Freud begins the second section by emphasizing the psychoanalytic importance of dreams. Dreams allow taboo desires, which would normally be repressed because of their shameful content, to reach the consciousness. Dreams thus provide an indirect representation of a patient’s innermost thoughts and enable the psychoanalyst to understand the mental processes of a hysteric.
After discussing the significance of dreams, Freud gives information on Dora’s family life and medical condition and explains how he came to take on her case. Dora was an eighteen year old girl whose immediate family consisted of her two parents and older brother. She was particularly fond of her father, who had been responsible for her education, and she grew more attached to him as he struggled with tuberculosis during her childhood. To alleviate his lung trouble, the family moved to a small town with a mild climate which Freud calls "B—" to protect the identity of his patient. After suffering an attack of paralysis, Dora’s father traveled to Vienna to receive Freud’s medical treatment. Four years later, he returned with his daughter whom he believed to be neurotic.
Freud believes that Dora’s neurotic symptoms started in her childhood. At age eight, Dora was subject to chronic dysponea (difficulty breathing). At age twelve, she began to suffer from migraine headaches and nervous coughing. When she begins her treatment with Freud, she continues to experience coughing attacks, which last between three and five weeks and cause a complete loss of voice for an extended period of time.
Despite the unexplained development of her symptoms, Freud comments that Dora’s case is rather ordinary as far as cases of hysteria are concerned. Dora suffers from the most common physical symptoms (difficulty breathing, nervous coughing, loss of voice, and migraines) along with the most common mental symptoms (depression and antisocial behavior). Although Freud considers the case to be unexciting, he asserts that the analysis of an ordinary case of hysteria will be most useful in furthering knowledge of the disorder.
Freud theorizes that hysterical symptoms stem from either psychological trauma or problems in the patient’s sexual life. To elucidate Dora’s symptoms, he considers her experiences while her father was recuperating at B—. During his time in the town, Dora’s father became close friends with a married couple, Herr and Frau K. Dora developed a close friendship with Herr K. who often accompanied her on walks and occasionally gave her gifts. However, their relation ship became strained after Dora alleged that Herr K. made an indecent proposal to her during one of their walks. Herr K. denied that this ever happened and Dora’s father agreed with his assessment that Dora imagined the event.
Freud believes that this experience was sufficiently traumatic to have influenced Dora’s hysteria, but not to explain it completely. Some of her symptoms existed before this incident, and thus if trauma is at the root of her hysteria, there must have been some analogous event that happened prior.
At the start of the second section, Freud makes two assertions that form the basis of his approach to psychoanalysis. The first is that dreams can be interpreted and that dream interpretation is crucial to understanding hysteria. The second is that hysterical symptoms can often be traced back to a patient’s sexual life.
In The Interpretation of Dreams, Freud argues that the focus of dreams is wish-fulfillment. People have many desires that they would like to act on but cannot because of social restrictions or a self-imposed sense of morality. The psychological agent that represses taboo impulses is what Freud calls the “super-ego.” During sleep, the “super-ego” or conscience is weakened and dreams can allow repressed desires to reach the consciousness. However, psychological resistance is still at work, and the dream material is distorted to hide its true meaning.
Freud believes that dream interpretation can help alleviate hysterical symptoms. In Dora’s case, Freud asserts that her hidden desires have manifested themselves through physical ailments. His goal in dream interpretation is to get the patient to acknowledge her repressed impulses and to provide them with an outlet.
Freud asserts that erotic desire is one of the prime motivators of human behavior. In his early works, he argues that sexual impulse is the only driver of people’s actions. In later works, such as Civilization and its Discontents, he adds a need for aggression or the “death-instinct.” In the case study, Freud relates nearly all of Dora’s symptoms back to her sexual life.
Freud's sex-based approach to pschoanalysis has drawn much criticism. At times, he reveals a key element of Dora’s thought process, but at other times, he appears to overreach and to make unsubstantiated conclusions to apply his theory. This tendency becomes particularly clear as the second section continues.