(1993). Brit. J. Psychother.

, (9)(4):436-443

Sandor Ferenczi's Analysis of ‘R.N.’: A Critically Important Case

in the History of Psychoanalysis

Christopher Fortune 

The recent publication of Sandor Ferenczi's Clinical Diary (1988), written in 1932,
is a rich source of material on Ferenczi and his last ideas. The diary has given us
access to Ferenczi's most intimate thoughts and feelings about his therapeutic
work and his relationship with Freud. It has also revealed unknown aspects of
Ferenczi's life and work: his experiment in mutual analysis, his discovery of his
own early childhood traumas, and a detailed look at the therapeutic process
which culminated in his final published papers, specifically his radical classic,
‘Confusion of Tongues Between Adults and the Child’ (1933). Along with
historical perspectives on Ferenczi, the diary has also introduced a number of
Ferenczi's last patients, most particularly ‘R.N.’, the critically important, yet
virtually unknown woman whose analytic treatment dominated Ferenczi's final
years.

‘R.N.’ was Ferenczi's code-name for Elizabeth Severn, an early American

‘psychotherapist’ whose chronic symptoms and desperate mental state led her
to seek the help of the famous Hungarian analyst. Severn's case - as R.N. - fills
the diary's pages and establishes her profound influence on Ferenczi, and her
role in his final radical challenge to classical psychoanalysis and to Freud
himself. His ‘principal patient’, Severn was in analysis with Ferenczi in Budapest
for eight years - from 1924 until just before his death in 1933. Elizabeth Severn's
case and her analytic relationship with Ferenczi is an important paradigm case,
a pivotal point in the history and development of psychoanalysis in the tradition
of Anna 0 and Dora. Through her initiation of the experiment in mutual
analysis, Severn was the catalyst for Ferenczi's recognition of the clinical
significance of countertransference (Wolstein 1989). She was also a critical
factor in his early understanding of the dynamics of childhood sexual trauma,
including his own. This understanding led Ferenczi to reconsider Freud's early
trauma theory; in doing so, he challenged Freud and questioned
psychoanalysis' emphasis on unconscious fantasy. In fact, Elizabeth Severn may
have been the first sexually abused analysand whose actual childhood trauma

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was the focus of psychoanalytic treatment since Freud abandoned his so-called
‘seduction theory’ in the late 1890's (Fortune 1989, 1993).

In this paper, I will present a brief historical-biographical overview of Elizabeth

Severn and her complex clinical relationship with Sandor Ferenczi. Through my
research, I have been able to clarify Elizabeth Severn's identity as well as correct
existing mistakes in the literature.

Christopher Fortune is a Doctoral Fellow of the Social Sciences and Humanities

Research Council of Canada in Applied Psychology at the University of Toronto
(Ontario Institute for Studies in Education). Address for correspondence: 11
Hummingbird Lane, Bowen Island, BC, Canada VON 1GO.

Preparation of this paper was supported by the Social Sciences and Humanities
Research Council of Canada.

436

Beyond his case descriptions of R.N. in the diary, Sandor Ferenczi provided few
biographical details about Elizabeth Severn. It was not until fifty years later, in
The Assault on Truth, that Jeffrey Masson (1984) drew attention to the mysterious
Elizabeth Severn* and speculated about her role in Ferenczi's controversial
ideas on truma. It was Masson's book, and a series of other events discussed in
detail elsewhere (Fortune, in preparation), which sparked my interest and led
me to investigate the question: who was Elizabeth Severn and how did she
come to take on this importance in Ferenczi's work?

Elizabeth Severn was born in 1879 in a small town in the American Mid-West. A
sickly child, she was plagued with fears and anxieties. Throughout her
childhood and teenage years she continued to be subject to chronic fatigue,
violent headaches and eating disorders. As a young adult, Severn had several
nervous breakdowns, recovering from them in sanitoriums. Medical treatment
provided only temporary relief. An early marriage failed, which left her with a
daughter. After a major breakdown in 1905, in her mid-twenties, Severn was
treated for two years by a medical doctor whose practice incorporated
psychological and ‘healing’ techniques based on the ‘power of positive thinking’
and theosophy. Severn became convinced she had healing powers herself, and
on completion of her treatment she began to work as a metaphysical therapist.

In 1913, after moving to London and setting up a ‘psychotherapy’ practice, she

published her first book Psychotherapy: Its Doctrine and Practice, based on her

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ideas on willpower, dreams, visualisation and telepathic healing. Joining the
Alchemical Society, she was elected an Honorary Vice-President and published
an article, ‘Some Mystical Aspects of Alchemy’ (1914) in the society's journal.
Although she lacked any formal academic or professional credentials, she
identified herself as ‘Elizabeth Severn Phd’ and continued to use the title ‘Dr’
throughout her life.

