The city of nervous splendor 

Stand on the Ringstrasse in 1900 and you are standing on a demolished wall. Vienna had pulled down its fortifications in the 1860s and replaced them with a ring boulevard of parliament buildings, museums, an opera house and a university, each dressed in a different borrowed style: Greek for democracy, Gothic for the town hall, Renaissance for art. It was a capital insisting in stone that it was modern, at the centre of an empire that was visibly coming apart.

The city was crowded and cosmopolitan, its population swollen past two million by arrivals from every province of Austria-Hungary. It was also, at the same moment, producing Gustav Mahler's symphonies, Gustav Klimt's gold, Arthur Schnitzler's plays about desire, Adolf Loos's arguments against ornament and Ludwig Wittgenstein's childhood. Coffee houses functioned as the city's offices and seminar rooms. You could sit for hours over one cup, read a dozen newspapers, and hear someone at the next table dismantle a reputation.

Underneath the confidence ran an anxiety the period gave a medical name. Doctors across Europe and America diagnosed neurasthenia, a nervous exhaustion supposedly produced by modern life: railways, telegrams, city noise, sexual repression, ambition. Wealthy patients took rest cures, electrical treatments, cold water, massage and mountain air. Symptoms that would now be described as anxiety, depression or trauma were treated as failures of an overtaxed nervous system, and often as failures of character.

One group carried the diagnosis more than any other. Middle-class women arrived at consulting rooms with paralysed limbs, lost voices, coughs, tremors and blindness that no lesion explained. The label was hysteria, an old word from the Greek for womb, and the mainstream response was to manage the body: rest, electricity, sometimes surgery. Few doctors thought the symptoms carried meaning worth hearing out.

It matters that this was Vienna specifically. The city's Jewish middle class, from which many of psychoanalysis's first practitioners came, had been emancipated within living memory and was climbing fast into medicine, law and journalism while a newly organised political antisemitism gathered force in the same streets. Careers were built with the knowledge they could be blocked. That combination, ambition plus insecurity, tends to produce people willing to work outside official approval.

So the setting was a wealthy, brilliant, self-conscious city with a large population of suffering patients and a medical profession running out of explanations. What it lacked was anyone prepared to treat those symptoms as messages rather than malfunctions.

In a consulting room at Berggasse 19, a neurologist trained on the anatomy of eels and nerve cells was about to try exactly that.