quatrie
`me semaine [8]. Le lien est significatif
en cas de douleur se
´ve
`re a
`l’ho
ˆpital ou de persistance de la
douleur au domicile. En revanche, ni Kain et al. [2] ni Stargatt
et al. [10] ne mettent en e
´vidence de corre
´lation entre douleur et
troubles du comportement a
`deux semaines. Pour Tuomilehto
et al. [11], l’ade
´noı
¨dectomie en ho
ˆpital de jour, avec
administration syste
´matique de ke
´toprofe
`ne au domicile et
une information des parents sur la douleur occasionne une
incidence « ne
´gligeable » de troubles du comportement a
`une et
trois semaines. Les auteurs attribuent leurs re
´sultats a
`une
attitude active de pre
´vention de la douleur, qui inclut une
information sur la douleur et un soutien relationnel des parents.
Ils en concluent qu’il est possible de diminuer la fre
´quence des
troubles comportementaux postope
´ratoires. Malgre
´l’absence
de certitude sur un lien entre douleur et TCPO, du fait de ces
re
´sultats contradictoires, il est justifie
´de mieux prendre en
compte la douleur en SSPI.
On dispose actuellement de diffe
´rentes me
´thodes de
pre
´paration et de prise en charge psychologique des enfants
et des familles [12]. Kain et al. [13] ont montre
´leur efficacite
´
sur l’anxie
´te
´pre
´ope
´ratoire, mais pas au moment de l’induction,
ni dans la pre
´vention des troubles postope
´ratoires. Stargatt et al.
[10] rapportent un effet ne
´gatif sur l’apparition de TCPO de
Tableau 3
Changements comportementaux mesure
´s avec le Post-Hospital Behavior Questionnaire a
`24 heures et a
`sept jours apre
`s l’intervention.
Changements comportementaux
24 h apre
`s l’intervention (n= 64) 7 j apre
`s l’intervention (n= 64)
Comportement Moins qu’avant Plus qu’avant Moins qu’avant Plus qu’avant
Sollicitation 0 (0 %) 26 (40,6 %) 0 (0 %) 15 (23,4 %)*
Cole
`res 5 (7,8 %) 24 (37,5 %) 5 (7,8 %) 9 (14,1 %)**
Re
´veils nocturnes 1 (1,6 %) 13 (20,3 %) 6 (9,4 %) 8 (12,5 %)
Proble
`mes d’alimentation 2 (3,1 %) 13 (20,3 %) 4 (6,3 %) 6 (9,4 %)*
Frayeurs 1 (1,6 %) 6 (9,4 %) 2 (3,1 %) 3 (4,7 %)
Cauchemars 1 (1,6 %) 6 (9,4 %) 2 (3,1 %) 5 (7,8 %)
Proble
`mes d’endormissement 5 (7,8 %) 14 (21,9 %) 1 (1,6 %) 8 (12,5 %)
Au moins un TCPO – 48 (75 %) – 26 (40,6 %)**
*Diffe
´rence significative ( p<0,05) entre les groupes. ** Diffe
´rence significative ( p<0,001) entre les groupes.
Tableau 4
Analyse de re
´gression logistique des facteurs lie
´sa
`la pre
´sence de trouble comportementaux postope
´ratoires a
`24 heures et a
`sept jours.
Variables TCPO a
`24 heures TCPO a
`7 jours
Analyse univarie
´e Analyse multivarie
´e Analyse univarie
´e Analyse multivarie
´e
Rho de Spearman p Odds ratio IC95 % pRho de Spearman p Odds ratio IC95 % p
A
ˆge 0,21 0,09 1,07 0,82–1,40 0,60 0,1 0,45 0,83 0,63–1,09 0,18
ENS j1 0,18 0,18 0,88 0,63–1,22 0,44 0,3 0,02 0,75 0,55–1,03 0,07
OPS entre
´e SSPI 0,1 0,47 1,07 0,88–1,35 0,56 0,14 0,29 1,02 0,82–1,26 0,87
VG 0,24 0,15 0,44 0,08–2,31 0,32 0,09 0,44 0,44 0,10–1,87 0,26
ATT 0,22 0,17 3,37 0,35–32,30 0,29 0,18 0,88 1,59 0,19–13,43 0,67
Morphine 0,05 0,72 0,91 0,22–3,72 0,90 0,11 0,39 0,59 0,17–2,11 0,42
Parace
´tamol 0,12 0,36 3,87 0,55–27,41 0,17 0,15 0,24 6,37 0,83–48,86 0,07
ATT : ae
´rateurs transtympaniques ; ENS j1 : score douleur mesure
´avec l’e
´chelle nume
´rique simple une journe
´e apre
`s l’hospitalisation ; OPS entre
´e SSPI : score
douleur mesure
´par l’Objective Pain Scale a
`l’entre
´e en salle de soin postinterventionnelle ; TCPO : troubles comportementaux postope
´ratoire ; VG : ve
´ge
´tations ; VG-
ATT : ae
´rateurs transtympaniques et ve
´ge
´tations.
R. Amouroux et al. / Annales Franc¸aises d’Anesthe
´sie et de Re
´animation 28 (2009) 11–1514
Author's personal copy
deux des strate
´gies d’information les plus couramment
utilise
´es : une discussion pre
´alable avec un anesthe
´siste
(associe
´ea
`des changements ne
´gatifs a
`j3) et la lecture d’un
livret de pre
´paration a
`l’anesthe
´sie (associe
´a
`des changements
ne
´gatifs a
`j30 pour les interventions de courte dure
´e). Mais
contrairement a
`nous, l’e
´quipe de Stargatt a utilise
´un livret
conc¸u pour de grands enfants et fournissant une quantite
´
d’informations inadapte
´ea
`des enfants jeunes, bien que leur
travail porte sur des enfants a
ˆge
´s de trois a
`12 ans. Par ailleurs,
les modalite
´s de l’entretien avec l’anesthe
´siste diffe
`rent :
consultation syste
´matique plusieurs jours avant l’intervention
en France ; entretien le jour me
ˆme de l’intervention, n’incluant
pas toujours un e
´change avec l’enfant dans l’institution de
Stargatt. Ces re
´sultats n’excluent pas que la pre
´paration soit
utile a
`certains enfants [14], mais soulignent la ne
´cessite
´
d’adapter les modalite
´s de la pre
´paration a
`chaque cas
particulier (de
´lai par rapport a
`l’intervention, type de document,
termes employe
´s). Dans notre travail, tous les enfants ont
be
´ne
´ficie
´de la me
ˆme pre
´paration. On ne peut donc pas e
´valuer
l’influence de cette pre
´paration sur les TCPO ulte
´rieurs.
La pre
´me
´dication par le midazolam (0,5 mg/kg), syste
´ma-
tiquement utilise
´e dans notre travail, a montre
´son efficacite
´
dans la pre
´vention des TCPO [13]. Cela pourrait e
ˆtre une
conse
´quence de l’effet anxiolytique et de l’amne
´sie des
e
´ve
´nements stressants. Toutefois, cet effet pre
´ventif n’est
perceptible que durant la premie
`re semaine postope
´ratoire.
D’autres travaux sont ne
´cessaires afin d’e
´valuer l’efficacite
´
pre
´ventive de la pre
´me
´dication sur les TCPO et de re
´e
´valuer
l’opportunite
´de pre
´me
´diquer tous les enfants. Leurs re
´sultats
pourraient permettre de repe
´rer dans la phase pre
´ope
´ratoire les
enfants qui peuvent be
´ne
´ficier d’une pre
´me
´dication.
5. Conclusion
Nous avons montre
´que, dans une population d’enfants
subissant des ope
´rations ORL en chirurgie ambulatoire, les
scores de douleur sont globalement faibles. Ne
´anmoins, ils sont
significativement plus e
´leve
´s chez les enfants subissant une
ade
´noı
¨dectomie simple, que lorsque le geste est associe
´a
`une
pose d’ae
´rateurs transtympaniques.
Dans les trois groupes, les parents rapportent de fre
´quents
troubles du comportement, principalement une sollicitation
parentale accrue et des cole
`res, malgre
´une analge
´sie correcte.
Le recueil syste
´matique des troubles comportementaux post-
ope
´ratoires est re
´alisable gra
ˆce au PHBQ. L’utilisation plus
syste
´matique de cet outil donnerait une ide
´e plus comple
`te du
retentissement psychologique de ces interventions sur l’enfant.
Cela permettrait de mieux informer les parents qui, en
hospitalisation de jour, supportent l’essentiel des suites
ope
´ratoires, et de mettre en place des strate
´gies de pre
´vention
dans une perspective d’ame
´lioration de la qualite
´des soins.
Remerciements
Les auteurs tiennent a
`remercier les professeurs Isabelle
Murat et Ricardo Carbajal pour leurs pre
´cieux conseils.
