'A Serious Venture': John Rodker (1894–1955) And

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‘A serious venture’: John Rodker (1894-1955) and the Imago Publishing Company (1939-60)

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Int J Psychoanal (2011) 92:1437–1454 doi: 10.1111/j.1745-8315.2011.00484.x

‘A serious venture’: John Rodker (1894–1955) and the Imago Publishing Company (1939–60)

Re´my Amouroux1,2 University of Western Brittany, Faculty of Medicine, Department of Human Sciences, 22 rue Camille Desmoulins, CS 93837, 29238 Brest Cedex 3, France – [email protected]

(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 ‘official 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 failure of the Gesammelte Werke project signalled the end of an era in which psychoanalysis 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 addition, 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

1This 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. 2Translated by David Alcorn.

Copyright ª 2011 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 1438 R. Amouroux 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 psychoanalytic 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 publications 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.

Int J Psychoanal (2011) 92 Copyright ª 2011 Institute of Psychoanalysis Rodker and Imago 1439

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 writer 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 important 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’s Ulysses and his own translations or editions of Lautramont’s The Lay of Maldoror, Pound’s Cantos 17–26,Le Corbusier’s Toward a New Architecture and Valry’s Introduction 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

Copyright ª 2011 Institute of Psychoanalysis Int J Psychoanal (2011) 92 1440 R. Amouroux 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 illustrated 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’s War, 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 matter 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

Int J Psychoanal (2011) 92 Copyright ª 2011 Institute of Psychoanalysis Rodker and Imago 1441 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 members 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 publish 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’s Collected 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

Copyright ª 2011 Institute of Psychoanalysis Int J Psychoanal (2011) 92 1442 R. Amouroux 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 complete 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 establish 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

Int J Psychoanal (2011) 92 Copyright ª 2011 Institute of Psychoanalysis Rodker and Imago 1443 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 writer 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 volumes. 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.

Copyright ª 2011 Institute of Psychoanalysis Int J Psychoanal (2011) 92 1444 R. Amouroux 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 company’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

Int J Psychoanal (2011) 92 Copyright ª 2011 Institute of Psychoanalysis Rodker and Imago 1445 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 nothing’’ (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 royalties 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

Copyright ª 2011 Institute of Psychoanalysis Int J Psychoanal (2011) 92 1446 R. Amouroux 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 publishers. 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

Int J Psychoanal (2011) 92 Copyright ª 2011 Institute of Psychoanalysis Rodker and Imago 1447 (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 formidable rival came into the picture, making everything look gloomier. After the success of Freud’s Collected 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

92 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 66 ? ? ? ? ? ? ? ? ? ? 107 262 253 150 135 91 79 191 94 157 in die Psychoanalyse (1940) The Origin and Development – – – – – – – – – – – – – – – 1328 177 126 57 50 53 of Psychoanalysis (1954) Amouroux R. The Question of Lay Analysis – – – – – – – – – 986 375 119 69 31 31 37 31 287 43 26 20 (1948) Zur Psychopathologie des – – – – – – – – – 530 158 233 87 144 105 59 18 17 51 53 140

Copyright Alltagslebens (1948) Selbstdarstellung (1948) – – – – – – – – – 134 56 43 35 82 57 25 20 30 26 16 20 Gesammelte Werke 66 26 30 70 82 67 232 ? 399 53 413 344 227 205 193 209 191 219 160 127 103 vol. 11 (1940)

ª Gesammelte Werkevol. 15 62 24 28 51 46 77 202 ? 105 451 219 239 205 205 206 198 197 237 153 107 107

01Isiueo Psychoanalysis of Institute 2011 (1940) The Psychoanalytic Treatment ? ? ? ? ? ? ? – – – 526 ? 876 ? 807 529 400 917 611 ? 140 of Children (1946) Rodker and Imago 1449 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’s Collected 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 situation than before. Everything seems to point to the fact that the project of publishing Freud’s Gesammelte 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 versions 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 publication 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,

Copyright ª 2011 Institute of Psychoanalysis Int J Psychoanal (2011) 92 1450 R. Amouroux 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 translated 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 opinion’ (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

Int J Psychoanal (2011) 92 Copyright ª 2011 Institute of Psychoanalysis Rodker and Imago 1451 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 commercial 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 Foreign Rights (general) (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

Copyright ª 2011 Institute of Psychoanalysis Int J Psychoanal (2011) 92 1452 R. Amouroux 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 movement 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 linguistic 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.

Int J Psychoanal (2011) 92 Copyright ª 2011 Institute of Psychoanalysis Rodker and Imago 1453 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 à l’aube de la Seconde Guerre mondiale. Cet diteur et crivain, tent un temps par une carrire de psychanalyste, va se heurter à 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 à 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 possibilità di portare a compimento quella che lui stesso definì ‘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 segnò la fine di un’era in cui il tedesco aveva rappresentato la lingua nella quale si esprimeva il mondo psicoanalitico. References Amouroux R (2010). Marie Bonaparte, her ﬁrst two patients and the literary world. Int J Psychoanal 91:879–94.

Bell J editor (1935). We did not ﬁght: 1914–1918 experiences of war resisters. London: Cobden Sanderson. Bonaparte M (1956). John Rodker 1894–1955. Int J Psychoanal 37:199–201. Crozier A (1996). Introduction. In: Rodker J. Poems and Adolphe 1920, vi–xxiii. London: Carcanet Press. Forrester J (1997). A whole climate of opinion. In: Dispatches from the Freud wars, 184–207. Cambridge, MA: Harvard UP. Freud S (1924-34). Gesammelte Schriften. 12 vols. Wien: IPV. Freud S (1924-50). Collected papers, vol. 1. New York, London, Wien: International Psychoanalytic Press; vol. 2–5. London: Hogarth and the Institute of Psycho-Analysis. Freud S (1953-74). Standard edition of the complete psychological works of Sigmund Freud. 24 vols. London: Hogarth. Freud S (1940-52). Gesammelte Werke: Chronologisch Geordnet. 17 vols. London: Imago. Freud S (1969-75). Studienausgabe. 10 vols + 1. Frankfurt am Main: Fischer. Glendinning V (2006). Leonard Woolf: A life. London: Simon & Schuster. Glover E (1933). War, sadism and paciﬁsm. London: George Allen & Unwin. Graham R (2000). Britain on the couch: The popularization of psychoanalysis in Britain 1918–1940. Science in Context 13:183–230. Grubrich-Simitis I (1996). Back to Freud’s texts. New Haven, CT, London: Yale UP. Hall MG (1988). The fate of the Internationaler Psychoanalytischer Verlag. In: Timms E, Segal N, editors. Freud in exile, 90–105. New Haven, CT, London: Yale UP. Holroyd M (1973). Lytton Strachey: A critical biography. London: Heinemann. Jones E, editor (1928). Glossary for the use of translators of psychoanalytical work. Int J Psychoanal suppl. 1. Jones E (1957). Sigmund Freud: Life and work, vol. 3: The last phase 1919–1939. London: Hogarth. King P, Steiner R (1991). The Freud–Klein controversies 1941–1945. London: Tavistock; New York, NY: Routledge. Laplanche J, Pontalis J-B (1967). Vocabulaire de la psychanalyse. Paris: PUF [(1973).The language of psychoanalysis, Nicholson-Smith D, translator. New York, NY: Norton]. Marinelli L (2009). Psyches Kanon. Wien: Verlag Turia & Kant. Patterson I (2003). Writing on other fronts: Translation and John Rodker. Translation and Literature 12:88–113. Steiner R (1987). A worldwide international trade mark of genuineness? Some observations on the history of the English translation of the work of Sigmund Freud, focusing mainly on his technical terms. Int Rev Psychoanal 14:33–102. Steiner R (1991). To explain our point of view to English readers in English words. Int Rev Psycho- anal 18:351–92. Strachey A (1943). New German–English psychoanalytical vocabulary. Baltimore, MD: Williams & Wilkins. Willis JR (1992). Leonard and Virginia Woolf as publisher: The Hogarth press 1917–41. Charlottes- ville, VA, London: U Virginia Press. Woolf V (1975–80). The letters of Virginia Woolf. 6 vols. New York, NY: Harcourt Brace Jovanovich. Woolf V (1977–84). The diary of Virginia Woolf. 4 vols. New York, NY: Harcourt.

