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With Freud's famous case of 'Dora' as foreground the author develops a multi-dimensional landscape of fin-de-siècle Vienna. The reader is provided with a wealth of information about the social, political, cultural, and medical climate in which Freud and his patient lived. Dora (whose real name was Ida Bauer) came from parents who were well-to-do Jewish bourgeoisie moving in the same circles as Freud who knew both Herr Bauer and the K's, as Freud referred to them. The author richly develops the background history of both families as well as Freud's, providing the reader with a panoramic view of the Austro-Hungarian Empire which dominated Central Europe in the nineteenth century up until the First World War, paying special attention to the precarious position of the Jews in Central Europe during that period.
Hannah Decker has more in mind than just setting the socio-cultural stage for the confrontation between Freud and Ida Bauer in 1900. The author clearly espouses the aetiological importance of family dynamics and cultural factors in pathogenesis. Frau Bauer's compulsive cleanliness is interpreted as a hostile and revengeful reprisal for the chronic gonorrhoea she contracted from her husband, for his affair with Frau K, for her daughter Ida's contempt, and for being forcibly removed away from her family (p. 55). While these interpretations may sound plausible, they are not valid aetiological factors of an obsessional neurosis in any psychoanalytic sense.
Analytic readers are likely to have similar difficulty with the author's methodology when she includes not only psychological factors in the aetiology of hysteria but also refers to a social component: 'Hysterical symptoms were physical manifestations of the anger and assertiveness a Victorian woman was encouraged not to express openly … women could express their dissatisfactions via physical illness and stay within the confines of appropriate and acceptable feminine behavior' (p. 71). This is not a new thesis