Re
´fe
´rences
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´animation 28 (2009) 11–15 15
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L’Encéphale (2008) 34, 504—510
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PSYCHOPATHOLOGIE
Anxiété et dépression chez l’enfant et l’adolescent
migraineux: revue de la littérature
Anxiety and depression in children and adolescents
with migraine: A review of the literature
R. Amouroux∗, C. Rousseau-Salvador
Centre de la migraine de l’Enfant, hôpital d’enfants Armand-Trousseau, 26, avenue du Dr.-Arnold-Netter, 75571 Paris cedex 12,
France
Rec¸u le 23 mars 2007 ; accepté le 31 aoˆ
ut 2007
Disponible sur Internet le 26 décembre 2007
MOTS CLÉS
Migraine ;
Mal de tête ;
Enfant ;
Adolescent, Anxiété ;
Dépression
Résumé Il a été démontré qu’il existe chez l’adulte une forte association entre la migraine,
la dépression majeure et certains troubles anxieux. Chez les enfants et les adolescents, il n’y
a pas de revue de la littérature récente portant spécifiquement sur la migraine, l’anxiété et la
dépression. On a recherché pour ce travail les études publiées sur cette question depuis le début
des années 1980. Elles devaient préciser les critères diagnostiques de la migraine et utiliser un
questionnaire validé pour l’évaluation de l’anxiété ou de la dépression. Les onze articles rete-
nus ne permettent pas de conclure qu’il existe chez l’enfant une comorbidité entre migraine,
anxiété et dépression. La majorité des études conduites sur une population clinique trouve,
pour au moins un des questionnaires d’anxiété ou de dépression, des scores moyens légère-
ment supérieurs au groupe contrôle. Cependant, dans tous ces travaux, les enfants migraineux
n’ont pas de scores pathologiques puisque les scores aux échelles ne dépassent pas les seuils
cliniques des études de validation. Par ailleurs, aucune des trois études menées en population
générale ne corrobore les résultats obtenus en population clinique. Enfin, la seule étude qui a
combiné des évaluations dimensionnelles et catégorielles de l’anxiété et de la dépression, n’a
pas pu mettre en évidence de différence entre le groupe migraine et le groupe contrôle.
© L‘Encéphale, Paris, 2008.
KEYWORDS
Migraine;
Headache;
Child;
Summary
Introduction. — The authors review the literature on anxiety and depression in children
and adolescents who experience migraine headaches. For over a century, clinicians and
researchers have noticed potential links between migraine and certain psychopathological
traits. More recently, rigorous methodological studies have confirmed some of those links.
∗Auteur correspondant.
Adresse e-mail : remy.amouroux@trs.aphp.fr (R. Amouroux).
0013-7006/$ — see front matter © L‘Encéphale, Paris, 2008.
doi:10.1016/j.encep.2007.08.005
Author's personal copy
Anxiété et dépression chez l’enfant et l’adolescent migraineux : revue de la littérature 505
For example, several reviews have shown a strong comorbidity in adults between migraine,
major depression and certain anxiety disorders. As for children and adolescents, no recent
work has thoroughly reviewed the literature specifically on the topic of migraine, anxiety, and
depression.
Methods. — For the purposes of this study, research published between January 1980 and
January 2007 was examined. In order to be included in the review, studies had to specify
the diagnostic criteria used to indicate migraine headaches and also use validated measures for
anxiety and depression. Of the eleven remaining articles, ten used a control group matched for
age and sex. Only three of the studies used a representative sample of the general population.
Carrying out a meta-analysis was not possible due to the dearth of articles and the wide variety
of methodologies applied. The studies included in this review do not provide conclusive findings
for the comorbidity of migraine, anxiety and depression in children.
Results. — The majority of the studies with clinical populations show slightly higher scores
on at least one of the anxiety or depression scales in the migraine group as compared to the
control group. However, in all eleven studies, the average score on the anxiety and depression
scales obtained by children with migraine did not reach a pathological level, according to the
norms established by the validated scales. Findings point to above average levels of anxiety or
depression, rather than diagnosed psychopathologies. Therefore, certain authors use the term
‘‘sub-clinical.’’ One study of a clinical population, paired dimensional assessment with tests and
categorical assessment, using diagnostic interviews. In this particular study, children with highly
predictive anxiety or depression scores were interviewed by a psychiatrist or psychologist, in
order to confirm or deny a diagnosis. No categorical difference was found. Moreover, none of the
three studies carried out in the general population revealed differences between the anxiety
and depression scores in children with migraine as opposed to children in the control group. The
difference in results from studies in the general population and clinical populations can most
likely be explained by a recruitment bias. Studies conducted with clinical populations recruit
subjects from specialised medical consultations for children and adolescents with migraine,
who are probably not representative of the general population. These results contradict those
found in the adult population.
Discussion. — More studies are needed to better clarify the links between anxiety, depression,
and migraine in children, adolescents and adults. To ensure the validity of future studies, the
following remarks should be taken into account.
The distinction between headache and migraine is not always clear, even when ICHD criteria
are used. The children considered to have migraines often have a variety of diagnoses. Future
studies should only use the ICHD 2nd edition criteria.
Children suffering from migraine are almost always recruited from specialized headache centres
in hospitals. This is a very specific population and probably not representative of children with
migraine in the general population. In the future, researchers should do their best to avoid this
recruitment bias.
The questionnaires used in these studies often contain questions related to migraine symptoms
such as headache, nausea, vomiting, etc. Several authors have therefore questioned the validity
of results from these questionnaires with migraine patients.
Conclusion. — Questionnaires created specifically for a research project, or containing vague
terminology, such as ‘‘psychosocial disorders’’, should never be used. Future studies should
rely on assessment tools validated for the specific population.
Adolescent;
Anxiety;
Depression
© L‘Encéphale, Paris, 2008.
Introduction
La migraine chez l’enfant et l’adolescent est une patho-
logie méconnue et sous diagnostiquée [4]. C’est pourtant
la première cause de céphalée récurrente chez l’enfant
avec une prévalence de5à10%selon les études [1,2].En
1988, l’International Headache Society (IHS) a validé des
critères diagnostiques précis de la migraine qui ont été révi-
sés en 2004 (Cf.Tableau 1). La sémiologie migraineuse chez
l’enfant est proche de celle de l’adulte hormis la localisation
bilatérale des céphalées et la durée plus courte des crises.
La classification IHS distingue deux grands types de céphalée
primaire, la migraine et la céphalée de tension (CDT). Dans
30 à 40 % des cas, la crise de migraine est précédée par une
aura visuelle, auditive, sensitive et/ou motrice. En présence
de ce trouble neurologique focal et réversible, on parle de
migraine avec aura (MAA) par opposition à la migraine sans
aura (MSA).
Depuis plus d’un siècle, les cliniciens et les cher-
cheurs ont noté l’existence de possibles liens entre
la migraine et certaines caractéristiques psychologiques
comme la tendance à la dépression et à l’anxiété. Plus
récemment, des études d’une plus grande rigueur métho-
dologique ont confirmé certains de ces liens. Chez les
adultes migraineux, on a démontré une forte association
entre migraine/céphalées de tension et dépression/anxiété
[19,20]. Chez l’enfant, les trois revues de la littérature
Author's personal copy
506 R. Amouroux, C. Rousseau-Salvador
Tableau 1 Classification de l’International Headache Society (2004).
Migraine sans aura
A Au moins cinq crises répondant aux critères B, C et D
B Crise d’une durée de une à 48 heures
C Au moins deux des caractéristiques suivantes : uni ou bilatérale (chez l’enfant), pulsatile, modérée à
sévère, aggravée par l’activité physique
D Associée à au moins une des caractéristiques suivantes: nausée ou vomissement, photo ou phonophobie
E Symptômes non attribués à une autre affection
Migraine avec aura
A Au moins deux crises répondant aux critères B, C et D des migraines avec aura
B Au moins un des symptômes suivant à l’exclusion d’un déficit moteur :
troubles visuels bilatéraux, homonymes et totalement réversibles
paresthésie ou engourdissement unilatéraux totalement réversibles
aphasie ou difficultés de langage inclassable
C Au moins deux des caractères suivants :
troubles visuels homonymes et/ou symptômes sensitifs unilatéraux
l’aura se développe progressivement en cinq minutes ou plus
la durée de chaque symptôme est de cinq à 60 minutes
D Céphalée accompagnant l’aura répondant aux critères B,C et D des migraines sans aura
Céphalée de tension
A Au moins dix épisodes répondant aux critères B, C et D
B Céphalée d’une durée variant entre 30 minutes et 7 jours
C La céphalée présente au moins deux des caractéristiques suivantes :
Localisation bilatérale
Sensation de pression ou de serrement (non pulsatile)
Intensité légère ou modérée
Aucune aggravation par l’activité physique
D Absence des deux caractéristiques suivantes:
Nausée ou vomissement
Photophobie et phonophobie
E Symptômes non attribués à une autre affection
publiées dans ce domaine n’ont pas permis de conclure sur
cette question. Les travaux de Karwautz et al. et de Mar-
tin et al. ne portent pas spécifiquement sur anxiété et/ou
dépression, mais sur les troubles psychopathologiques en
général [10,14]. Les articles sélectionnés pour ces revues
de la littérature ne prennent pas toujours en compte les
critères I.H.S. En outre, elles comparent des études compor-
tant des questionnaires validés d’évaluation de la dépression
et de l’anxiété avec des études aux critères méthodolo-
giques moins précis où, bien souvent, le questionnaire a
été construit à l’occasion de cette recherche. Powers et
al. ont quant à eux effectué une sélection d’études rigou-
reuses méthodologiquement, portant sur l’anxiété et la
dépression avec les questionnaires ad hoc, mais chez des
enfants céphalalgiques [18]. Ces derniers n’étant pas néces-
sairement migraineux, il est donc difficile de suivre les
conclusions de ces auteurs.
Méthode
L’objectif de ce travail est de faire une revue de la littéra-
ture sur les troubles anxieux et dépressifs chez les enfants
et les adolescents migraineux. Nous avons repris la litté-
rature sur le sujet de janvier 1980 à janvier 2007 dans
les moteurs de recherches suivants : Pascal/INIST-CNRS,
PsychInfo et Medline. Les mots clés étaient : migraine,hea-
dache,anxiety,depression,child,adolescent. Les articles,
pour être retenus, devaient avoir été publiés en anglais,
allemand ou franc¸ais, porter sur la migraine chez l’enfant
et l’adolescent, préciser les critères diagnostiques de la
migraine et utiliser un questionnaire validé pour l’évaluation
dimensionnelle de la dépression ou de l’anxiété. Nous
avons choisi de sélectionner les articles utilisant le CBCL
qui un gold standard dans les pays anglo-saxons dans
l’évaluation des troubles psychopathologiques chez l’enfant
et l’adolescent, et ce bien que celui-ci n’ait pas d’échelle
qui distingue l’anxiété de la dépression.