Int J Psychoanal (2011) 92 Copyright ª 2011 Institute of Psychoanalysis e International Journal of

Int J Psychoanal (2010) 91:879–894 doi: 10.1111/j.1745-8315.2010.00278.x

Marie Bonaparte, her ﬁrst two patients and the literary world

Re´my Amouroux1 Unite´ Douleur, Hoˆpital Trousseau, 26 av. Du Dr Arnold Netter, 75571 Paris, France – [email protected]

(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 several 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 circles. 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 university 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 psychoanalysis 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).

1Translated by Andrew Weller.

Copyright ª 2010 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 880 R. Amouroux 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 Bonaparte2 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)

2The 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.

Int J Psychoanal (2010) 91 Copyright ª 2010 Institute of Psychoanalysis Marie Bonaparte, her ﬁrst two patients and the literary world 881 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 correspondence 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,

Copyright ª 2010 Institute of Psychoanalysis Int J Psychoanal (2010) 91 882 R. Amouroux 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 resolving 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 published 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 extremely 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 interested 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’s The 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

Int J Psychoanal (2010) 91 Copyright ª 2010 Institute of Psychoanalysis Marie Bonaparte, her ﬁrst two patients and the literary world 883 Paul Bourget and Andr Gide were also giving prominence to psychoanalysis 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 suffering 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’:

Copyright ª 2010 Institute of Psychoanalysis Int J Psychoanal (2010) 91 884 R. Amouroux 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 analysis 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

Int J Psychoanal (2010) 91 Copyright ª 2010 Institute of Psychoanalysis Marie Bonaparte, her ﬁrst two patients and the literary world 885 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 suffering 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 serious 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 information 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

Copyright ª 2010 Institute of Psychoanalysis Int J Psychoanal (2010) 91 886 R. Amouroux 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 everything 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 childhood. 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 memories. 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 sessions’’ (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)

Int J Psychoanal (2010) 91 Copyright ª 2010 Institute of Psychoanalysis Marie Bonaparte, her ﬁrst two patients and the literary world 887 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

Copyright ª 2010 Institute of Psychoanalysis Int J Psychoanal (2010) 91 888 R. Amouroux 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 husband’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 happened 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 contrary. She was convinced that, thanks to the treatment that he began in 1928,

Int J Psychoanal (2010) 91 Copyright ª 2010 Institute of Psychoanalysis Marie Bonaparte, her ﬁrst two patients and the literary world 889 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 therapeutic 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, particularly sensitive to their psychoanalyst’s interest in literature. On numerous occasions, they both attest that, as an analyst and writer, she gave considerable support to their literary creativity. Valerio referred to his literary tastes in his correspondence with Bonaparte. He thus suggested that she read Thomas Mann’s Death 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).

Copyright ª 2010 Institute of Psychoanalysis Int J Psychoanal (2010) 91 890 R. Amouroux Valerio Jahier also discusses his wife’s texts with the Princess. He is particularly 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 occasions, 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 interesting 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

Int J Psychoanal (2010) 91 Copyright ª 2010 Institute of Psychoanalysis Marie Bonaparte, her ﬁrst two patients and the literary world 891 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 cyclothymia, 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 analyst’ 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 oneself; 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

Copyright ª 2010 Institute of Psychoanalysis Int J Psychoanal (2010) 91 892 R. Amouroux 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 successful 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 correspondence 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 ‘analysands’? 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’ psychoanalyst. 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 therapeutic 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

Int J Psychoanal (2010) 91 Copyright ª 2010 Institute of Psychoanalysis Marie Bonaparte, her ﬁrst two patients and the literary world 893

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 roˆ le 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. References Amouroux R (2006). Marie Bonaparte et les milieux litte´raires [Marie Bonaparte and literary circles]. Rev Bibliothe`que Nationale de France 24:63–70. Amouroux R (2008). Marie Bonaparte, l’analyse pratiqueé par les laı¨ques et les psychologues [Marie Bonaparte, analysis practised by laymen and psychologists]. Bull psychol 61:485–93. Appignanesi L, Forrester J (2000). Freud’s women. New York, NY: Other Press. Ardolino F, Druet AC (2005). La psychanalyse raconteé par Italo Svevo [Psychoanalysis as related by Italo Svevo]. Savoirs et cliniques 6:75–80. Bertin C (1982). Marie Bonaparte: A life. San Diego, CA ⁄ New York, NY: Harcourt Brace. Bonaparte M (1933). Edgar Poe, sa vie, son œuvre: e´tude analytique. Paris: Denoe¨l et Steele. [(1949). The life and works of Edgar Allan Poe: A psychoanalytic interpretation, Rodker J, translator. London: Imago.] Dalbiez R (1936). La me´thode psychanalytique et la doctrine freudienne [The psychoanalytic method and Freudian doctrine]. Paris: Descleé de Brouwer.

Gatt-Rutter J (1988). Italo Svevo: A double life. Oxford: Clarendon. Hugues P (1997). Vale´ry Jahier. In: Ciment M, editor. La critique de cine´ma en France [Cinema criticism in France], 340–53. Paris: Ramsay. Jahier A (1936). Note sur la presse fe´minine [Note on women’s press]. Esprit 44:390–1. Jahier A (1944). France remembered. London: Sylvan Press. Jahier A (1955). Quelques lettres d’Italo Svevo [Some letters by Italo Svevo]. Preuves 48:26–32. Jahier A (1957). Les trois romans de Françoise Sagan [The three novels of Françoise Sagan]. Le Flambeau 40:705–13. Jahier A (1959). Petite me´ditation sur la chance: le quatrie` me roman de Françoise Sagan [A short meditation on chance: The fourth novel of Françoise Sagan].Le Flambeau 42:765–9. Jahier A (1965). Françoise Sagan:La Chamade [Françoise Sagan: That Mad Ache].Le Flambeau 48:404–6. Jahier A (1986). Entretiens avec Michel Colleé et Nicole Humbrech [Interviews with Michel Colleéet Nicole Humbrech]. Freńe´sie 1:117–24. Jahier V (1937). 42 ans de cine´ma [42 years of cinema]. In: Le roˆle intellectuel du cine´ma [The intellectual role of cinema], 11–151. Paris: Institut international de coope´ration intellectuel. Mann C (1981). Alice Jahier: ‘I still write on my knees’. International Herald Tribune, 4 July. Mijolla A de (1988). Quelques aperçus sur leˆ role de la Princesse Marie Bonaparte dans la creátion de la Socie´te´Psychanalytique de Paris [Some insights into the role of Princess Marie Bonaparte in the creation of the Paris Psychoanalytic Society]. Rev fr Psychanal 52:1197–214. Moore A (2009). Relocating Marie Bonaparte’s clitoris. Aust Feminist Stud 24:149–65. Mounier E (1939). Vale´ry Jahier. Esprit 82:653–4. Ohayon A (1999). L’impossible rencontre, psychologie et psychanalyse en France 1919–1969 [The impossible encounter, psychology and psychoanalysis in France 1919–1969]. Paris: La dećouverte. Raczimov H (1988). Maurice Sachs ou les travaux force´s de la frivolite´ [Maurice Sachs or the forced labour of frivolity]. Paris: Gallimard. Ralph AJ (1958). Les pre´textes de Mary Wood [The pretexts of Mary Wood]. Avignon: Presses universelles. Roudinesco E (1990). Jacques Lacan & Co: A history of psychoanalysis in France, 1925–1985, Mehl- man J, translator. Chicago, IL: Chicago UP. Sachs M (1946). Le Sabbat. Me´moires d’une jeunesse orageuse [The Sabbath: Memories of a stormy youth]. Paris: Correâ. Svevo I (1930 [1923]). Confessions of Zeno. New York, NY: Knopf. [(1923). La coscienza di Zeno. Bologna: Cappelli, Stampa.] Svevo I (1978). Carteggio con James Joyce, Eugenio Montale, Valery Larbaud, Benjamin Cre´mieux, Marie-Anne Comne`re, Valerio Jahier. Trieste: Dall’Oglio. Thompson NL (2003). Marie Bonaparte’s theory of female sexuality: Fantasy and biology. Am Imago 60:343–78. Weiss E (1970). Sigmund Freud as consultant. New York, NY: Intercontinental Medical Books.