In 1914 Severn returned to New York where she continued to practice as a

‘psychotherapist’ for the next ten years. In 1917 she published her second book
The Psychology of Behaviour in which she combined her metaphysical
approaches with ideas based upon her emerging interest in psychoanalysis.

Severn's chronic symptoms, including exhaustion, severe depression and

suicidal impulses, continued. She sought help from a number of analysts,
including Otto Rank who had recently arrived from Europe. None of them was
able to alleviate her suffering. In 1924 the 44-year-old Severn was referred to
Sandor Ferenczi who was renowned for his success with other analysts'
incurables. Desperate, and believing that he was perhaps her last hope, Severn
travelled to Budapest later that summer to begin an analytical treatment with
Ferenczi.

Initially, Ferenczi found Severn unpleasant. In his diary (Ferenczi 1932), he

admits to being anxious and in awe of her (p. 97). In his entry for 5 May 1932,
recollecting his first impressions of Severn eight years earlier, Ferenczi wrote (p.
97): ‘[She had] excessive independence and self-assurance, immensely strong
willpower as reflected by the marblelike rigidity of her facial features’.

Even though Ferenczi seems to have felt challenged in his masculinity (p. 97),
the

*It should be noted that in Masson's book, Severn was twice confused with her

daughter Margaret. First, a portrait of Margaret, reproduced in the book, was

misidentified as ‘Mrs. Elizabeth Severn’ (p. 162) and, second, Elizabeth was
described as a dancer; in fact it was her daughter Margaret who was a
professional dance artiste (p. 161).
437

analysis had a promising start and for the next few years Severn divided her
time between Budapest and New York, where she continued to maintain her
psychotherapy practice. Several of her devoted and financially well-off American
patients even followed her to Budapest to continue therapy with her.

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In 1926, after a few years of intensive analysis, Severn's treatment stalled. For
the next two years Severn's case showed little progress. Ferenczi (1928)
experimented with indulgence and elasticity techniques and openly
overcompensated. He wrote: ‘I redoubled my efforts … gradually I gave into
more and more of the patient's wishes’ (Ferenczi 1932, p. 97).

In 1928 a breakthrough came. Utilising relaxation and regression techniques,

including trance states, Severn and Ferenczi lifted a veil of early amnesia and
began to uncover the missing details of Elizabeth's childhood and fragmented
self. They reconstructed the events of a severe case of early abuse. Elizabeth
Severn's father had physically, emotionally and sexually abused her from the
age of one-and-a-half. The recovered unconscious material was horrific and
bizarre. It included Severn's ‘memories’ of having been forced to participate in a
murder, and of being drugged and prostituted to other men. Recording the
case history of ‘R.N.’ in his clinical diary, Ferenczi (1932) wrote that Severn had
made a precarious psychological adaptation to an apparently unbearable
childhood situation: he theorised that she had established a fragile equilibrium
of three split psychic fragments. This tenuous grip on reality was shattered at
age eleven and a half, however, when her father deserted the family, inflicting a
final horrific shock upon the already severely traumatised child. He had ‘cursed’
Elizabeth, a further act of terror which left her in a state of almost total psychic
disintegration, with severe amnesia about the events (pp. 8-10).

In shock, Ferenczi and Severn grappled with the central question that often
plagues the therapeutic reconstruction and ‘remembering’ of early childhood
trauma: could they believe these disturbing and enigmatic ‘memories’ in all
their graphic detail? Ferenczi wrote that each repetition of the trauma in the
analysis ended with Severn's statement; ‘And still I don't know if the whole thing
is true’ (p. 98). Establishing the reality of the traumatic ‘shocks’-always a difficult
and often impossible task-became the focus of the analysis. (To this day, there
has been no definitive objective corroboration of the extreme details of Severn's
abuse.)

As this nightmare continued to erupt into her consciousness, Elizabeth Severn's

condition became acute. Already Ferenczi's most demanding and difficult
patient, and driven by what Freud called Ferenczi's furor sanandi (rage to cure),
Elizabeth Severn's case occupied much of Ferenczi's attention. He regularly saw
her twice a day - often at her home - for a total of four to five hours. They also
had sessions at weekends and, if necessary, at night. Ferenczi even continued
Severn's analysis during vacations abroad. (While this sounds extreme, at that
time it was not uncommon for some analysts to see patients during their
holidays.)