Résultats
Compte tenu de nos critères de recherche, onze articles
portant sur les relations entre migraine, anxiété et dépres-
sion ont été retenus pour cette revue de la littérature. Ces
travaux portaient tous à la fois sur anxiété et dépression.
Le faible nombre d’études et la diversité des modalités
d’évaluation ont empêché la conduite d’une méta-analyse.
Le Tableau 2 résume les principales caractéristiques métho-
dologiques de ces études. Toutes précisent les critères
diagnostiques de la migraine et utilisent un ou plusieurs
questionnaires validés des domaines d’évaluation (dépres-
sion et anxiété). Parmi ces articles, dix ont un groupe
contrôle apparié en sexe et en âge. Seuls trois de ces tra-
Author's personal copy
Anxiété et dépression chez l’enfant et l’adolescent migraineux : revue de la littérature 507
Tableau 2 Caractéristiques méthodologiques des études sélectionnées.
Référence IHS Nombre de sujets Âge Échantillon Pays Échelles d’évaluation
Migraine CDT Autre Contrôle
Mazzone et al., 2006 Oui 67 47 — 36 6—16 Clin Italie CBCL, CDI, R-CMAS
Laurell et al., 2005 Oui 42 37 — 49 7—17 Pop Suède CBCL
Pakalnis et al., 2005 Oui 47 — — 30 6—17 Clin États-Unis ASI-4, CSI-4
Antilla et al., 2004 Oui 59 65 — 59 10—14 Pop Finlande CBCL, CDI
Just et al., 2003 Oui 103 25 — 83 6—18 Clin Allemagne CBCL, CDI
Smith et al., 2003 Oui 179 — 92 32 11—18 Clin États-Unis CDI, STAIC
Lanzi et al., 2001 Oui 41 16 — — 8—18 Clin Italie CDI, TAI
Kowal et al., 1990 Non 23 — — 23 9—12 Pop Australie CDRS, R-CMAS,
Andrasik et al., 1988 Non 32 — — 32 8—17 Clin États-Unis CDI, CDRS, BDI, STAIC, STAIX, PIC
Cooper et al., 1987 Non 39 — — 39 6—16 Clin Canada R-CMAS, STAIC, PIC
Cunningham et al., 1987 Non 20 — 20 20 9—17 Clin Canada CBCL, CDRS, STAIC
ASI-4 : Adolescent Symptom Inventory-4 ; CBCL : Children’s Behavior Check-List; CDI : Children’s Depression Inventory ; CDRS : Children’s Depression Rating Scale; Clin : clinique; CSI-4 :
Children Symptom Inventory-4 ; CDT : céphalée de tension ; DSRS : Depression Self Rating Scale ; IHS : International Headache Society ; PIC : Personality Inventory for Children ; Pop :
population générale ; R-CMAS : Revised Child Manifest Anxiety Scale; STAIC : State and Trait Anxiety Inventory for Children ; TAI : Test Anxiety Inventory.
vaux ont une population issue d’un échantillon représentatif
de la population générale. La majorité de ces travaux ont
été mené en Amérique du nord (N = 5) et en Europe (N =5).
Une étude a été conduite en Australie. Le Tableau 3 résume
les résultats de ces études.
La dépression chez l’enfant et l’adolescent
migraineux
Parmi ces études, trois sont des études contrôlées portant
sur des sujets issus de la population générale, sept sont des
études prospectives contrôlées en population clinique, et
une est prospective non contrôlée.
Les trois études contrôlées portant sur des sujets issus de
la population générale sont les suivantes : Anttila et al. ont
évalué avec le CDI et le CBCL 183 sujets issus d’une popula-
tion de 1135 enfants finnois âgés de dix à 14 ans [5], Kowal
et al. ont évalué avec le CDRS 46 sujets issus d’une popula-
tion de 2000 sujets de neuf à 12 ans [11], et Laurell et al.
ont évalué avec le C.B.C.L. 126 sujets issus d’une population
de 1371 enfants finnois âgés de sept à 17 ans [13]. Aucune
de ces trois études n’a trouvé de différence entre le groupe
d’enfants migraineux et le groupe d’enfants contrôles.
Parmi les sept études prospectives contrôlées en popu-
lation clinique, cinq trouvent des scores de dépression
supérieurs pour le groupe d’enfants migraineux avec au
moins un des questionnaires utilisés. Cooper et al. ont trouvé
des scores supérieurs à l’échelle de dépression du PIC-R chez
les enfants migraineux par rapport au groupe contrôle [6].
Andrasik et al. ont mis en évidence l’existence d’une dif-
férence significative en faveur du groupe migraine avec le
CDRS, le CDI et le PIC [3]. Trois autres études ont trouvé que
les enfants migraineux avaient un score supérieur à celui du
groupe contrôle pour le CBCL [7,9,15].
Par ailleurs, deux travaux parmi les sept études prospec-
tives contrôlées en population clinique ne trouvent pas de
différence entre le groupe migraine et le groupe contrôle
pour la dépression. C’est le cas de l’étude de Smith et al.
[21] qui évaluait les enfants avec le CDI et l’étude de Pakal-
nis [17] qui utilisait comme outils d’évaluation le CSI-4 et
l’ASI-4.
Enfin dans leur étude prospective non contrôlée, Lanzi et
al. ont mis en évidence l’existence de scores de dépression
supérieurs chez les céphalalgiques par rapport à la popula-
tion sur laquelle le C.D.I. a été validé en Italie [12].
L’anxiété chez l’enfant et l’adolescent migraineux
De même que pour la dépression, les trois études contrôlées
portant sur des sujets issus de la population générale n’ont
pas mis en évidence l’existence d’une différence pour le
score d’anxiété entre le groupe de sujets migraineux et le
groupe de sujets contrôles. Deux de ces études ont utilisé
l’échelle d’anxiété—dépression du CBCL [5,13], et une le
R-CMAS [11].
Parmi les sept études prospectives contrôlées portant
sur anxiété et migraine chez l’enfant et l’adolescent,
six trouvent une association significative. Dans l’étude
d’Andrasik et al., les enfants migraineux de plus de 13
ans avaient des scores supérieurs au STAIX par rapport aux
enfants du groupe contrôle [3]. Une autre étude a trouvé
Author's personal copy
508 R. Amouroux, C. Rousseau-Salvador
Tableau 3 La dépression et l’anxiété chez l’enfant et l’adolescent migraineux.
Références Questionnaires Comparaisons
Migraine/Contrôle CDT/Contrôle Migraine/CDT
Mazzone et al., 2006 CDI 9,75 ±6,47/7,8 ±1,14 (M>C,p<0,05)11±6,72/7,2 ±1,14 (CDT >C,p<0,05) 9,75 ±6,47/11 ±6,72 (N.S.)
R-CMAS 41,77±13,9/36 ±6,06 (M>C,p<0,05) 46,4 ±18,49/36 ±6,06 (CDT >C,p<0,05) N.C. (N.S.)
CBCL (anx-dép) N.C. N.C. N.C.
Laurell et al., 2005 CBCL (anx-dép) N.C. (N.S.) N.C. (N.S.) N.C (N.S.)
Pakalnis et al., 2005 CSI-4 et ASI-4 (dépression) 55,24±8,32/55,36 ±5,3 (N.S.)
CSI-4 et ASI-4 (anxiété) 59,24 ±9,44/54,36 ±6,64 (M>C,p<0,05)
Antilla et al., 2004 CDI 5,2 ±4,7/4,4 ±4,3 (N.S.) 4,8 ±3,9/4,4 ±4,3 (N.S.) 5,2±4,7/4,8 ±3,9 (N.S.)
CBCL (anx-dép) 2,5±2,8/1,7 ±2,1 (N.S.) 2,3 ±2,5/1,7 ±2,1 (N.S.) 2,5±2,8/2,3 ±2,5 (N.S.)
Just et al., 2003 CDI N.C. (N.S.) N.C. (N.S.) N.C. (N.S.)
CBCL (anx-dép) N.C. (M>C,p<0,001)
Smith et al., 2003 CDI 7,7 ±7,1/6,6±6,8 (N.S.) N.C. N.C.
STAIC 44,9 ±7,2/39,1 ±9,3 (M>C,p<0,05)
Lanzi et al., 2001 TAI N.C. (M>C,p<0,05)
CDI N.C. (M>C,p<0,05)
Kowal et al., 1990 CDRS 130,7 ±28,4/127,8 ±25,1 (N.S.)
R-CMAS 11,3±7,5/7,8 ±5,9 (P= 0,77 NS)
Andrasik et al., 1988 STAIX 39,1/30,2 (M>C,p<0,04)
STAIC N.C. (N.S.)
PIC (anxiété) N.C. (N.S.)
CDI 8,7/4,0 (M>C,p<0,007)
BDI 9,1/3,1 (M>C,p<0,017)
CDRS 20,7/17,1 (M>C,p<0,01)
PIC (dépression) 57,3/51,9 (M>C,p<0,01)
Cooper et al., 1987 PIC-R (dépression) N.C. (M>C,p<0,01) N.C. N.C.