Int J Psychoanal (2010) 91 Copyright ª 2010 Institute of Psychoanalysis This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier’s archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright Author's personal copy

Annales Franc¸aises d’Anesthe´sie et de Re´animation 28 (2009) 11–15

Article original Douleur et troubles comportementaux apre`s adeńoı¨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-reánimation, hoˆpital d’enfants Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France Reçu le 23 mai 2006 ; accepte´ le 30 octobre 2008 Disponible sur Internet le 10 dećembre 2008

Re´sume´ Objectifs. – Cette e´tude avait pour but d’e´valuer la douleur postope´ratoire apre`s adeńoı¨dectomie (VG) et/ou pose d’ae´rateur transtympanique (ATT) a` l’hoˆpital 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 Æ 2,4 ans) : 28 VG, 16 ATT, 20 VG-ATT. La douleur postope´ratoire a e´te´ e´valueé (entreé SSPI, sortie SSPI, sortie hoˆpital) avec l’Objective Pain Scale (OPS). Les parents ont e´value´ au domicile pendant sept jours la douleur de leur enfant avec l’ećhelle 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. – Entreé 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 hoˆpital 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 Æ 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.

* Auteur correspondant. Adresse e-mail : [email protected] (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

12 R. Amouroux et al. / Annales Franc¸aises d’Anesthe´sie et de Re´animation 28 (2009) 11–15

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 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 %. Dans la chirurgie pe´diatrique en hospitalisation de jour, la prise en charge de la douleur de l’enfant au domicile est souvent 2.3. E´ valuation de la douleur et des troubles inade´quate [1]. Apre`s une hospitalisation de jour pour comportementaux postope´ratoires intervention chirurgicale, des troubles de comportement sont fre´quemment rapporte´s chez les enfants ope´re´s. Leur fre´quence La douleur postope´ratoire a e´te´ e´valueé en utilisant une est tre`s variable, pouvant aller jusqu’a` 88 % des enfants [2]. version modifieé de l’ećhelle Objective Pain Scale (OPS) L’adeńoı¨dectomie et la pose d’ae´rateur transtympanique comprenant quatre items : pleurs, mouvements, comportement comptent parmi les interventions chirurgicales les plus et expression de la douleur. Les re´sultats de cette ećhelle se fre´quentes chez l’enfant. Elles repre´sentent, en France, jusqu’a` traduisent par un score a` huit points, chaque item pouvant eˆtre deux tiers des actes chirurgicaux pratique´s avant quatre ans [3]. cote´ 0, 1 ou 2 selon la pre´sence et l’intensite´ de la On dispose cependant de tre`s peu de renseignements sur les caracte´ristique e´valueé. Les enfants ont e´te´ e´value´sa` trois suites ope´ratoires de ce type d’intervention, en particulier pour reprises, a` la sortie du bloc ope´ratoire, a` la sortie de salle de la douleur postope´ratoire et le comportement de l’enfant. surveillance postinterventionnelle (SSPI), et enfin a` la sortie de L’adeńoı¨dectomie et la pose d’ae´rateur transtympanique sont l’hoˆpital. Pour des raisons de commodite´, l’ećhelle nume´rique en effet couramment pratiqueés en hospitalisation de jour. Par simple (ENS) d’autoe´valuation de la douleur a e´te´ utiliseé conse´quent, l’essentiel des suites ope´ratoires se passe au quotidiennement en he´te´roe´valuation par les parents pendant la domicile, hors de la surveillance des e´quipes soignantes, et semaine suivant l’intervention. repose principalement sur la famille. Les troubles comportementaux postope´ratoires ont e´te´ Cette e´tude observationnelle a pour but d’e´valuer la douleur recueillis a` l’aide d’une version simplifieé du Post-Hospital postope´ratoire a` l’hoˆpital et au domicile et les troubles Behaviour Questionnaire (PHBQ) de Vernon et Schulmann [5]. comportementaux au domicile pendant la semaine suivant Le questionnaire utilise´ e´value, a` l’aide de questions fermeés l’intervention. standardiseés diffe´rentes dimensions du comportement de l’enfant : sollicitation des parents, cole`res, re´veils nocturnes, 2. Patients et me´thodes alimentation, frayeurs, cauchemars, et proble`mes d’endormissement. Les diffe´rentes questions sont de´tailleés dans le 2.1. Patients 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 Une se´rie de 64 enfants ont e´te´ e´tudie´s consećutivement sur sept questions, il leur a e´te´ demande´ d’e´valuer dans quelle une pe´riode de quatre mois par deux investigateurs non mesure le comportement de l’enfant avait e´te´ modifie´ par implique´s dans la prise en charge anesthe´sique et analge´sique. rapport a` son statut habituel, en choisissant entre trois Tous les enfants e´taient classe´s ASA 1 ou 2. Ils e´taient admis en re´ponses : « moins qu’avant », « autant qu’avant », « plus hospitalisation de jour pour adeńoı¨dectomie et/ou pose qu’avant ». Le jour de l’intervention, les parents ont reçu un d’ae´rateurs transtympaniques. Tous les parents et enfants formulaire de recueil de donneés sur le PHBQ et l’ENS. Des sollicite´s ont accepte´ de participer. Cette e´tude observationnelle explications leur ont e´te´ donneés pour l’utilisation de ces outils. n’a pas entraıˆne´ de modifications par rapport a` la prise en charge habituelle. 2.4. Statistiques