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Not surprisingly, Ferenczi's behaviour convinced Severn that she had found her
‘perfect lover’ (Ferenczi 1932, p. 98). Faced with this turn of events, Ferenczi
took fright and retreated, all the while interpreting for Severn the negative
emotions that she ought to have felt towards him. Severn countered with
identical interpretations which Ferenczi had to concede were justified (p. xx).

In October 1929 Ferenczi wrote to Groddeck: ‘I am afraid the patients … are

literally trying to overwhelm me’ (Ferenczi & Groddeck 1982, p. 118). Two
months earlier, in August, at the Oxford Congress, Ferenczi (1929) introduced

438

the notions of psychotic splitting and dissociation, acknowledging his debt to

‘discoveries made by our colleague, Elisabeth [sic] Severn, which she personally
communicated to me’ (pp. 121-22).

In June 1930 Severn's condition deteriorated even further. She lapsed into
periodic comas and was unable to look after herself. Alarmed, Ferenczi
admitted her to a sanitorium near Budapest where she rested for four months.
On 21 December that year Ferenczi wrote again to Groddeck (Ferenczi &
Groddeck 1982, p. 122):

My principal patient, the ‘queen’, [is] … exhausting but worthwhile. I

believe I will shortly, or in the not too distant future, be in a position
finally, to announce what it means to complete an analysis.

(Possibly Ferenczi hoped to ‘cure’ Severn to prove to Freud and the

psychoanalytic community that his new technique were effective. He may have
also believed that to ‘complete’ Severn's analysis through these methods would
confirm that actual trauma was the critical aetiological factor in neurosis.)

The only other professional reference that Ferenczi made to Severn was in his
1931 paper ‘Child Analysis in the Analysis of Adults’. He credited Severn with a
perceptive correction to his analytic technique: ‘[Severn said] I sometimes
disturbed the spontaneity of the fantasy-production with my questions and
answers. She thought that I ought to confine my assistance to … very simple
questions instead of statements’ (pp. 133-134).

Sometime in 1929-1930 Severn demanded that Ferenczi allow her to analyse

him. Even with Ferenczi's super-human therapeutic efforts, her analysis had
made little progress in the previous two years. She told Ferenczi that she
suspected he harboured hidden negative feelings - hate and anger - towards
her, which blocked the analysis. Until she analysed those feelings in him, she

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said, the analysis would remain at an impasse. Ferenczi resisted for a year, then
reluctantly agreed to submit to Severn's analysis of him (Ferenczi 1932, p. 99).

On the couch in January 1932, the month he began his clinical diary, Ferenczi
admitted: ‘I did hate the patient [Severn] in spite of the friendliness I displayed’
(p. 99). Braced for the worst, he was surprised by Severn's reaction. He wrote (p.
99):

The first torrent of the patient's affects (desire to die, notions of

suicide, flight) is succeeded … by … relative composure and progress in
the work: attention becomes freer of exaggerated fantasies (p. 11).
Curiously, this had a tranquilizing effect on the patient, who felt
vindicated.

Ferenczi felt afraid, humiliated, and exposed by his self-disclosures, yet he was
intrigued by their positive outcomes (p. 99):

Once I had openly admitted the limitations of my capacity, she even

began to reduce her demands on me. … I really find her less
disagreeable now. … My interest in the details of the analytical
material and my ability to deal with them - which previously seemed
paralyzed - improved significantly.

As well, Ferenczi discovered that through her analysis of him, Severn

strengthened her belief in the reality of her own early traumas. On 31 January
1932 he noted: ‘The first real advances toward the patient's gaining conviction
[of the external reality of the traumatic events] occurred in conjunction with
some genuinely emotionally coloured fragments of the … analysis of the
analyst’ (p. 26).

As a patient, Ferenczi had the valuable experience of being subjected to his own
analytic technique, aspects of which he did not like. ‘The mechanical egocentric

439

interpretation of things by the analyst [Severn] touched me in a highly

disagreeable way’, he wrote, ‘however, this is the method this patient has
learned from me’ (Ferenczi 1932, p. 96).

In summary, through mutual analysis, Ferenczi found that honesty, even

admitting his dislike for Severn, increased her trust, deepened the therapy, and
made him a better analyst for all his patients. He was less sleepy during
sessions and made ‘sincerely sensitive’ interventions. Ferenczi concluded that
the ‘real’ relationship between analyst and analysand can be therapeutic and

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strengthen the therapeutic alliance. ‘Who should get credit for this success?’ he
asks (pp. 99-100). His answer? Himself, for risking the experiment, but
‘foremost, of course, the patient, who … never ceased fighting for her rights’ (p.
101).

