Two cases of induced insanity. Helene Deutsch, Cambridge, Mass

"Two cases of induced insanity", hitherto untranslated, was Helene Deutsch's first (1918) psychoanalytic paper; she presented Freud with a copy of it during the beginning of her analysis with him. As an experienced clinician who had studied under both Wagner von Jauregg in Vienna and Emil Kraepelin in Munich, Deutsch observed these cases during World War I as the University of Vienna's psychiatric facilities. Although the general reading public knows her best for her The Psychology of Women, she also wrote some well-known clinical papers; and it is characteristic of her that she brought these two cases without excessive theoretical speculation. In "Two cases in induced insanity" Deutsch described some of the strains of the wartime situation, and how whole families could join in hysterical confabulations in order to cope with emotional distress. One of her most famous later clinical contribution had to do with the emotional impoverishment of 'as if' personalities and their specific suggestibility. In other papers she continued her early concern with disturbed identification. As one examines Deutsch's work it is possible to fill out the history of psychoanalytic psychology. Without ignoring her later increase in theoretical sophistication, in "Two cases of induced insanity" we find Deutsch remarkably tolerant in her willingness to suspend judgement about the sources and fate of morbid thinking. A key therapeutic recommendation of hers was to separate the family members to allow their reality to return. Like some recent critics of undue diagnostic name-calling she advocated hesitation in discerning of disease entities as well as cautionary approach to treatment. The nature of familial love may leave everyone "normal" prone to disturbances which are not necessarily to be treated as a psychiatric illness. This example of one of Deutsch's first professional essays reflects the early thinking of a giant in psychoanalysis. She followed Freud in the conviction that the exceptional can highlight the everyday. The paper is a tentative groping and illustrates how far she came when she published her mature work.