2.2. Protocole anesthe´sique et analge´sique Toutes les analyses ont e´te´ reáliseés avec un programme statistique (SPSS 13.0 ; SPSS Inc, Chicago, Ill). Les donneés Tous les enfants ont e´te´ vus en consultation preánesthe´sique ont e´te´ analyseés avec des tests non parame´triques ad hoc plusieurs jours avant l’intervention. Au cours de celle-ci, des (Mann-Whitney et Kruskall-Wallis). On a exprime´ les valeurs explications sur l’intervention et sur l’e´tude ont e´te´ donneés aux quantitatives par les me´dianes assorties des percentiles 25 et parents et a` l’enfant. Celui-ci a pu essayer le masque 75 %. Une valeur de p < 0,05 e´tait conside´reé comme d’anesthe´sie et a reçu un livret de pre´paration « Je vais me significative. faire ope´rer – Alors on va t’endormir » [4]. La pre´me´dication Une analyse de re´gression logistique a e´te´ meneé afin de comprenait du midazolam (0,5 mg/kg) par voie rectale de´terminer l’impact de diffe´rentes variables explicatives sur les 30 minutes avant l’heure pre´vue de l’anesthe´sie. L’anesthe´sie troubles comportementaux postope´ratoires. Les relations entre Author's personal copy

R. Amouroux et al. / Annales Franc¸aises d’Anesthe´sie et de Re´animation 28 (2009) 11–15 13

Tableau 1 Tableau 2 Version simplifieé du Post-Hospital Behavior Questionnaire. Scores douleur mesure´sa` l’aide de l’Objective Pain Scale (OPS). Questions du Post-Hospital Behavior Questionnaire version 7 items Score OPS Effectif VG ATT VG-ATT Est-ce que votre enfant cherche a` ce que vous vous occupiez de lui ? total (n = 28) (n = 16) (n = 20) Est-ce que votre enfant a un tempe´rament cole´rique ? (n = 64) Est-ce que votre enfant se re´veille la nuit ? Entreé SSPI 3 [0–6] 5 [2,25–7,75]* 0 [0–5,5] 2 [0–5,75] Est-ce que votre enfant a des difficulte´s pour manger ? Sortie SSPI 1 [0–2] 1 [0–2] 0 [0–2,5] 1 [0–2] Est-ce que votre enfant vous a semble´ effraye´ ? Sortie Hoˆpital 0 [0–1] 0 [0–1] 0 [0–1] 0 [0–0] Est-ce que votre enfant a fait des cauchemars ou des mauvais reˆves ? Est-ce que votre enfant a besoin d’aide pour dormir ? ATT : ae´rateurs transtympaniques ; OPS : Objective Pain Scale ; SSPI : salle de soin postinterventionnelle ; VG : ve´ge´tations ; VG-ATT : ae´rateurs transtympaniques et ve´ge´tations ; * diffe´rence significative ( p < 0,05) entre les groupes. les variables inde´pendantes (l’aˆge des enfants, le score de 3.4. Scores de douleur a` l’hoˆpital et au domicile douleur a` l’entreé en SSPI et une journeé apre`s l’hospitalisation, le type d’intervention, l’administration de morphine et de La totalite´ des re´sultats est pre´senteé dans le Tableau 2.Le parace´tamol au bloc ope´ratoire) et les variables de´pendantes score de douleur me´dian, e´value´ a` l’entreé en SSPI a` l’aide de (les troubles comportementaux postope´ratoires a` 24 heures et a` l’OPS e´tait de 3 [0–6]. Il existait une diffe´rence significative 7 jours) ont e´te´ examineés en deux e´tapes. Premie`rement, toutes ( p < 0,05) entre le groupe VG d’une part (OPS = 5 [2,25– les corre´lations possibles entre les variables ont e´te´ analyseés en 7,75]) et les groupes ATT (OPS = 0 [0–5,5]) et VG-ATT utilisant le coefficient rhoˆ de Spearman. Deuxie`mement, a` (OPS = 2 [0–5,75]) d’autre part. La me´diane des scores OPS a` partir des variables corre´leés a` la variable de´pendante ( p < 0,2) la sortie de SSPI e´tait de 1 [0–2]. A` la sortie de l’hoˆpital, il e´tait ou cliniquement pertinentes, on a reálise´ une analyse de nul (0 [0–1]). Il n’y a pas de diffe´rences significatives entre les re´gression logistique pas a` pas descendante. groupes pour ces deux dernie`res e´valuations. Les scores de douleur recueillis a` la maison a` l’aide de l’ećhelle ENS e´taient 3. Re´sultats 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. 3.1. Population 3.5. Troubles comportementaux au domicile Les 64 enfants e´taient aˆge´s de 4,3 Æ 2,4 ans et se re´partissaient de la manie`re suivante: 28 adeńoı¨dectomies Les trois quarts des parents rapportaient l’existence d’au (VG : 3,7 Æ 2,4 ans), 16 poses d’ae´rateurs transtympaniques moins un changement ne´gatif du comportement 24 heures (ATT : 5,2 Æ 2,6 ans), 20 associations des deux interventions apre`slasortie.Apre`s sept jours, 40,6 % des parents (VG-ATT : 4,4 Æ 2,2 ans). Il n’y avait pas de diffe´rences mentionnaient la fre´quence accrue d’au moins un de ces significatives d’aˆge entre les trois groupes. Le nombre me´dian troubles. Les changements les plus fre´quemment rapporte´s d’hospitalisations ante´rieures par enfant e´tait de 1 [0–2]. e´taient la sollicitation parentale accrue et les cole`res. Les changements juge´s positifs ne concernaient qu’un petit 3.2. Protocole anesthe´sique et analge´sique nombre d’enfants. Une analyse sur ećhantillons apparie´sa permis de mettre en e´vidence une diffe´rence significative dans Le protocole anesthe´sique et analge´sique e´tait laisse´ au choix le sens d’une diminution des TCPO entre l’e´valuation a` de l’anesthe´siste et non connu par les investigateurs. L’analge´sie 24 heures et a` sept jours (Tableau 3). Une analyse logistique postope´ratoire comprenait du parace´tamol (15 mg/kg) adminis- multivarieéae´te´ meneéafindede´terminer l’impact de tre´ par voie veineuse ou par voie rectale pendant l’anesthe´sie. diffe´rentes variables explicatives sur les TCPO a` 24 heures et a` Environ 40 % des enfants de chaque groupe ont reçu de la sept jours. Aucune des variables choisies n’est apparue morphine comme antalgique de relais en SSPI. de´terminante (Tableau 4).

3.3. Modalite´sdese´paration et pre´sence des parents en 4. Discussion SSPI L’objectif principal de ce travail e´tait d’e´valuer les TCPO Les modalite´sdese´paration entre l’enfant et ses parents dans une population d’enfants subissant des gestes chirurgicaux e´taient les meˆmes dans les trois groupes. Apre`s la pre´me´dica- ORL en ambulatoire. Il s’agissait aussi d’e´valuer la douleur tion, les enfants e´taient accompagne´s par un aide-soignant postope´ratoire et de rechercher d’e´ventuels facteurs influant sur jusqu’au bloc ope´ratoire. Les parents n’e´taient pas pre´sents lors l’incidence des TCPO. L’incidence e´leveé des TCPO contras- de l’induction anesthe´sique. Au moment de cette e´tude, la tait avec un controˆle satisfaisant de la douleur au domicile. pre´sence des parents n’e´taient pas syste´matique en SSPI, mais Nous avons mene´ une analyse multivarieé qui n’a pas pu mettre laisseéa` l’apprećiation de l’e´quipe infirmie`re. Dans 58 % des en e´vidence de facteur lie´ a` une plus grande fre´quence de cas, un parent (33 me`res et 4 pe`res) a e´te´ admis aupre`sde troubles comportementaux. De plus, dans notre e´tude, l’enfant en SSPI. l’absence de standardisation du protocole anesthe´sique et Author's personal copy