R-CMAS 51,6±8,6/49,2 ±12,1 (N.S.)
STAIC-E 31,1 ±5/31,1 ±4,3 (N.S.)
STAIC-T 35,8 ±7,4/33,8 ±7,5 (N.S.)
Cunningham et al., 1987 CDRS (BSRS) N.C. (N.S.)
CBCL (dépression) 59,2/47,6 (M>C,p<0,05)
CBCL (anxiété) 61,9/57,2 (M>C,p<0,005)
STAIC N.C. (N.S.)
M : migraine; C: contrôle ; CDT: céphalée de tension; NC : non communiquée; NS: Non significatif.
Author's personal copy
Anxiété et dépression chez l’enfant et l’adolescent migraineux : revue de la littérature 509
que les enfants migraineux avaient des scores d’anxiété au
STAIC supérieurs à ceux des enfants présentant une fatigue
chronique et à ceux du groupe contrôle [21]. Pakalnis et al.
rapportent l’existence de scores d’anxiété (CSI-4 et l’ASI-4)
significativement supérieurs chez les enfants et adolescents
migraineux par rapport à des sujets contrôle [17]. Enfin, trois
études utilisant le CBCL ont trouvé que les enfants migrai-
neux avaient un score supérieur à celui du groupe contrôle
[7,9,15]. Une seule étude contrôlée en population clinique
ne trouve pas de différence de ce type [6].
Concernant l’étude prospective non contrôlée de Lanzi
et al., seuls les sujets de 15 à 18 ans avaient un score au TAI
supérieur à celui de la population sur laquelle le TAI a été
validé en Italie [12].
Discussion
Migraine anxiété et dépression
Aucune des trois études contrôlées menées en popula-
tion générale n’a pu déterminer de différences entre les
groupes pour l’anxiété comme pour la dépression. La majo-
rité des études conduites sur une population clinique trouve
des scores légèrement supérieurs pour le groupe migraine
par rapport au groupe contrôle, et ce pour au moins un
des scores d’anxiété et de dépression. Néanmoins, dans
toutes ces études, les enfants migraineux n’ont pas de
scores pathologiques, puisque les scores aux échelles ne
dépassent pas les seuils cliniques des études de valida-
tion. Il s’agit donc pour la majorité d’entre eux de niveaux
d’anxiété et dépression supérieurs à la norme, plutôt que
de troubles psychopathologiques avérés. Certains auteurs
parlent ainsi de «troubles subcliniques »[15]. Une seule
étude a couplé l’évaluation dimensionnelle effectuée avec
un questionnaire à une évaluation catégorielle consistant
en des entretiens diagnostiques [17]. Dans ce travail, les
enfants ayant des scores hautement prédictifs pour l’anxiété
et la dépression ont été évalués lors d’entretiens semi-
directifs par un psychiatre ou un psychologue afin de
confirmer le diagnostic. Aucune différence n’a pu être mise
en évidence au niveau catégoriel. Ainsi la contradiction
entre les résultats issus de la population générale et ceux
de la population clinique pourrait s’expliquer par un biais de
recrutement. Les études en population clinique recrutent
en effet leurs sujets au sein de «consultations céphalée »
spécialisées. On peut donc émettre l’hypothèse que la dif-
férence observée est liée au fait que les enfants fréquentant
ces consultations présenteraient des troubles suffisamment
invalidants pour venir consulter, ce qui ne serait pas le reflet
de la majorité des sujets migraineux.
L’association entre migraine et anxiété/dépression ne
semble pas aussi forte chez l’enfant que chez l’adulte.
Ces résultats contrastent en effet fortement avec ceux
obtenus chez l’adulte, où différentes revues de la littéra-
ture concluent à une comorbidité entre migraine, troubles
anxieux et dépression majeure [19,20]. Les chercheurs
ont proposé différentes hypothèses concernant les causes
sous-jacentes (biologiques et/ou psychosociales) de cette
comorbidité entre la migraine, la dépression et l’anxiété
chez l’adulte [19]. Certains ont ainsi développé l’idée que
la migraine avec anxiété/dépression pourrait être un syn-
drome distinct. Selon Merikangas et al., dans la majorité
des cas, des troubles anxieux dans l’enfance précèderaient
la migraine, puis la dépression suivrait la migraine à l’âge
adulte [16]. Waldie et al. ont quant à eux mené une étude
prospective où ils ont suivi une cohorte de 980 enfants pen-
dant 23 ans [22]. L’anxiété durant l’enfance, évaluée au
niveau dimensionnel et catégoriel, était un facteur de risque
de migraine à l’age adulte. Cette hypothèse offre l’avantage
de rendre en partie compte de l’évolution de la comorbi-
dité entre migraine et anxiété/dépression entre l’enfance
et l’âge adulte, mais elle demanderait à être étayée par de
nouvelles études.
Recommandations pour des futures études
Ce travail proposait une revue de la littérature concer-
nant migraine, anxiété et dépression dans la migraine de
l’enfant. Les études devaient préciser les critères diagnos-
tiques de la migraine et utiliser un questionnaire validé
pour l’évaluation de l’anxiété et/ou de la dépression. Onze
articles ont satisfait les critères d’inclusion retenus.
À l’issue de cette revue de la littérature, trois critères
nous semblent importants à retenir pour les futures études
sur la comorbidité entre migraine et troubles psychopa-
thologiques : la spécificité du diagnostic de migraine, la
représentativité de la population étudiée et la validité des
outils d’évaluation des troubles psychopathologiques.
Le diagnostic de la migraine pose problème dans de
nombreuses études citées. La distinction entre migraine et
céphalée de tension n’est pas toujours claire, même quand
les critères IHS sont utilisés. Le groupe de sujets migraineux
comprend ainsi souvent des enfants et adolescents porteurs
de diagnostics disparates. Les futures études devraient se
référer aux critères I.H.S. révisés de 2004.
Les enfants migraineux de ces études proviennent
presque toujours de consultations céphalée hospitalières.
Ils constituent une population particulière, probablement
peu représentative de l’enfant migraineux en population
générale. Les futures études devraient limiter autant que
possible les biais de recrutement.
Les questionnaires utilisés contiennent souvent des items
portant sur certains symptômes associés à la migraine
(céphalée, nausée, vomissement...). La question de la vali-
dité de ce type de questionnaire avec des enfants et
adolescents migraineux a été contestée par certains auteurs
[8]. Le recours à des questionnaires créés pour l’occasion ou
qui portent sur des notions floues, comme celle de troubles
psychosociaux, est à bannir. Les futures études devraient
utiliser des questionnaires spécifiques de l’évaluation du
trouble et validés pour la population étudiée. Enfin, il serait
souhaitable de coupler l’évaluation dimensionnelle à une
évaluation catégorielle pour déterminer si l’augmentation
éventuelle d’un score se traduit par un syndrome clinique
spécifique.
Conclusion
Les articles retenus ne permettent pas de conclure qu’il
existe chez l’enfant une comorbidité entre migraine,
anxiété et dépression. Les études en population générale
n’ont pas mis en évidence de différence. Tout au plus
Author's personal copy
510 R. Amouroux, C. Rousseau-Salvador
peut-on noter qu’une majorité de travaux en population
clinique portant sur des enfants migraineux trouve des
scores supérieurs, mais non pathologiques, pour l’anxiété
et la dépression par rapport à un groupe contrôle. Ces
résultats contrastent avec ceux obtenus dans les revues
de la littérature chez l’adulte où l’association entre
migraine, anxiété et dépression a été clairement établie.
D’autres études pourraient être menées afin de confirmer
et d’expliquer la contradiction entre les résultats chez
l’enfant et chez l’adulte. Ces études devraient se référer
aux critères diagnostiques IHS de la migraine, s’assurer de
la représentativité de la population étudiée, utiliser des
questionnaires validés et spécifiques pour l’évaluation de
l’anxiété et de la dépression et suivre les enfants de fac¸on
prospective.
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[1] Abu-Arefeh I, Russell G. Prevalence of headache and migraine
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[2] Al Jumah M, Awada A, Al Azzam S. Headache syndromes
amongst schoolchildren in Riyadh, Saudi Arabia. Headache
2002;42:281—6.
[3] Andrasik F, Kabela E, Quinn S, et al. Psychological functio-
ning of children who have recurrent migraine. Pain 1988;34:
43—52.
[4] Annequin D, Tourniaire B, Dumas C. La migraine pathologie
méconnue chez l’enfant. Arch Pediatr 2000;7:985—90.
[5] Anttila P, Sourander A, Metsahonkala L, et al. Psychiatric symp-
toms in children with primary headache. J Am Acad Child
Adolesc Psychiatry 2004;43:412—9.
[6] Cooper PJ, Bawden HN, Camfield PR, et al. Anxiety and life
events in childhood migraine. Pediatrics 1987;79:999—1004.
[7] Cunningham SJ, McGrath PJ, Ferguson HB, et al. Personality
and behavioural characteristics in pediatric migraine. Hea-
dache 1987;27:16—20.
[8] Harris ES, Canning RD, Kelleher KJ. A comparison of measures
of adjustment, symptoms, and impairment among children
with chronic medical conditions. J Am Acad Child Adolesc Psy-
chiatry 1996;35:1025—32.
[9] Just U, Oelkers R, Bender S, et al. Emotional and behavioural
problems in children and adolescents with primary headache.
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[10] Karwautz A, Wober C, Lang T, et al. Psychosocial factors
in children and adolescents with migraine and tension-type
headache: a controlled study and review of the literature.
Cephalalgia 1999;19:32—43.
[11] Kowal A, Pritchard D. Psychological characteristics of children
who suffer from headache: a research note. J Child Psychol
Psychiatry 1990;31:637—49.