Although mutual analysis brought analytical progress and yielded valuable

clinical insights, Ferenczi decided there was some risk in putting himself ‘into
the hands of a not undangerous patient’ (p. 100). As well, he recognised that
the analysis' central concern might be jeopardised; that, by analysing the
analyst, the patient could deflect attention from herself. Needless to say, there
were other practical difficulties. Ferenczi concluded that mutual analysis could
only be a last resort. ‘Proper analysis by a stranger, without any obligation,
would be better’, he cautioned (p. xxii).

Towards the end Ferenczi tried to return to a traditional analytic relationship

with Severn. It proved to be impossible. On 2 October 1932, in his last diary
entry, a discouraged and exhausted Ferenczi wrote (p. 213):

An attempt to continue analyzing unilaterally. Emotionality

disappeared; analysis insipid. Relationship - distant. Once mutuality
has been attempted, one-sided analysis then is no longer possible - not
productive.

Finally, anticipating psychoanalysis' future concern with the therapeutic

relationship, Ferenczi asks: ‘Now the question: must every case be mutual? -
and to what extent?’ (p. 213). Ferenczi's query about mutuality begs another:
what was Elizabeth Severn's experience of mutual analysis? And, as his analyst,
what was Severn's view of Ferenczi? In another study (Fortune, in preparation), I
will elaborate on these questions in detail. Suffice to say at this point that
Elizabeth Severn not only convinced Ferenczi of her trauma but, as his analyst,
helped uncover and persuade him of the significance of his own childhood
traumas.

The experiment in mutual analysis was paradoxical - a brilliant and daring idea,
yet possibly a clinical mistake. It can be viewed from a number of perspectives.
For example, Freud wrote that Ferenczi felt ‘saved’ by Severn's analysis (letter to
Jones, in Masson 1984, pp. 180-181). For Ferenczi, she succeeded where Freud,
as his former analyst, had failed. Yet to what extent did Ferenczi fall under
Severn's spell? Was he so overwhelmed by her power and pathology that he lost
his clinical detachment? By failing to interpret - instead of submitting to -
Severn's demand to analyse him, did Ferenczi undermine her analysis? To what
degree did she influence his belief that his own deep-rooted traumas were the

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source of his psychological suffering? In the end, mutual analysis remains
enigmatic and may have proved to be both a success and a failure.

In his final diary entry, Ferenczi acknowledges Severn's support as critical in his
struggle with Freud: ‘My pupils’ confidence in me could give me a certain
selfassurance; in particular, the confidence of one person who is both a pupil
and a teacher' (p. 212).

440

By the fall of 1932, Ferenczi was a sick man, dying of pernicious anaemia.
Severn herself was desperate. She had no money and was distraught, suffering
from extremes of emotion as she reacted to Ferenczi's necessary withdrawal to
conserve his dwindling strength. She spent another six months in this state of
agitation and despair before she left Budapest for Paris, only a few months
before Ferenczi's death in May 1933. There, she received news of his death.
Shortly after, Severn returned to London where she resumed practising
psychotherapy. There is no record of her comments on the death of her
devoted analyst who, she believed, had ultimately saved her life.

Severn's third book, The Discovery of the Self, begun in Budapest in 1932, was
published in London in the fall of 1933. In it, she attempts to integrate her
earlier ‘psychotherapy’ approaches with her later analytic influences, setting
them within her overarching metaphysical-spiritual beliefs. Although hardly
mentioning him, Severn demonstrates solidarity with Ferenczi. Championing
the primacy of early external trauma, she calls for the recognition of the
dynamics of childhood sexual abuse. She claims that unsettling psychic events,
such as nightmares, simply reflect ‘forgotten facts’ - ‘real’ past traumas (p. 120).
With this position, Severn appears to eliminate any influence of fantasy in
mental disturbance. However, when she then defines ‘reality’ as including
‘psychic reality’ (pp. 120-121), intentionally or not, she posits a more complex
psychic relationship between reality and fantasy. Professionally, the book made
little impact.

In London in the 1930's, Severn was not active in psychoanalytic circles. She did,
however, participate in the Practical Psychology Club and resumed her
association with the metaphysical community.

In 1939 Severn returned to New York, where she lived and practised until her
death in 1959 at 79 years of age. Her status as a lay analyst, her lack of
academic credentials, her own history of mental instability, and the shadow of
controversy over Ferenczi's last work - and possibly even her own unvoiced

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sense of responsibility for his exhaustion and death - no doubt contributed to
her professional psychoanalytic isolation.