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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 univarieé Analyse multivarieé Analyse univarieé Analyse multivarieé Rho de Spearman p Odds ratio IC95 % p Rho de Spearman p Odds ratio IC95 % p Aˆ ge À0,21 0,09 1,07 0,82–1,40 0,60 À0,1 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 entreé 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 À0,22 0,17 3,37 0,35–32,30 0,29 À0,18 0,88 1,59 0,19–13,43 0,67 Morphine 0,05 0,72 0,91 0,22–3,72 0,90 À0,11 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’ećhelle nume´rique simple une journeé apre`s l’hospitalisation ; OPS entreé SSPI : score douleur mesure´ par l’Objective Pain Scale a` l’entreé en salle de soin postinterventionnelle ; TCPO : troubles comportementaux postope´ratoire ; VG : ve´ge´tations ; VG- ATT : ae´rateurs transtympaniques et ve´ge´tations. analge´sique, ainsi que le faible nombre de sujets inclus limitent Le lien entre la douleur postope´ratoire et l’apparition les conclusions de ce type d’analyse statistique. ulte´rieure de TCPO reste controverse´. Dans la se´rie de La version du PHBQ utiliseéae´te´ mise au point par Kotiniemi, la douleur postope´ratoire a` j0 est pre´dictive de Kotiniemi et al. [6],a` partir du questionnaire original de Vernon TCPO jusqu’a` la quatrie`me semaine [8]. Le lien est significatif en 27 items, sur une population d’enfants en hospitalisation en cas de douleur se´ve`re a` l’hoˆpital ou de persistance de la bre`ve. Cette e´quipe propose deux versions simplifieés douleur au domicile. En revanche, ni Kain et al. [2] ni Stargatt diffe´rentes du PHBQ [7,8]. Il existe deux modes de recueil et al. [10] ne mettent en e´vidence de corre´lation entre douleur et du PHBQ : comparatif avec une seule cotation ou absolu avec troubles du comportement a` deux semaines. Pour Tuomilehto deux cotations a` deux dates diffe´rentes. La me´thode de et al. [11], l’adeńoı¨dectomie en hoˆpital de jour, avec passation comparative, qui a e´te´ employeé ici, est conside´reé administration syste´matique de ke´toprofe`ne au domicile et comme la plus sensible [9]. une information des parents sur la douleur occasionne une Les trois quarts des parents interroge´sa` j1, et 40,6 % des incidence « ne´gligeable » de troubles du comportement a` une et parents a` j7 signalent au moins un changement ne´gatif du trois semaines. Les auteurs attribuent leurs re´sultats a` une comportement. Les changements les plus fre´quemment cite´s attitude active de pre´vention de la douleur, qui inclut une sont la sollicitation parentale accrue et les cole`res. Ils information sur la douleur et un soutien relationnel des parents. correspondent aux cate´gories « anxie´te´ de se´paration » et Ils en concluent qu’il est possible de diminuer la fre´quence des « agressivite´ envers l’autorite´ » du questionnaire original de troubles comportementaux postope´ratoires. Malgre´ l’absence Vernon. Les proble`mes a` l’endormissement sont e´galement de certitude sur un lien entre douleur et TCPO, du fait de ces fre´quents. A` l’exception des frayeurs et des cauchemars, ces re´sultats contradictoires, il est justifie´ de mieux prendre en troubles diminuent de façon marqueé entre le premier et le compte la douleur en SSPI. septie`me jour postope´ratoire. Cette fre´quence importante est en On dispose actuellement de diffe´rentes me´thodes de accord avec les donneés de la litte´rature [2,10]. Dans notre pre´paration et de prise en charge psychologique des enfants travail, la douleur des enfants subissant une adeńoı¨dectomie et des familles [12]. Kain et al. [13] ont montre´ leur efficacite´ seule e´tait significativement plus importante que celle des sur l’anxie´te´ preópe´ratoire, mais pas au moment de l’induction, enfants qui subissaient une pose d’ae´rateur transtympanique, ni dans la pre´vention des troubles postope´ratoires. Stargatt et al. que celle-ci ait e´te´ accompagneé ou non d’adeńoı¨dectomie. [10] rapportent un effet ne´gatif sur l’apparition de TCPO de Author's personal copy

R. Amouroux et al. / Annales Françaises d’Anesthe´sie et de Reánimation 28 (2009) 11–15 15 deux des strate´gies d’information les plus couramment syste´matique de cet outil donnerait une ideé plus comple`te du utiliseés : une discussion preálable avec un anesthe´siste retentissement psychologique de ces interventions sur l’enfant. (associeéa` des changements ne´gatifs a` j3) et la lecture d’un Cela permettrait de mieux informer les parents qui, en livret de pre´paration a` l’anesthe´sie (associe´ a` des changements hospitalisation de jour, supportent l’essentiel des suites ne´gatifs a` j30 pour les interventions de courte dureé). Mais ope´ratoires, et de mettre en place des strate´gies de pre´vention contrairement a` nous, l’e´quipe de Stargatt a utilise´ un livret dans une perspective d’ame´lioration de la qualite´ des soins. conçu pour de grands enfants et fournissant une quantite´ d’informations inadapteéa` des enfants jeunes, bien que leur Remerciements travail porte sur des enfants aˆge´s de trois a` 12 ans. Par ailleurs, les modalite´s de l’entretien avec l’anesthe´siste diffe`rent : Les auteurs tiennent a` remercier les professeurs Isabelle consultation syste´matique plusieurs jours avant l’intervention Murat et Ricardo Carbajal pour leurs prećieux conseils. en France ; entretien le jour meˆme de l’intervention, n’incluant pas toujours un ećhange avec l’enfant dans l’institution de Re´fe´rences Stargatt. Ces re´sultats n’excluent pas que la pre´paration soit utile a` certains enfants [14], mais soulignent la nećessite´ [1] Wolf AR. Tears at bedtime: a pitfall of extending paediatric day-case d’adapter les modalite´s de la pre´paration a` chaque cas surgery without extending analgesia. Br J Anaesth 1999;82:319–20. particulier (de´lai par rapport a` l’intervention, type de document, [2] Kain ZN, Mayes LC, Wang SM, Hofstadter MB. Postoperative behavioral outcomes in children: effects of sedative premedication. Anesthesiology ´ termes employes). Dans notre travail, tous les enfants ont 1999;90:758–65. beńe´ficie´ de la meˆme pre´paration. On ne peut donc pas e´valuer [3] Clergue F, Auroy Y, Pequignot F, Jougla E, Lienhart A, Laxenaire MC. l’influence de cette pre´paration sur les TCPO ulte´rieurs. French survey of anesthesia in 1996. Anesthesiology 1999;91:1509–20. La pre´me´dication par le midazolam (0,5 mg/kg), syste´ma- [4] Sparadrap. Je vais me faire ope´rer – Alors on va t’endormir. 1996. tiquement utiliseé dans notre travail, a montre´ son efficacite´ [5] Vernon DT, Schulman JL, Foley JM. Changes in children’s behavior after hospitalization. Some dimensions of response and their correlates. Am J dans la pre´vention des TCPO [13]. Cela pourrait eˆtre une Dis Child 1966;111:581–93. conse´quence de l’effet anxiolytique et de l’amne´sie des [6] Kotiniemi LH, Ryhanen PT. Behavioural changes and children’s mem- e´veńements stressants. Toutefois, cet effet pre´ventif n’est ories after intravenous, inhalation and rectal induction of anaesthesia. perceptible que durant la premie`re semaine postope´ratoire. Paediatr Anaesth 1996;6:201–7. D’autres travaux sont nećessaires afin d’e´valuer l’efficacite´ [7] Kotiniemi LH, Ryhanen PT, Moilanen IK. Behavioural changes following routine ENT operations in two-to-ten-year-old children. Paediatr Anaesth ´ ´ ´ ´´ preventive de la premedication sur les TCPO et de reevaluer 1996;6:45–9. l’opportunite´ de pre´me´diquer tous les enfants. Leurs re´sultats [8] Kotiniemi LH, Ryhanen PT, Moilanen IK. Behavioural changes in chil- pourraient permettre de repe´rer dans la phase preópe´ratoire les dren following day-case surgery: a 4-week follow-up of 551 children. enfants qui peuvent beńe´ficier d’une pre´me´dication. Anaesthesia 1997;52:970–6. [9] Thompson RH, Vernon DT. Research on children’s behavior after hospitalization: a review and synthesis. J Dev Behav Pediatr 1993;14:28–35. 5. Conclusion [10] Stargatt R, Davidson AJ, Huang GH, Czarnecki C, Gibson MA, Stewart SA, et al. A cohort study of the incidence and risk factors for negative Nous avons montre´ que, dans une population d’enfants behavior changes in children after general anesthesia. Paediatr Anaesth subissant des ope´rations ORL en chirurgie ambulatoire, les 2006;16:846–59. scores de douleur sont globalement faibles. Neánmoins, ils sont [11] Tuomilehto H, Kokki H, Ahonen R, Nuutinen J. Postoperative behavioral changes in children after adenoidectomy. Arch Otolaryngol Head Neck ´ ´ significativement plus eleves chez les enfants subissant une Surg 2002;128:1159–64. adeńoı¨dectomie simple, que lorsque le geste est associe´ a` une [12] Wright kd, Stewart SH, Finley GA, Buffett-Jerrott SE. Prevention and pose d’ae´rateurs transtympaniques. intervention strategies to alleviate preoperative anxiety in children: a Dans les trois groupes, les parents rapportent de fre´quents critical review. Behav Modif 2007;31:52–79. troubles du comportement, principalement une sollicitation [13] Kain ZN, Caramico LA, Mayes LC, Genevro JL, Bornstein MH, Hof- stadter MB. Preoperative preparation programs in children: a comparative ` ´ ´ parentale accrue et des coleres, malgre une analgesie correcte. examination. Anesth Analg 1998;87:1249–55. Le recueil syste´matique des troubles comportementaux post- [14] Watson AT, Visram A. Children’s preoperative anxiety and postoperative ope´ratoires est reálisable graˆce au PHBQ. L’utilisation plus behaviour. Paediatr Anaesth 2003;13:188–204. This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier’s archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright Author's personal copy