[12] Lanzi G, Zambrino CA, Ferrari-Ginevra O, et al. Persona-
lity traits in childhood and adolescent headache. Cephalalgia
2001;21:53—60.
[13] Laurell K, Larsson B, Eeg-Olofsson O. Headache in school-
children: association with other pain, family history and
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[14] Martin SE, Smith MS. Psychosocial factors in recurrent pediatric
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[15] Mazzone L, Vitiello B, Incorpora G, et al. Behavioural and
temperamental characteristics of children and adolescents suf-
fering from primary headache. Cephalalgia 2006;26:194—201.
[16] Merikangas KR, Stevens DE. Comorbidity of migraine and psy-
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[17] Pakalnis A, Gibson J, Colvin A. Comorbidity of psychiatric
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[18] Powers SW, Gilman DK, Hershey AD. Headache and psycho-
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[19] Radat F, Swendsen J. Psychiatric comorbidity in migraine: a
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[20] Silberstein SD, Lipton RB, Breslau N. Migraine: association with
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[21] Smith MS, Martin-Herz SP, Womack WM, et al. Comparative
study of anxiety, depression, somatization, functional disabi-
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24
Gesnerus 61 (2004) 24–36
«Le précieux livre de W. Bölsche»
Freud et la culture évolutionniste allemande du début du XXesiècle*
Rémy Amouroux
Summary
Wilhelm Bölsche (1861–1939) is the author of a poetic history of the evolu-
tion of love entitled Das Liebesleben in der Natur (1898–1903). This work,
inspired by the writings of biologist Ernst Haeckel, was greatly successful
in Germany at the beginning of the 20th century. Freud kept a copy of the
three volumes in his London library and cites the text in his lectures on an
Introduction to psychoanalysis.
Bölsche develops an Entwicklungsgeschichte (history of evolution) of the
distinguishing sexuality of several types of love (oral, anal and urinary).
In addition, he describes the “zoological reactionary” homosexual and ties
this sexual behaviour to the history of the development of anal sexuality. This
paper will address an excerpt on this topic from Bölsche’s text that has been
translated for the occasion. The task at hand is to prepare the ground for
a study of German evolutionism, both popular and scientific, and its ties to
psychoanalysis.
*Le présent article est le prolongement de mon mémoire de DEA, «Freud, Lamarck et le
lamarckisme», soutenu à l’Ecole des Hautes Etudes en Sciences Sociales (Paris),en juin 2002
auprès de Mme Jacqueline Carroy et de M.Pietro Corsi.
Mes plus vifs remerciements à Jacqueline Carroy, Directrice d’études à l’Ecole des Hautes
Etudes en Sciences Sociales (Paris), mon directeur de thèse, ainsi qu’à Marielène Weber,
traductrice de l’allemand, qui a eu l’obligeance d’établir la traduction française définitive de
l’extrait présenté de Wilhelm Bölsche.
Rémy Amouroux, Hôpital Armand Trousseau, Service d’anesthésie, 26, avenue du Docteur
Arnold-Netter, F-75571 Paris cedex 12 (remy.amouroux@laposte.net).
25
Résumé
Wilhelm Bölsche (1861–1939), est l’auteur d’une histoire poétique de l’évo-
lution de l’amour: Das Liebesleben in der Natur (1898–1903). Ce texte,
singulier et lyrique, qui s’inspire des travaux du biologiste Ernst Haeckel,
connaîtra un vif succès au début du XXeen Allemagne. Freud, qui possédait
un exemplaire des trois volumes de ce texte dans sa bibliothèque de Londres,
le cite dans ses conférences d’Introduction à la psychanalyse. Bölsche, dans
ce texte, développe une Entwicklungsgeschichte (histoire de l’évolution) de
la sexualité qui distingue plusieurs formes d’amour (oral, anal et urinaire).
Il qualifie, en outre, l’homosexuel de «réactionnaire zoologique», et lie ce
comportement sexuel à l’histoire du développement de la sexualité anale.
Nous commenterons,à ce sujet,un extrait de ce texte,traduit pour l’occasion.
L’enjeu sera de poser les jalons d’une étude de l’évolutionnisme allemand,
tant populaire que scientifique, et de ses liens avec la psychanalyse.
A partir de 1885, date à laquelle il fut nommé Privatdozent,Freud fit des cours
à l’université de Vienne. Il ne rédigea aucun de ces cours,à l’exception de la
série donnée durant les semestres d’hiver de 1915/16 et de 1916/17. Cette
trentaine de cours fut publiée presque aussitôt sous le titre Vorlesungen
zur Einführung in die Psychoanalyse (Conférences d’introduction à la
psychanalyse)1. Dans cette présentation de la psychanalyse, qui s’adressait
à des auditeurs venant de toutes les facultés, Freud aborde la question du
moi et de son développement en la mettant en parallèle avec ce qu’il appelle
la libido et le développement de celle-ci:
Tous deux sont au fond des legs,des répétitions abrégées de l’évolution que l’humanité dans
son ensemble a parcourue depuis la nuit des temps.Pour ce qui est du développement de la
libido,il me semble qu’on voit tout de suite cette origine phylogénétique. Rappelez-vous,dans
telle classe d’animaux l’appareil génital a des rapports très étroits avec la bouche, dans telle
autre il est inséparable de l’appareil d’excrétion, et dans telle autre encore il est rattaché aux
organes de la locomotion. Vous trouverez cela, décrit de façon attrayante, dans le précieux
livre de W. Bölsche.2
Cette référence prouve la réelle popularité, à l’époque, du livre phare du
polygraphe allemand Wilhelm Bölsche: une grande «histoire de l’évolution
de l’amour» en trois volumes, Das Liebesleben in der Natur. Eine Entwick-
lungsgeschichte der Liebe3,dont la publication s’échelonna de 1898 à 1903.
1 Freud 1922.
2 Freud 1922, 334.
3 Bölsche, 1898–1903.
26
Un auteur populaire du tournant du siècle
Né à Cologne en 1861, dans une famille bourgeoise et intellectuelle, Wilhelm
Bölsche est éduqué dans le libéralisme protestant. Son père, Karl Bölsche,
rédacteur en chef du journal de Cologne,Kölnische Zeitung,avait commencé
par faire des études de théologie mais renonça à la carrière pastorale.Il s’était
rangé du côté des partisans du théologien David Friedrich Strauss, auteur
d’une histoire de la vie de Jésus, publiée en 1835, qui soumet les évangiles à
la critique historique.
Après un parcours scolaire médiocre, il quitte l’école sans même obtenir
l’équivalent allemand du baccalauréat, l’Abitur.Il entame alors un voyage à
travers l’Europe,et va suivre des cours de philosophie et d’histoire de l’art à
Bonn et à Paris.Par la suite,il s’établit à Berlin, où il rencontre le romancier,
philosophe et théologien libéral Bruno Wille. Bölsche va mêler sa passion
pour la littérature et la poésie avec celle qu’il voue aux sciences naturelles.
Ainsi tente-t-il de tirer des sciences naturelles une méthode applicable au
domaine esthétique dans son livre, «Les sciences naturelles, fondement de
la poésie: prolégomènes à une esthétique réaliste»4publié en 1887.Les deux
volumes de son «Histoire du développement de la nature», Entwicklungs-
geschichte der Natur5,publiés en 1894 et en 1896, attirèrent sur lui l’attention
du public. L’écrivain est contacté par le futur éditeur à succès de Leipzig,
Eugen Diederichs (1867–1930). Ce dernier recherche des auteurs pour sa
nouvelle maison d’édition, qui entend promouvoir des ouvrages qui mêlent
poésie et science. De 1898 à 1903, Bölsche publie chez Diederichs les trois
volumes de Das Liebesleben in der Natur.Eine Entwicklungsgeschichte der
Liebe, dont le succès est tel, 80 000 exemplaires en 1927, que l’ouvrage est
réédité quatre fois en l’espace de dix ans. Parallèlement, Bölsche collabore
activement à la revue à grand tirage, Kosmos.Tout au long de sa vie, il accu-
mule les ouvrages: des essais – par exemple «Nature et art»,Natur und Kunst,
en deux volumes publiés à Leipzig en 1921–1923, et, «Les conversations sur
les sciences naturelles et la culture: Meurs et deviens», Stirb und Werde.
Naturwissenschaftliche und kulturelle Plaudereien, publié à Jena en 1921 –,
mais aussi des romans, par exemple le roman historique, Paulus. Roman
aus der Zeit Kaiser Marcus Aurelius (Paul,un roman de l’époque de l’empe-
reur Marc Aurèle), publié en 1885; le roman humoristique, Der Zauber
des Königs Arpus (L’envoûtement du roi Arpus), publié deux après, et
constamment réédité durant les décennies suivantes; le roman autobio-
4 Bölsche 1887.
5 Bölsche, 1894–1896.
27
graphique,Die Mittagsgöttin (La déesse de midi),publié en 1910. Il entretient
enfin une importante correspondance avec de nombreuses personnalités
littéraires et scientifiques,dont le biologiste Ernst Haeckel et la romancière
et psychanalyste Lou Andreas-Salomé.Wilhelm Bölsche meurt en 1939.
