Books which tell us that the work of the intellectual pioneers that we have come to idolize was actually fundamentally flawed seem to be in vogue recently, so it was probably only a matter of time before someone questioned the central tenets of the theories of Sigmund Freud. Yet even for such a strongly iconoclastic work, Jeffrey M. Masson's The Assault on Truth Freud's Suppression of the Seduction Theory has received a tremendous amount of pre-publication publicity, most of it negative.

In a book which is surprisingly interesting and readable, given its heavy documentation. Masson attempts to show why Freud abandoned his earlier seduction theory in favor of theories which emphasized the role of fantasies in producing neuroses. In 1896, a controversial paper Freud called "the Aetiology of Hysteria" proposed that childhood "seduction" was the root cause of most human problems in later life. This interpretation was criticized by other psychiatrists, and ten years later Freud renounced his seduction theory. Traditional psychoanalytic history holds that this abandonment was necessary for the development of Freud's pathbreaking theories of the Oedipus complex and infantile sexuality.

To Masson, however, Freud's change of belief was anything but good for psychoanalysis Indeed, Masson even writes. By shitting the emphasis from an actual world of sadnes, misery, and cruelty to an internal stage on which actors performed invented dramas for an invisible audience of their own creation. Freud began a trend away from the real world that, it seems to me, is at the root of the present-day sterility of psychoanalysis and psychiatry throughout the world." In The Assault on Truth Masson traces the circumstances and events which he believes led the young Freud away from the seduction theory towards a greater emphasis on patients fantasy life.

The most interesting of these influences is the case history of Freud's patient Emma Eckstein. One of the first patients treated to Freud-style psychoanalysis, Emma suffered from stomach ailments and menstrual problems. Freud's closest personal and professional friend at the time was Wilhelm Fliess, a Berlin physician who developed the unusual theory that sexual problems are closely linked to the nose and could be corrected by nasal surgery. After conferring, the two doctors decided that such surgery might help Emma, and early in 1895 Fliess came to Vienna to operate on her.

The surgery was hardly a success: Emma's nose began to bleed regularly and profusely. A few weeks after the operation, another doctor found that Fliess had left over half a meter of gauze inside her nose. As Freud later wrote to Fliess, the other physician "pulled at something like a thread, kept on pulling and before either one of us had time to think, at least half a meter of gauze had been removed from the cavity. The next moment came a flood of blood. The patient turned white, her eyes bulged, and she had no pulse." However, with the gauze removed and her nose properly bandaged. Emma slowly began to recover from the bungled operation.

In the aftermath of this fiasco, Masson maintains, Freud gradually and subconsciously convinced himself that Emma's bleeding was not caused by the actions of his friend Fliess, but occurred for other reasons. Freud came to believe that her spells of bleeding were Emma's ways of expressing a longing for his presence. Freud wrote that "her episodes of bleeding were hysterical, were occasioned by longing" and that "she became restless during the night because of an unconscious wish to entice me to go there, and since I did not come during the night, she renewed the bleeding, as an unfailing means of rear-ousing my affection."

Masson carefully traces this shift, chronicled in the letters Freud wrote to Fliess in the aftermath of the operation. According to Masson. "The powerful tool that Freud was discovering the psychological explanation of physical illness, was being pressed into service to exculpate his own dubious behavior [in allowing the operation] and the even more dubious behavior of his closest friend. Freud has begun to explain away his own bad conscience."

The other main influence on Freud's thought, according to Masson, was the criticism and pressure which he received after proposing the seduction theory in the mid-1890's. Standard psychiatric theory in the 19th century emphasized that much of patient's recollections are fantasies, and Freud's original challenge to this orthodoxy was greeted with disapproval. Largely ostracized from the psychoanalytic community. Freud gradually discarded his new theory in order to end his professional isolation, Masson argues.

In an earlier chapter, Masson discusses the years Freud spent in Paris in the 1880's, where it is likely that he witnessed autopsies performed on young children who had been abused, raped, and murdered. To Masson, this means that Freud must have known that sexual abuse was a common part of many childhoods and only surrendered his seduction theory to criticism and his guilt over the Eckstein case. Indeed, Masson maintains that Freud was haunted by the seduction theory all his life, for he knew how widespread child abuse was from his time in Paris.

Yet the chapter on Freud in Paris is largely conjecture, based mostly on vague circumstancial evidence about medical activities in late 19th century France. In a passage indicative of the thin ice his assumptions slide on, Masson admits that, "although we cannot prove, in the strict sense of the word, that Freud, too, witnessed such autopsies, it seems very probable that he did."

Freud, however, was apparently not "haunted" by his earlier theory, and he wrote in 1925 that "I was at last obliged to recognize that these scenes of seduction had never taken place, and that they were only fantasies which my patients had made up."

The Assault on Truth raises important questions about the origins of psychoanalysis and the rationale for Freud's emphasis on fantasy life, but it may not--as Masson predicts--signal the imminent demise of Freudian psychoanalysis. He clearly distorts much of Freud's later work in order to bring out a contrast with his earlier theories. Freud never excluded real experiences from the realm of psychoanalysis, as Masson contends, but rather came to recognize the importance of fantasy and of personal distortions of actual occurrences in shaping human recollections. General Freudian dian orthodoxy involves a mixture of the two "realities."

Because of this, the book is important as intellectual history, but comes up short as a real challenge to orthodox psychoanalytic theory. Masson has helped to identify the blurring distinctions between fantasy and reality, the modern denial of absolutes. As he has pointed out elsewhere, Freud's emphasis on fantasy has partially led to relativistic concepts in modern ethical, anthropological, and sociological theories.

More important still is Masson's concluding argument which suggests that the denial of childhood experiences in psychoanalysis has allowed and condoned an oppression of female patients by a male-dominated profession. To Masson, Freud's theories ignore the early sexual traumas many women suffer, and therefore have led to undue skepticism towards the frequent, and very real, occurrence of incest and child rape.

To call Freud sexist is nothing new, but this book is striking in its account of Eckstein's bungled treatment at the hands of Freud and Fliess. The illfated operation can be excused as potentially well-meaning, but the two men's attitudes toward her in the aftermath of the surgery are truly appalling. Neither doctor, Masson's research reveals, felt any guilt or compassion towards Emma, who nearly died as a result of the failed operation.

Instead Fliess' first concern was apparently the modern reflex--he wanted a letter absolving him from any malpractice. Freud's reaction, too, was entirely self-centered. When Emma first began to hemorrhage, Freud immediately headed for the next room to comfort himself with a glass of cognac. His additional concern was not for Emma, but for Fliess, who Freud believed he had wronged by asking him to operate in a foreign city. Masson cannot seriously tarnish Freud's reputation as one of the great minds of recent times. His theories--including those on seduction--still have much to offer. But the author does cast a harsh light on Freud's sensitivity and humanity. The Assault on Truth occasions, new skepticism of Freud's character, and new sympathy for Emma Eckstein, who suffered so much for modern psychoanalytic theory.