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 aoutˆ 2007 Disponible sur Internet le 26 décembre 2007

MOTS CLÉS Résumé Il a été démontré qu’il existe chez l’adulte une forte association entre la migraine, Migraine ; la dépression majeure et certains troubles anxieux. Chez les enfants et les adolescents, il n’y Mal de tête ; a pas de revue de la littérature récente portant spéciﬁquement sur la migraine, l’anxiété et la Enfant ; dépression. On a recherché pour ce travail les études publiées sur cette question depuis le début Adolescent, Anxiété ; des années 1980. Elles devaient préciser les critères diagnostiques de la migraine et utiliser un Dépression questionnaire validé pour l’évaluation de l’anxiété ou de la dépression. Les onze articles retenus 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.

Summary KEYWORDS Introduction. — The authors review the literature on anxiety and depression in children Migraine; and adolescents who experience migraine headaches. For over a century, clinicians and Headache; researchers have noticed potential links between migraine and certain psychopathological Child; traits. More recently, rigorous methodological studies have conﬁrmed some of those links.

∗ Auteur correspondant. Adresse e-mail : [email protected] (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 Adolescent; work has thoroughly reviewed the literature specifically on the topic of migraine, anxiety, and Anxiety; depression. 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. © L‘Encéphale, Paris, 2008.

30 à 40 % des cas, la crise de migraine est précédée par une Introduction aura visuelle, auditive, sensitive et/ou motrice. En présence de ce trouble neurologique focal et réversible, on parle de La migraine chez l’enfant et l’adolescent est une patho- migraine avec aura (MAA) par opposition à la migraine sans logie méconnue et sous diagnostiquée [4]. C’est pourtant aura (MSA). la première cause de céphalée récurrente chez l’enfant Depuis plus d’un siècle, les cliniciens et les cher- avec une prévalence de5à10%selon les études [1,2].En cheurs ont noté l’existence de possibles liens entre 1988, l’International Headache Society (IHS) a validé des la migraine et certaines caractéristiques psychologiques critères diagnostiques précis de la migraine qui ont été révi- comme la tendance à la dépression et à l’anxiété. Plus sés en 2004 (Cf. Tableau 1). La sémiologie migraineuse chez récemment, des études d’une plus grande rigueur métho- l’enfant est proche de celle de l’adulte hormis la localisation dologique ont conﬁrmé certains de ces liens. Chez les bilatérale des céphalées et la durée plus courte des crises. adultes migraineux, on a démontré une forte association La classiﬁcation IHS distingue deux grands types de céphalée entre migraine/céphalées de tension et dépression/anxiété primaire, la migraine et la céphalée de tension (CDT). Dans [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 dache, anxiety, depression, child, adolescent. Les articles, cette question. Les travaux de Karwautz et al. et de Mar- pour être retenus, devaient avoir été publiés en anglais, tin et al. ne portent pas spécifiquement sur anxiété et/ou allemand ou français, porter sur la migraine chez l’enfant dépression, mais sur les troubles psychopathologiques en et l’adolescent, préciser les critères diagnostiques de la général [10,14]. Les articles sélectionnés pour ces revues migraine et utiliser un questionnaire validé pour l’évaluation de la littérature ne prennent pas toujours en compte les dimensionnelle de la dépression ou de l’anxiété. Nous critères I.H.S. En outre, elles comparent des études compor- avons choisi de sélectionner les articles utilisant le CBCL tant des questionnaires validés d’évaluation de la dépression qui un gold standard dans les pays anglo-saxons dans et de l’anxiété avec des études aux critères méthodolo- l’évaluation des troubles psychopathologiques chez l’enfant giques moins précis où, bien souvent, le questionnaire a et l’adolescent, et ce bien que celui-ci n’ait pas d’échelle été construit à l’occasion de cette recherche. Powers et qui distingue l’anxiété de la dépression. 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 Résultats enfants céphalalgiques [18]. Ces derniers n’étant pas néces- sairement migraineux, il est donc difficile de suivre les Compte tenu de nos critères de recherche, onze articles conclusions de ces auteurs. 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. Méthode Le faible nombre d’études et la diversité des modalités d’évaluation ont empêché la conduite d’une méta-analyse. L’objectif de ce travail est de faire une revue de la littéra- Le Tableau 2 résume les principales caractéristiques métho- ture sur les troubles anxieux et dépressifs chez les enfants dologiques de ces études. Toutes précisent les critères et les adolescents migraineux. Nous avons repris la litté- diagnostiques de la migraine et utilisent un ou plusieurs rature sur le sujet de janvier 1980 à janvier 2007 dans questionnaires validés des domaines d’évaluation (dépres- les moteurs de recherches suivants : Pascal/INIST-CNRS, sion et anxiété). Parmi ces articles, dix ont un groupe PsychInfo et Medline. Les mots clés étaient : migraine, hea- 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

vaux ont une population issue d’un échantillon représentatif : : de la population générale. La majorité de ces travaux ont Pop

CSI-4 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.