Dans son ouvrage The Descent of Darwin6, qui traite de la vulgarisation
du darwinisme en Allemagne entre 1860 et 1914, l’historien des sciences
américain Alfred Kelly soutient que Bölsche a été oublié de l’histoire de la
diffusion des théories évolutionnistes, alors que, selon lui, «Bölsche fut pro-
bablement de tous les auteurs d’ouvrages de langue allemande qui n’étaient
pas des fictions, le plus vendu avant 1933»7. Kelly affirme même qu’il était
le vulgarisateur scientifique par excellence pour ses contemporains, et ce,
devant Haeckel.Ainsi, La descendance de l’homme de Bölsche, publiée tout
d’abord en feuilleton dans la revue à grand tirage Kosmos, sera ensuite
diffusée en librairie sous forme d’ouvrage, qui s’arracha à plus de 100 000
exemplaires8. Mais Bölsche, comme nous le verrons, c’est aussi un style sin-
gulier: dès 1907,le critique viennois Egon Friedell qualifiait de «Bölschiade»
ce type de vulgarisation scientifique aux accents étonnamment lyriques9.
Enfin, Ellenberger,dans son célèbre ouvrage, nous donne une interprétation
intéressante de ce type de littérature:
Contrairement à la légende assez répandue de nos jours qui voudrait nous faire croire que
cette époque [celle de Freud] se caractérisait par un obscurantisme sexuel, il n’existait alors,
du moins sur le continent européen, aucune entrave à la publication, à la diffusion et à la
lecture de ces ouvrages; c’est à cette époque qu’apparurent un peu partout des ouvrages
populaires sur la sexualité. En Allemagne,par exemple, un livre de Bölsche,la vie amoureuse
dans la nature, […] fut un succès de librairie.10
Le roman de l’évolution selon Wilhelm Bölsche
Das Liebesleben in der Natur propose une histoire de l’amour qui est celle
de l’évolution de l’organisation sexuelle de l’ensemble des êtres vivants.
L’ouvrage peint, par conséquent, comme l’indique Freud, l’évolution de la
reproduction sexuelle depuis les organismes les plus primitifs jusqu’à
l’homme, avec en filigrane la loi biogénétique de Haeckel, selon laquelle
«l’ontogenèse récapitule la phylogenèse», c’est-à-dire que l’évolution de
l’individu serait en quelque sorte la succession des périodes vécues par ses
6 Kelly 1981.
7 Kelly 1981, 37.
8 Daum 1997.
9 Fellman 1988.
10 Ellenberger 1994, 323.
28
ancêtres11. Les pages présentées ci-dessous sont extraites du chapitre intitulé
«La porte de l’amour» (Die Liebespforte). Nous les avons choisies parce
qu’elles sont caractéristiques de «la description attrayante» des rapports
possibles de l’appareil génital avec d’autres organes, dont Freud créditait
Bölsche.Ce dernier y retrace, en effet,une histoire phylogénétique de l’ana-
tomie sexuelle, où il distingue plusieurs stades, ou phases anatomiques,
corrélatives de certaines formes d’amour ou de sexualité.
Une histoire des orifices corporels
Tu te souviens que plus haut nous est apparue fugitivement la possibilité d’un amour anal,
d’un vrai amour passant par l’orifice anal.
Lorsque les matières sexuelles se détachaient encore de la paroi stomacale et que l’estomac
fut ensuite devenu un tube qui comportait une ouverture antérieure et une ouverture
postérieure, l’anus pouvait naturellement être utilisé,tout comme la bouche,pour l’évacua-
tion du sperme et des ovules. Mais, comme tu le sais, cet amour stomacal cesse très tôt de
jouer le moindre rôle dans ton ascendance, car les organes génitaux s’installent dans la cavité
abdominale et utilisent toujours le rein comme voie des sortie.Cela commence déjà chez les
vers et s’étend au règne de tes ancêtres directs, celui des animaux vertébrés. Cependant, au
cours de ce mouvement ascendant, tu vois également se manifester une tendance qui, du
moins après coup, crée de nouveau un lien entre le canal intestinal et l’amour.
Cela commence par un tour de force de celui qui occupe le degré le plus bas dans la hiérar-
chie des vertébrés,le fameux amphioxus qui se trouve encore à la frontière entre le ver et le
poisson. Chez lui, reins et matières sexuelles débouchent déjà bel et bien dans une cavité
unique, qui, bien qu’elle ait encore d’autres fonctions, peut aussi être qualifiée de canal
urinaire. Ce canal commun, cependant, ouvre par des fentes sur la partie antérieure des
intestins, et en passant à travers celles-ci, les ovules de la femelle,de même que les sperma-
tozoïdes du mâle, finissent par sortir joyeusement de la vraie bouche de l’amphioxus. Si cet
état des choses avait continué à s’implanter, cet amour urinaire aurait fini par redevenir
malgré tout un amour oral, et tu devrais aujourd’hui faire transiter par le gosier,outre l’air
et la nourriture, l’urine, le sperme et les enfants. Mais les multiples raisons qui étaient en
défaveur de tout amour oral, étaient visiblement encore deux fois plus fortes après que,de
surcroît, l’amour et l’urine furent réunis.Voilà pourquoi monsieur Amphioxus est le premier
et le dernier vertébré qui aime avec la bouche. […]
Chez un grand nombre de poissons, les ovules, le sperme, l’urine et les excréments solides
s’écoulent tous ensemble par un seul et unique orifice. C’est en particulier le cas chez tes
ancêtres plus directs, les requins. L’amphibien, c’est-à-dire la grenouille et le triton, ne
connaissent plus rien d’autre.Tous les canaux du corps, qui sont orientés vers l’arrière,conver-
gent en un point unique: le gros rectum.[…]
Si tu voulais trouver une appellation pour ce nouvel état des choses, il te faudrait en créer
une qui engloberait l’amour urinaire et l’amour anal. Le naturaliste te propose un terme,
même s’il n’est pas très bon. Il appelle une telle réunion du méat urinaire et de l’anus, chaque
fois qu’il la rencontre chez des animaux, tout simplement «cloaque».Et nous en serions donc
arrivés à l’amour cloacal. Les animaux appartenant à ce stade, qui, à la manière des coré-
gones,s’aiment en rapprochant le plus possible leurs orifices d’évacuation du sperme et des
ovules,du fait de cet état des choses devaient, dans l’acte d’amour,tout simplement tourner
leurs «cloaques» l’un vers l’autre.
11 Pour plus de précision sur la loi biogénétique de Ernst Haeckel, cf. Mengal 1993. Sur la
question de l’importance de Ernst Haeckel et de sa loi en psychanalyse, cf. Ritvo 1992 et
Sulloway 1992.
29
Depuis le triton, cet amour cloacal a effectivement joué un rôle décisif pendant longtemps
encore. Tous les reptiles l’ont hérité de lui, les lézards, les serpents, les crocodiles et les
tortues, et en tout cas aussi tous les monstres reptiles disparus, les ichtyosaures, les chiro-
ptères, les terribles dragons, etc. Quant à l’oiseau, ce n’est rien d’autre qu’un lézard volant
très développé, à sang chaud et recouvert de plumes. C’est pourquoi, invariablement, tu
trouves développé, chez la poule et chez l’autruche,chez l’aigle et chez le rossignol, comme
chez les milliers d’autres êtres ailés des champs, de la forêt, de la mer et des airs, un vrai
cloaque – l’œuf solide et la semence liquide, l’excrément de l’intestin et l’urine des reins
(chez eux, semblable à de la bouillie) sortant toujours par la même grande porte postérieure
du corps.
Et ce n’est que chez le mammifère que, par la suite, se produit de nouveau un grand arrêt.
Car si grand qu’ait été le triomphe de la parcimonie qui avait réussi à fondre tous les orifices
en un seul, il a été impossible de s’y tenir jusque dans le degré le plus élevé de l’évolution.
Encore aujourd’hui vit en Australie, un animal, l’ornithorynque, qui incarne le changement
qui mène au sommet radieux de toute la nature animée de la terre. L’ornithorynque pond
encore des œufs,à peu près comme le fait un oiseau, ou plutôt un lézard.De plus,l’ornitho-
rynque a vraiment encore un cloaque, et il est le seul des mammifères à en avoir un.Car c’est
sans aucun doute déjà un mammifère puisqu’il nourrit ses petits avec du lait. Mais il a tout
de même encore un cloaque. […]
Puis vient le marsupial – la sarigue et le kangourou –, et c’est la fin du cloaque.Tout à coup,
il y a de nouveau un solide verrou, une cloison, entre l’ouverture urinaire et sexuelle et
l’ouverture anale.A partir de ce moment-là, il y a tout de même de nouveau deux orifices.
Et cela reste ainsi jusqu’à toi, qui l’as finalement hérité des singes. L’amour cloacal, tu ne le
connais plus, sauf dans le cas d’un acte violent particulièrement malheureux, c’est-à-dire si,
au moment de l’accouchement, la paroi située vers l’anus se déchire, mais ce n’est plus
quelque chose de normal; c’est un cas pathologique isolé.
En tous cas, il serait totalement inutile d’essayer de faire passer de nouveau la procréation
par l’anus. Depuis l’ornithorynque, aucun spermatozoïde de mammifère n’est plus jamais
arrivé par l’extrémité postérieure de l’intestin jusqu’à une ovule.Tout au plus peut-on voir
dans l’acte pédérastique une caricature d’essai externe.
Le pédéraste, en recherchant la voie intestinale comme voie sexuelle, régresse dans une
certaine mesure jusqu’à l’ornithorynque, sauf que ce qui était conforme à la nature chez ce
dernier et en possédait le sens plein et sacré se transforme en absurdité dans son cas. Il est
vrai que la tentative simultanée de constituer un individu aimant composé de deux hommes
est une régression encore plus grande. Elle fait redescendre jusqu’à ces vers et ces poissons
hermaphrodites, chez qui chaque moitié sexuée était encore à la fois mâle et femelle, c’est-
à-dire qu’un organe mâle pouvait féconder dans un corps qui possédait lui-même des organes
mâles.