Until recently, Severn has been a mysterious figure in psychoanalysis. The few,
often veiled, references to her have frequently conveyed suspicion, even
hostility, regarding her relationship with Ferenczi. The most notable example is
Freud's 29 May 1933 letter to Ernest Jones, in which he discusses Ferenczi a
week after his death (Masson 1984, pp. 180-181, my italics):

[Ferenczi held] the conviction that I did not love him enough, tht I
did not want to recognize his works, and also that I had badly
analyzed him. His innovations in technique were connected with this,
since he wanted to show me how lovingly one must treat one's patients
in order to help them. In fact, these were regressions to the complexes
of his childhood. … He would himself become a better mother, and in
fact found the children he needed. Among them was a suspect
American woman, to whom he devoted four or five hours a day (Mrs.
Severn?). When she left he believed that she could influence him
through vibrations sent across the ocean. He said that she analyzed
him and thereby saved him. (So he played both roles, was both the
mother and the child.) She seems to have produced in him a
pseudologia phantastica, since he believed her accounts of the most
strange childhood traumas, which he then defended against us. In
these disorders was snuffed out his once so brilliant intelligence. But
let us preserve his sad exit as a secret among ourselves.

In his book The Basic Fault Ferenczi's executor, Michael Balint (1968)
characterised Ferenczi's intense work with an unnamed female patient -
identified here as Elizabeth Severn - as a “‘grand experiment” … perhaps the
first of its kind in analytic history’ (p. 112).

441

Elizabeth Severn is one of a number of historical patients, mostly women,

whose contributions to the development of psychoanalysis have recently been
brought to light and re-evaluated (Ellenberger 1991, Kerr 1988, Shamdasani
1990, Swales 1986). For example, Martin Stanton (1991) credits Severn's
influence in Ferenczi's emphasis on trauma on his later technical developments,
specifically the relaxation principle, and on his insights into
countertransference. Furthermore, Wolstein (1989) believes that, in leading
Ferenczi to recognise the clinical importance of countertransference, Severn,
along with Breuer's Anna 0 and Freud's Dora, represents one of the landmark
cases in psychoanalytic therapy (p. 676).

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 Conclusion

The relationship between Elizabeth Severn and Sandor Ferenczi was complex,
problematic and historic. Through it, Sandor Ferenczi was led to question the
foundations of psychoanalysis and to challenge his long-time mentor, Sigmund
Freud. In so doing, he expanded the frontiers of psychoanalytic theory and
technique.

Elizabeth Severn - as ‘R.N.’ - may well be one of the most important patients in
the history of psychoanalysis. Although not the first sexually abused patient to
be analysed, she was, for her time, the most extensively treated one. Her
desperate attempt to piece together a cohesive identity from a self shattered by
her seemingly horrendous childhood experiences induced Ferenczi to risk
radical technical experiments with her - and with himself - that uncovered
unique clinical material probably unavilable to classical analytical technique of
the time. The resulting insights were the prime source for Ferenczi's (1932,
1933) early understanding of the dynamics of sexual trauma - initial shock,
denial (by adults), identification with the aggressor, fragmentation, amnesia,
and body memory - which have only in recent years been recognizd by the
profession. In addition, through Ferenczi's diary, Elizabeth Severn's case
continues to offer significant insights into current theoretical and clinical issues
in sexual abuse - regression, dissociation and multiple personality, for example,
as well as the recovery of early trauma.

Through all his later cases, but particularly through his treatment of Severn,
Ferenczi gained new technical perspectives, many of which are currently the
subject of lively debate within psychoanalysis. Ferenczi stressed re-living, not
just remembering, the early trauma within the analytical relationship. As a
result, he raised the therapeutic significance of this relationship itself. He took
seriously the idea that patient resistance and analytical impasses could be a
function of countertransference. Furthermore, he anticipated the current study
of the role of the analyst's personality, of analyst subjectivity, and of the
benefits and risks of countertransference interpretations and disclosures.

At the Wiesbaden Congress in 1932, Ferenczi presented his revolutionary paper

‘Confusion of Tongues Between Adults and the Child’ (1933) containing many
ideas from his groundbreaking work with Elizabeth Severn. He charged
psychoanalysis with overemphasising fantasy, affirmed that ‘sexual trauma as
the pathogenic factor cannot be valued highly enough’ (p. 161), and called for
reforms in analytic therapy. The paper was dismissed by the psychoanalytic
community. Nine months later Ferenczi was dead. Since he left no method and
no school, much of his radical work was left suspended for over fifty years, only

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recently coming to light with the publication of his clinical diary. The diary also
reveals Elizabeth Severn's critical importance and

442

provides the opportunity to assess more properly her influential role in the
development of Ferenczi's last ideas.

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