: clinique ; La dépression chez l’enfant et l’adolescent

Clin 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 : Personality Inventory for Children ; la population générale sont les suivantes : Anttila et al. ont PIC évalué avec le CDI et le CBCL 183 sujets issus d’une population 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-

: Test Anxiety Inventory. tion de 2000 sujets de neuf à 12 ans [11], et Laurell et al.

: Children’s Depression Rating Scale ; ont évalué avec le C.B.C.L. 126 sujets issus d’une population TAI de 1371 enfants ﬁnnois âgés de sept à 17 ans [13]. Aucune

CDRS 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 population 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 : International Headache Society ; des scores supérieurs à l’échelle de dépression du PIC-R chez IHS 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

: Children’s Depression Inventory ; les enfants migraineux avaient un score supérieur à celui du groupe contrôle pour le CBCL [7,9,15]. CDI Par ailleurs, deux travaux parmi les sept études prospectives contrôlées en population clinique ne trouvent pas de : State and Trait Anxiety Inventory for Children ; différence entre le groupe migraine et le groupe contrôle

STAIC pour la dépression. C’est le cas de l’étude de Smith et al.

: Depression Self Rating Scale ; [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

DSRS 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 population sur laquelle le C.D.I. a été validé en Italie [12]. : Children’s Behavior Check-List ; Migraine CDT Autre Contrôle

CBCL L’anxiété chez l’enfant et l’adolescent migraineux : céphalée de tension ; De même que pour la dépression, les trois études contrôlées

CDT portant sur des sujets issus de la population générale n’ont

: Revised Child Manifest Anxiety Scale ; 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 R-CMAS l’échelle d’anxiété—dépression du CBCL [5,13], et une le R-CMAS [11].

Caractéristiques méthodologiques des études sélectionnées. 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 : Adolescent Symptom Inventory-4 ; d’Andrasik et al., les enfants migraineux de plus de 13 ans avaient des scores supérieurs au STAIX par rapport aux population générale ; RéférenceMazzone et al., 2006Laurell et al., 2005Pakalnis et al., 2005Antilla et al., 2004Just IHS et Oui al., 2003Smith et al., 2003 OuiLanzi et Oui al., Nombre 2001 67 deKowal sujets et al., 1990 OuiAndrasik et 42 al., 1988 47Cooper et al., 1987 OuiCunningham et Oui 59 al., 1987 47 Oui 103 Non 37 Non 179 Non — Non 41 — 65 23 32 20 — 25 39 — — 36 16 — — — 49 Âge — — 92 30 — 59 — 6—16 Échantillon — — 83 20 32 7—17 — Clin Pays — 23 6—17 32 Pop 20 10—14 Clin 39 Pop 6—18 11—18 Échelles d’évaluation Italie Clin Clin 8—18 Suède 9—12 8—17 États-Unis Clin 9—17 Pop Clin Finlande 6—16 Clin CBCL, CDI, R-CMAS Clin ASI-4, CSI-4 Allemagne États-Unis CBCL CBCL, CDI Italie CBCL, CDI, CDI STAIC Australie États-Unis Canada Canada CDI, CDRS, CDRS, BDI, R-CMAS, STAIC, STAIX, CDI, PIC TAI CBCL, CDRS, STAIC R-CMAS, STAIC, PIC Tableau 2 ASI-4 Children Symptom Inventory-4 ; enfants du groupe contrôle [3]. Une autre étude a trouvé Author's personal copy 508

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. Rousseau-Salvador C. Amouroux, R. 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 drome distinct. Selon Merikangas et al., dans la majorité STAIC supérieurs à ceux des enfants présentant une fatigue des cas, des troubles anxieux dans l’enfance précèderaient chronique et à ceux du groupe contrôle [21]. Pakalnis et al. la migraine, puis la dépression suivrait la migraine à l’âge rapportent l’existence de scores d’anxiété (CSI-4 et l’ASI-4) adulte [16]. Waldie et al. ont quant à eux mené une étude signiﬁcativement supérieurs chez les enfants et adolescents prospective où ils ont suivi une cohorte de 980 enfants pen- migraineux par rapport à des sujets contrôle [17]. Enﬁn, trois dant 23 ans [22]. L’anxiété durant l’enfance, évaluée au études utilisant le CBCL ont trouvé que les enfants migrai- niveau dimensionnel et catégoriel, était un facteur de risque neux avaient un score supérieur à celui du groupe contrôle de migraine à l’age adulte. Cette hypothèse offre l’avantage [7,9,15]. Une seule étude contrôlée en population clinique de rendre en partie compte de l’évolution de la comorbi- ne trouve pas de différence de ce type [6]. dité entre migraine et anxiété/dépression entre l’enfance Concernant l’étude prospective non contrôlée de Lanzi et l’âge adulte, mais elle demanderait à être étayée par de et al., seuls les sujets de 15 à 18 ans avaient un score au TAI nouvelles études. supérieur à celui de la population sur laquelle le TAI a été validé en Italie [12]. Recommandations pour des futures études