Du reste, les racines tenaces de la pédérastie, qui se manifeste tout au long du laborieux
progrès de l’humanité, sont très enchevêtrées, allant bien au-delà de ces réminiscences, et
seul un observateur très superficiel prétendra se débarrasser de la question en invoquant une
seule résonance. Si sur un navire isolé en mer, le marin,privé de toute compagnie féminine,
a recours à la pédérastie, la racine est incontestablement différente: l’acte de pédérastie
n’est qu’une variante de l’onanisme, un pis-aller vu le manque de femmes. Et il est hors
de doute que depuis les temps les plus reculés c’est une des situations qui en toute logique
n’a cessé de l’engendrer. Mais si tu trouves des motifs pédérastiques dans l’art le plus élevé,
dans le monde des idées imprégné d’art de la Grèce antique, dans l’idéal incarné par Anti-
noüs, dans la poésie orientale, et encore et toujours à la Renaissance et dans les Temps
modernes, cela te mènera à une racine d’une toute autre nature. La pédérastie, dans ce
cas, a son origine dans un acte en lui-même parfaitement moral: c’est d’abord de l’amour à
distance. L’œil prend plaisir à la beauté du corps masculin, comme à celle du corps féminin,
et cette beauté lui fait goûter la sensualité supérieure, spiritualisée, de l’amour à distance.
Mais,par la suite, les motifs de cet amour à distance se brouillent: il devient un essai d’amour-
fusion, ce qui signifie tomber du sublime dans une situation, dont la punition la plus dure
consiste incontestablement dans le ridicule.On peut encore mettre en évidence d’autres voies
qui mènent à la pédérastie. En tous cas, ce qui est intéressant, y compris par rapport à
l’amphioxus et à l’ornithorynque, c’est le «réactionnaire zoologique»,qu’il y a dans le pédé-
30
raste comme dans celui qui se masturbe. Quant au caractère tragi-comique qui est le sien,
c’est un trait commun à tous les réactionnaires.12
Ce texte peut sembler fort étrange pour un lecteur du début du XXIesiècle.
Comme nous l’avons déjà signalé, Bölsche, loin d’être marginal, constitue
l’auteur vulgarisateur phare du début du XXesiècle en Allemagne. A ce titre,
la récente publication de la correspondance entre Bölsche et Haeckel par
Rosemarie Nöthlich, nous permet de rapporter les propos de Haeckel au
sujet de Das Liebesleben in der Natur:
Je dois vous adresser mes sincères remerciements pour votre livre esthético-biologique sur
l’amour dans la nature.Je l’ai lu aussitôt, d’un bout à l’autre,avec le plus grand intérêt, puisque
j’avais moi-même le projet, depuis plusieurs années, d’écrire quelque chose de semblable.
Vous l’avez fait d’une bien meilleure façon que je n’aurais pu le faire, en particulier au sujet
de la forme légère et élégamment artistique.13
Parmi les particularités stylistiques de l’«Histoire de l’évolution de l’amour»,
il est intéressant de relever que Bölsche tutoie son lecteur, et propose un ton
à la fois familier et emphatique.L’histoire de l’évolution devient un récit, qui
prend par moments l’allure d’un conte aux rebondissements divers, et des
expressions imagées,parfois cocasses,animent les descriptions.La «porte de
l’amour» et toutes les autres «portes» du corps sont personnifiées et se voient
attribuer, l’anus comme la bouche, des sentiments, ou quelque volonté
secrète, que seule la Nature connaît. Le monde humain est totalement inté-
gré au monde naturel: «l’acte pédérastique», est comparé à la sexualité
de l’ornithorynque, comme à celle d’un animal marin primitif, l’amphioxus.
De même, les références à l’art antique, à l’idéal incarné par Antinoüs croi-
sent celles au cloaque primitif des reptiliens.
Comme Freud, Bölsche, qui emploie les mêmes termes que celui-ci, pour
les diverses formes d’amour ou de sexualité (oral, anal et urinaire ou uro-
génital), lie l’homosexualité avec un retour à l’amour anal.La diversification
des orifices corporels (bouche,cloaque,anus et appareil uro-génital) est pré-
sentée comme corrélative de différentes formes de sexualité: l’amour oral
(Mundliebe), dont le principal représentant serait l’amphioxus, chez qui la
bouche joue un rôle primordial dans la reproduction; l’amour anal (After-
liebe) où l’ornithorynque s’illustre par son anatomie qualifiée de «réaction-
naire»; l’amour urinaire (Urinliebe), qui apparaît avec les marsupiaux et que
l’on retrouve chez tous les mammifères jusqu’à l’homme.
Bölsche compare le comportement homosexuel humain aux pratiques
sexuelles et à l’anatomie de l’ornithorynque. Il considère ce mammifère
comme un «réactionnaire zoologique». L’expression est tout à fait intéres-
12 Bölsche 1898–1903, 255–261.
13 Nöthlich 2002, 85.
31
sante. Rappelons que l’ornithorynque constitue un animal particulier pour
les zoologues.Sa découverte arriva comme un défi. Dès 1802,l’année même
de sa description anatomique détaillée par un certain Sir Everard Home, il
est inclus dans la classe des mammifères, dans laquelle un nouvel ordre est
créé, désigné sous le nom de monotrème. Ce terme, qui signifie «un seul
orifice», fait allusion à la présence d’un cloaque, alors qu’anus et orifice
génito-urinaire sont séparés dans les autres ordres de mammifères. Bölsche
semble donc voir chez l’ornithorynque une sorte de tentative de retour à une
phase antérieure de l’évolution des animaux. Ce dernier possède, en effet, un
cloaque, ce qui est pourtant une caractéristique des reptiliens.
De la théorie des stades à la fantaisie phylogénétique:
Freud lecteur de Bölsche?
Nous l’avons dit, Freud ne cite Bölsche qu’une seule fois dans son œuvre
scientifique. Dès lors, on peut se demander quelle serait la légitimité de
l’hypothèse qui ferait de Freud un lecteur de Bölsche? Sur cette question
précise nous avons plusieurs éléments de réponse. Bölsche est certes, pour
ses contemporains, un vulgarisateur de renom, mais reste à connaître et à
préciser sa réception dans les milieux psychiatriques et psychanalytiques.
Quelle a pu être la place de Bölsche parmi les sexologues? Il semblerait que
ni le psychiatre Richard von Krafft-Ebing, ni le neurologue Albert Moll ne
l’aient jamais cité. Le caractère vulgarisateur et non académique de Bölsche
pourrait expliquer cela, comme l’illustre cette remarque du psychiatre et
entomologiste suisse Auguste Forel:
Un auteur allemand, ed. Bölsche (Das Liebesleben in der Natur. La vie de l’amour dans la
nature), a décrit dernièrement l’amour dans les êtres organisés, sans oublier l’homme, sur un
ton de plaisanterie forcé qui gâte les connaissances approfondies de l’auteur sur les sujets
zoologiques et autres qu’il traite.14
On retrouve peu de références à Bölsche dans les textes de psychanalystes
avant l’allusion de Freud en 1917 à Das Liebesleben in der Natur dans les
conférences d’Introduction à la psychanalyse. Cependant,en 1908 lors d’une
des réunions du mercredi des premiers analystes à Vienne, l’écrivain et
philosophe Wittels, qui prendra en 1910 la voie de la dissidence, fait une
conférence où les idées de Bölsche seront évoquées15. Mais c’est chez Sandor
Ferenczi que l’on trouve les références les plus nombreuses à Bölsche. On
peut citer en particulier son Thalassa, dont le thème, la version psychana-
14 Forel 1906, 598.
15 Federn/Nünberg 1978, 360–367.
32
lytique des origines de la vie sexuelle, n’est pas sans rappeler notre propos.
Au sujet du rapport en ontogenèse et phylogenèse, il y écrit:
Des idées semblables à celles que nous venons d’exprimer nous en retrouvons – sous forme
de comparaisons et d’images poétiques – dans les écrits pleins d’imagination et d’esprit
de Bölsche, auteur populaire bien connu qui n’est pourtant pas encore apprécié à sa juste
valeur comme penseur original.16
Enfin, Freud possédait, dans sa bibliothèque de Londres, un exemplaire
de l’édition princeps du deuxième et du troisième volume (1900 et 1903) de
Das Liebesleben in der Natur, ainsi qu’un exemplaire portant la mention
«Freud 22. XI. 09» de l’édition de 1909 du premier volume17.
Nous allons maintenant essayer de cerner les éléments qui permettent de
créditer la thèse d’une certaine forme de réappropriation freudienne des
«Entwicklungsgeschichten» (histoires de l’évolution) à la Bölsche. Rappelons
qu’il ne s’agit ici en aucun cas de faire de Bölsche un précurseur de Freud,
mais plutôt de souligner l’importance de la référence évolutionniste dans
certains textes psychanalytiques. Nous nous appuierons sur deux textes qui
possèdent un statut différent dans le corpus psychanalytique: un texte fon-
dateur avec les Trois essais sur la théorie sexuelle (1905)18, et un texte plus
controversé, la Vue d’ensemble sur les névroses de transfert (1915)19.
Parmi les écrits de Freud, Trois essais sur la théorie sexuelle reste un écrit
fondamental et incontournable pour les psychanalystes. Je m’attacherai ici
surtout à la troisième édition, celle de 1915.C’est en effet à cette époque que
Freud émet l’idée d’une organisation prégénitale de la libido, et introduit les
expressions «organisation sexuelle orale» et «organisation sexuelle anale».
La notion d’érotisme anal apparaît dès 1908 dans un article intitulé,
«Caractère et érotisme anal»20. Freud y met en relation des traits de carac-
tère de l’adulte et l’érotisme anal de l’enfant. Il faut, cependant, attendre
l’article de 1913, «La disposition à la névrose obsessionnelle»21, pour que soit
formulée clairement la thèse de l’existence d’une organisation prégénitale
dominée par l’érotisme anal. En 1915, dans la troisième édition des Trois
essais, Freud l’intègre au chapitre qui porte sur les «phases de développement
de l’organisation sexuelle». Il y distingue explicitement le stade oral et le
stade anal. Par la suite, dans l’édition de 1924 des Trois essais, Freud adop-
tera la subdivision, proposée par Karl Abraham, de ces deux stades prégéni-
taux, en une phase précoce et une phase tardive. Enfin Freud introduira un
16 Ferenczi 1924, 98f.
17 Sulloway 1992, 247–250.
18 Freud 1997a.
19 Freud 1986.
20 Freud 1997b.
21 Freud 1997c.
33
dernier stade, le stade phallique ou génital, qui domine dans la sexualité
adulte.
Freud, dans le chapitre en question, note que ces phases «évoquent un
retour à des états primitifs de la vie animale»22. A la même époque, Freud
rédige en vue de la publication une observation clinique,L’homme aux loups.
Il y reprend l’idée que les phases du développement de l’organisation
sexuelle trouvent leur origine dans l’histoire du développement des espèces.
«On ne peut s’empêcher», écrit-il, «de faire ici des parallèles biologiques et
d’édifier l’hypothèse d’après laquelle les organisations prégénitales de
l’homme seraient les vestiges de conditions qui, dans certains classes d’ani-
maux, ont été conservées de façon permanente»23.Le premier des Trois essais
sur la théorie sexuelle s’intitule «Les aberrations sexuelles». La conception de
l’homosexualité qui y est exposée fait écho à celle de Bölsche.Dans une note
bas de page de l’édition de 1915, Freud précise son point de vue sur les liens
entre analité et homosexualité:
Dans le cas des types inversés,on constate en permanence la prédominance de constitutions
archaïques et de mécanismes psychiques primitifs.La valeur accordée aux objets narcissiques
et le maintien de la signification érotique de la zone anale paraissent en constituer les carac-
tères les plus essentiels.24
Cette fixation ou régression anale fait l’objet de développements en 1913
dans «La disposition à la névrose obsessionnelle», où Freud écrit:
Le courant passif est alimenté par l’érotisme anal, dont la zone érogène correspond à l’ancien
cloaque indifférencié. L’accentuation de cet érotisme anal au stade de l’organisation pré-
génitale déposera chez l’homme quand le stade suivant de la fonction sexuelle, celui des
organes génitaux, sera atteint,une importante prédisposition à l’homosexualité.25
Freud, d’autre part, étend l’influence de ces restes historiques au-delà du
comportement strictement sexuel:
Pour certains traits de caractère, il a même été possible d’établir un lien avec des compo-
santes érogènes déterminées.Ainsi, l’entêtement, l’économie, le goût de l’ordre, découlent-
ils de l’utilisation de l’érotisme anal. L’orgueil est déterminé par une forte disposition à
l’érotisme urinaire.26
Enfin à propos des théories de la naissance échafaudées par les enfants,
qui supposent que les bébés viennent au monde de la même manière que
l’on évacue les selles, il note que «ces théories enfantines rappellent cer-
taines dispositions du règne animal, en particulier le cloaque des espèces
inférieures aux mammifères»27. Il semble donc que Freud voie dans les dif-
22 Freud 1997a, 129.
23 Freud 1992, 409.
24 Freud 1997a, 52.
25 Freud 1997c, 194.
26 Freud 1997c, 190.
27 Freud 1997a, 126.
34
férentes composantes de l’érotisme la source même de la complexité du
psychisme humain. Dès lors, «la conséquence inévitable de ces considérations
est qu’il faut prêter à chaque individu un érotisme oral-anal-urinaire […]»28.
Toutes ces références soulignent le soubassement évolutionniste des Trois
essais. Il est en outre évident qu’il existe une certaine parenté de thème
et de terme entre Freud et Bölsche.
Ilse Grubrich Simitis a retrouvé en 1983, joint à une lettre de Freud à
Ferenczi, un manuscrit datant de 1915, qui a été publié depuis, et qui est
intitulé, Vue d’ensemble sur les névroses de transfert29. Dans ce texte, Freud
s’appuie sur l’idée suivante: les pathologies du fonctionnement psychique
seraient liées à des phénomènes de régression, à des points de fixation de la
libido. Sur le manuscrit, à l’attention de Ferenczi, figurait la mention: «Vous
pouvez le jeter ou le conserver», ce qui porte à croire que ce que Freud pré-
sentait lui-même comme une «fantaisie scientifique» ne répondait pas aux
exigences de scientificité qu’il s’était fixées.Dans cette Vue d’ensemble, il se
propose d’étudier l’histoire du développement psychique de l’être humain.
Pour cela,il dégage deux axes: le développement de la vie sexuelle humaine,
c’est-à-dire le développement de la libido, et le développement du moi:
[O]n a l’impression que l’histoire du développement de la libido répète une séquence beau-
coup plus ancienne du développement (phylogénétique) que ne le fait l’histoire du déve-
loppement du moi: la première répète peut-être les conditions de développement de l’em-
branchement des vertébrés, tandis que la seconde est dépendante de l’histoire de l’espèce
humaine.30
Freud reprend à la lettre la loi biogénétique de Haeckel,selon laquelle notre
développement récapitule l’histoire de nos ancêtres. Les points de fixation
des névroses sont dès lors aussi les restes d’acquisitions phylogénétiques,
c’est-à-dire en quelque sorte des legs d’événements incontournables du
passé. Mais, à vrai dire, Freud s’inspirait de considérations de celui à qui il
confia le destin du manuscrit, Ferenczi. «Sans doute réussira-t-on un jour»,
écrivait ce dernier en 1913, «à mettre en parallèle les différents stades évo-
lutifs du moi, ainsi que leurs types de régressions névrotiques, et les étapes
parcourues par l’histoire de l’espèce humaine»31. On doit en outre citer
les travaux du psychologue américain G. Stanley Hall qui, toujours dans la
perspective de Haeckel, voit dans la pathologie mentale la persistance de
formes primitives de conduite32.Ainsi, Freud,à son tour,dans Vue d’ensemble
sur les névroses de transfert, tente d’établir un parallèle entre les psycho-
28 Freud 1997a, 139.
29 Freud 1986.
30 Freud 1986, 30f.
31 Ferenczi 1978, 63.
32 Hall 1904.
35
névroses et l’évolution phylogénétique: à chaque entité nosographique, cor-
respondrait une période de «dénuement» de l’histoire de l’humanité. Le
bouleversement des circonstances aurait ainsi entraîné l’inscription d’une
marque indélébile, une disposition, dans la phylogenèse. Par effet de la loi
de Haeckel, ces dispositions se seraient potentialisées en fixation dans le
développement ontogénétique.La névrose constituerait donc une régression
à ces points de fixation, et les symptômes névrotiques seraient une lutte
contre l’instauration nouvelle du «dénuement» vécu par les ancêtres.
Sur leur versant biologique,les écrits spéculatifs de Freud,comme les Trois
essais sur la théorie sexuelle, et la Vue d’ensemble sur les névroses de transfert
s’avèrent donc nourris d’une pensée évolutionniste dont le livre de Bölsche,
Das Liebesleben in der Natur, devait représenter une vulgarisation parti-
culièrement bienvenue, puisque le thème de l’ouvrage est l’évolution de
l’amour. Notons enfin, que malgré ces éléments quelque peu troublants, il
n’existe pas de travaux portant sur Freud et Bölsche, et les spécialistes
de Bölsche n’ont pas non plus rapproché sa vision de la sexualité de celle
de la psychanalyse freudienne. La thèse de Rolf Schmidt33, qui porte sur
l’approche bolschéenne de la sexualité, ne mentionne pas une seule fois le
nom de Freud.
La mention du «roman scientifique bolschéen» par le fondateur de la
psychanalyse à l’intention d’un auditoire supposé profane en la matière
souligne l’importance des sources évolutionnistes de la pensée freudienne et
la nécessité de l’éclairage qu’apporte l’histoire des idées.Il ne s’agit évidem-
ment pas de d’affirmer que l’ensemble de l’œuvre de Freud se trouve déjà
chez Bölsche, mais plutôt, de souligner l’importance de certains aspects,
aujourd’hui sous-estimés ou méconnus, de la culture évolutionniste alle-
mande scientifique et populaire du début du XXesiècle.Le style de Bölsche
ne semble cependant pas toujours avoir bonne presse auprès des psychiatres
qui s’intéressent à la sexologie,comme Forel.Bölsche a cependant le soutien
de Haeckel et, surtout, connaît un très large succès populaire. L’évolution-
nisme de Freud semble donc puiser ses sources autant dans les écrits scien-
tifiques contemporains des évolutionnistes et des sexologues que dans des
textes de vulgarisation. L’historien qui s’intéresse aux rapports qu’entretien-
nent psychanalyse et évolutionnisme ne saurait se contenter de lire ceux que
l’on considère aujourd’hui comme les «grands auteurs», c’est-à-dire Darwin
et Lamarck. Il lui faut se réapproprier le climat évolutionniste qui carac-
térisait la culture allemande au début du XXesiècle, ce qui inclut l’étude de
vulgarisateurs scientifiques.
33 Schmidt 1964.
36
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