Discussion Ce travail proposait une revue de la littérature concernant migraine, anxiété et dépression dans la migraine de Migraine anxiété et dépression l’enfant. Les études devaient préciser les critères diagnostiques de la migraine et utiliser un questionnaire validé pour l’évaluation de l’anxiété et/ou de la dépression. Onze Aucune des trois études contrôlées menées en popula- articles ont satisfait les critères d’inclusion retenus. tion générale n’a pu déterminer de différences entre les À l’issue de cette revue de la littérature, trois critères groupes pour l’anxiété comme pour la dépression. La majo- nous semblent importants à retenir pour les futures études rité des études conduites sur une population clinique trouve sur la comorbidité entre migraine et troubles psychopa- des scores légèrement supérieurs pour le groupe migraine thologiques : la spécificité du diagnostic de migraine, la par rapport au groupe contrôle, et ce pour au moins un représentativité de la population étudiée et la validité des des scores d’anxiété et de dépression. Néanmoins, dans outils d’évaluation des troubles psychopathologiques. toutes ces études, les enfants migraineux n’ont pas de Le diagnostic de la migraine pose problème dans de scores pathologiques, puisque les scores aux échelles ne nombreuses études citées. La distinction entre migraine et dépassent pas les seuils cliniques des études de valida- céphalée de tension n’est pas toujours claire, même quand tion. Il s’agit donc pour la majorité d’entre eux de niveaux les critères IHS sont utilisés. Le groupe de sujets migraineux d’anxiété et dépression supérieurs à la norme, plutôt que comprend ainsi souvent des enfants et adolescents porteurs de troubles psychopathologiques avérés. Certains auteurs de diagnostics disparates. Les futures études devraient se parlent ainsi de « troubles subcliniques » [15]. Une seule référer aux critères I.H.S. révisés de 2004. étude a couplé l’évaluation dimensionnelle effectuée avec Les enfants migraineux de ces études proviennent un questionnaire à une évaluation catégorielle consistant presque toujours de consultations céphalée hospitalières. en des entretiens diagnostiques [17]. Dans ce travail, les Ils constituent une population particulière, probablement enfants ayant des scores hautement prédictifs pour l’anxiété peu représentative de l’enfant migraineux en population et la dépression ont été évalués lors d’entretiens semi- générale. Les futures études devraient limiter autant que directifs par un psychiatre ou un psychologue afin de possible les biais de recrutement. confirmer le diagnostic. Aucune différence n’a pu être mise Les questionnaires utilisés contiennent souvent des items en évidence au niveau catégoriel. Ainsi la contradiction portant sur certains symptômes associés à la migraine entre les résultats issus de la population générale et ceux (céphalée, nausée, vomissement...). La question de la vali- de la population clinique pourrait s’expliquer par un biais de dité de ce type de questionnaire avec des enfants et recrutement. Les études en population clinique recrutent adolescents migraineux a été contestée par certains auteurs en effet leurs sujets au sein de « consultations céphalée » [8]. Le recours à des questionnaires créés pour l’occasion ou spécialisées. On peut donc émettre l’hypothèse que la dif- qui portent sur des notions floues, comme celle de troubles férence observée est liée au fait que les enfants fréquentant psychosociaux, est à bannir. Les futures études devraient ces consultations présenteraient des troubles suffisamment utiliser des questionnaires spécifiques de l’évaluation du invalidants pour venir consulter, ce qui ne serait pas le reflet trouble et validés pour la population étudiée. Enfin, il serait de la majorité des sujets migraineux. souhaitable de coupler l’évaluation dimensionnelle à une L’association entre migraine et anxiété/dépression ne évaluation catégorielle pour déterminer si l’augmentation semble pas aussi forte chez l’enfant que chez l’adulte. éventuelle d’un score se traduit par un syndrome clinique Ces résultats contrastent en effet fortement avec ceux spécifique. 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 Conclusion ont proposé différentes hypothèses concernant les causes sous-jacentes (biologiques et/ou psychosociales) de cette Les articles retenus ne permettent pas de conclure qu’il comorbidité entre la migraine, la dépression et l’anxiété existe chez l’enfant une comorbidité entre migraine, chez l’adulte [19]. Certains ont ainsi développé l’idée que anxiété et dépression. Les études en population générale la migraine avec anxiété/dépression pourrait être un syn- 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 [9] Just U, Oelkers R, Bender S, et al. Emotional and behavioural clinique portant sur des enfants migraineux trouve des problems in children and adolescents with primary headache. scores supérieurs, mais non pathologiques, pour l’anxiété Cephalalgia 2003;23:206—13. et la dépression par rapport à un groupe contrôle. Ces [10] Karwautz A, Wober C, Lang T, et al. Psychosocial factors résultats contrastent avec ceux obtenus dans les revues in children and adolescents with migraine and tension-type headache: a controlled study and review of the literature. de la littérature chez l’adulte où l’association entre Cephalalgia 1999;19:32—43. migraine, anxiété et dépression a été clairement établie. [11] Kowal A, Pritchard D. Psychological characteristics of children D’autres études pourraient être menées afin de confirmer who suffer from headache: a research note. J Child Psychol et d’expliquer la contradiction entre les résultats chez Psychiatry 1990;31:637—49. l’enfant et chez l’adulte. Ces études devraient se référer [12] Lanzi G, Zambrino CA, Ferrari-Ginevra O, et al. Persona- aux critères diagnostiques IHS de la migraine, s’assurer de lity traits in childhood and adolescent headache. Cephalalgia la représentativité de la population étudiée, utiliser des 2001;21:53—60. questionnaires validés et spécifiques pour l’évaluation de [13] Laurell K, Larsson B, Eeg-Olofsson O. Headache in school- l’anxiété et de la dépression et suivre les enfants de façon children: association with other pain, family history and prospective. psychosocial factors. Pain 2005;119:150—8. [14] Martin SE, Smith MS. Psychosocial factors in recurrent pediatric headache. Pediatr Ann 1995;24:464—74. Références [15] Mazzone L, Vitiello B, Incorpora G, et al. Behavioural and temperamental characteristics of children and adolescents suf- [1] Abu-Arefeh I, Russell G. Prevalence of headache and migraine fering from primary headache. Cephalalgia 2006;26:194—201. in schoolchildren. BMJ 1994;309:765—9. [16] Merikangas KR, Stevens DE. Comorbidity of migraine and psy- [2] Al Jumah M, Awada A, Al Azzam S. Headache syndromes chiatric disorders. Neurol Clin 1997;15:115—23. amongst schoolchildren in Riyadh, Saudi Arabia. Headache [17] Pakalnis A, Gibson J, Colvin A. Comorbidity of psychiatric 2002;42:281—6. and behavioral disorders in pediatric migraine. Headache [3] Andrasik F, Kabela E, Quinn S, et al. Psychological functio- 2005;45:590—6. ning of children who have recurrent migraine. Pain 1988;34: [18] Powers SW, Gilman DK, Hershey AD. Headache and psycho- 43—52. logical functioning in children and adolescents. Headache [4] Annequin D, Tourniaire B, Dumas C. La migraine pathologie 2006;46:1404—15. méconnue chez l’enfant. Arch Pediatr 2000;7:985—90. [19] Radat F, Swendsen J. Psychiatric comorbidity in migraine: a [5] Anttila P,Sourander A, Metsahonkala L, et al. Psychiatric symp- review. Cephalalgia 2005;25:165—78. toms in children with primary headache. J Am Acad Child [20] Silberstein SD, Lipton RB, Breslau N. Migraine: association with Adolesc Psychiatry 2004;43:412—9. personality characteristics and psychopathology. Cephalalgia [6] Cooper PJ, Bawden HN, Camfield PR, et al. Anxiety and life 1995;15:358—69. events in childhood migraine. Pediatrics 1987;79:999—1004. [21] Smith MS, Martin-Herz SP, Womack WM, et al. Comparative [7] Cunningham SJ, McGrath PJ, Ferguson HB, et al. Personality study of anxiety, depression, somatization, functional disabi- and behavioural characteristics in pediatric migraine. Hea- lity, and illness attribution in adolescents with chronic fatigue dache 1987;27:16—20. or migraine. Pediatrics 2003;111:e376—81. [8] Harris ES, Canning RD, Kelleher KJ. A comparison of measures [22] Waldie KE, Poulton R. Physical and psychological correlates of of adjustment, symptoms, and impairment among children primary headache in young adulthood: a 26 year longitudinal with chronic medical conditions. J Am Acad Child Adolesc Psy- study. J Neurol Neurosurg Psychiatry 2002;72:86—92. chiatry 1996;35:1025—32. Gesnerus 61 (2004) 24–36

«Le précieux livre de W. Bölsche» Freud et la culture évolutionniste allemande du début du XXe siècle*

Rémy Amouroux

Summary

Wilhelm Bölsche (1861–1939) is the author of a poetic history of the evolution 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 ([email protected]).

24 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 XXe en 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.

25 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»4 publié 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.

26 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 probablement 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 singulier: 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.

27 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’anatomie 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.

28 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’ornithorynque 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-

29 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 XXIe siècle. Comme nous l’avons déjà signalé, Bölsche, loin d’être marginal, constitue l’auteur vulgarisateur phare du début du XXe siècle 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.

30 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.

31 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 fondateur 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.

32 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’animaux,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 composantes 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 certaines 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.

33 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.

34 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 allemande scientifique et populaire du début du XXe siècle. 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 scientifiques 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 XXe siècle, ce qui inclut l’étude de vulgarisateurs scientifiques.

33 Schmidt 1964.

35 Bibliographie

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