The rape that made Theranos

On Elizabeth Holmes, Freud, sexism, and transference

Warning: Discussion of sexual violence. Also, spoilers! If you haven’t yet seen The Dropout on Hulu, you may want to watch it before reading this.

Hulu’s The Dropout gives a dramatized account of the rise and fall of Elizabeth Holmes, the Theranos founder who lied to investors and the public about her company’s ability to provide medical diagnoses. At its height, Theranos had a $10 billion valuation, based on its claims to use a small amount of blood to provide diagnoses for a range of medical conditions. But after the company’s claims proved to be false, resulting in false positives for many patients (including for HIV, cancer, and miscarriage), Holmes and her associates have faced a number of criminal charges.

The first episode of the show depicts Holmes’s first year at Stanford, including a party where she was raped. Holmes reported the attack, but no disciplinary or criminal action was taken against the perpetrator. Holmes considers leaving Stanford and tells her mother in the show, “I can’t get anyone to believe me.”

Her mother tells her, “Men will… take and… take from you. So you have to decide right now if you are going to let that stop you.”

Holmes asks her mother how.

Her mother responds, “You just put it away and forget it. And then one day, one day, you’ll be fine again.”

The show brings us back to this conversation in its final episode. And to make sense of the return, it can be helpful to explore the Freudian idea of transference.

Transference: two types

Freud’s views are significantly developed through his work with a patient he names Dora. Dora claimed to have been sexually propositioned by a married man named Herr K, and in response she slapped him in the face. Herr K denied this happened, and Dora’s father refused to believe her. Dora eventually wrote a suicide note and fainted, which prompted her father to send her to Freud.

Freud saw Dora for a time, but his treatment was cut short. Philosopher and psychoanalyst Jonathan Lear, commenting on this, writes that Dora’s abrupt ending of treatment was “a metaphorical slap to Freud” and provides a basis for the exploration of transference: “[Freud] was aware that Dora was treating him like her father, but that blinded him to an association she was making between him and Herr K.” Freud himself writes of it:

“[T]he transference took me unawares, and, because of the unknown quantity in me which reminded Dora of Herr K, she took her revenge on me as she wanted to take her revenge on him, and deserted me as she believed herself to have been deceived and deserted by him. Thus she acted out an essential part of her recollections and phantasies instead of reproducing them in the treatment.”

Freud saw Dora as transferring her feelings towards Herr K and her father onto himself. As he and Dora explored her past troubles, they came alive for Dora, and Freud became the subject of them.

But Lear argues that this is just one type of transference, something which Freud seems to become aware of as his views develop over the course of his career. In a second type, transference can also take place through the experiential frameworks one develops over time. What can be transferred is not just a specific feeling in a certain kind of situation, but also a web of meanings established through certain set roles. Lear writes:

“[I]t is a hallmark of Dora’s predicament that she has a relatively limited, although idiosyncratic, set of roles in terms of which she experiences people and events. She quells her own anxiety, calms herself, by experiencing the world in a familiar pattern. She thus has a tendency to experience people as though they are occupying fixed positions.”

For example, Dora has established Herr K as occupying a key role in the world. When Dora encounters new persons, one role that she might read that person through is the the role that Herr K established: an older man seeking to take advantage of her, and which she must thoroughly reject. In a world of ambiguity, where new persons are met all the time, having a set list of roles can help alleviate anxiety, injecting a familiarity into others that allows Dora to quickly decide how to respond to them.

This can also be helpful for making sense of why the culture wars are both appealing and calming for many. The culture wars present a simplified narrative of the world that alleviates the discomfort that comes along with ambiguity and complexity. It is more comforting to be able to quickly classify another as an ally or an opponent than it is to encounter another as a full complex person who might surprise us or challenge our perceptions.

And this is relevant to a young man I recently heard had described religion as "inherently harmful" and "the opiate of the masses." This description was based on his own adverse religious experiences. It may be true that this is the experience of religion for many. The problem, however, is that the universalizing of his own experiences inhibits his ability to understand or take seriously others who may relate to religion in other ways. (Not to mention that this view is, by definition, Islamophobic and anti-Semitic, something which the self-described progressive young man likely does not realize.)

Transference: a third type

Lear goes beyond Freud in arguing for a third type of transference, “transference as the breakdown of a world.” In making sense of this type of transference, Lear notes how anger has a developmental history that might include failures of development through outbursts. So in a hypothetical case based on Dora, Lear argues that someone might find feelings of anger very uncomfortable, become flooded with anxiety, and then have an angry-outburst as a way of disrupting her angry feelings. That is, when hypothetical Dora becomes overwhelmed with feelings of anger, rather than processing those feelings, hypothetical Dora shocks herself out of experiencing anger through an outburst. “[S]he disrupts this process by overwhelming herself with anxiety. In this way she also disrupts her own emotional development.”

A slap for hypothetical Dora, whether physical or metaphorical, thus becomes the default response when she has feelings of anger that lead to anxiety. Lear writes:

“Dora has been reacting to anxiety since childhood with angry outbursts. This has had the unfortunate consequence of inhibiting the development of anger as a mature emotion. So, at eighteen, she still has few emotional resources with which to respond to anxiety. As anxiety rises, she still tends towards (immature) angry outbursts. And thus while one can say ‘She slapped him because she was angry at him’ and ‘She was angry at him because he propositioned her,’ it does not follow that his propositioning her is the reason for her anger. Rather, his proposition is the occasion for the outbreak of overwhelming anxiety, and the anxiety triggers a massive, angry reaction. The reaction is strategic - it breaks an anxiety-provoking situation apart - and thus we can consider it a defense. But the anger is not mature enough to make a real claim for its own reasonableness. She lacks the thoughtful resources through which she can experience her own emotions as warranted.”

This is a process (or, rather, a failure of process) with which I have personal experience. In my early twenties, I had thought I struggled with depression. I would have periods where I experienced flat affect, debilitating lethargy, and a response to difficult situations where I would need to lie down or go to sleep to make those situations “go away.” Through therapy, however, I was able to discover that my primary problem was not depression. Instead, I struggled with anxiety. When I experienced significant interpersonal conflicts, at times I would not be able to process them and would experience the onset of anxiety. And when the anxiety became overwhelming, I had conditioned myself to a response where I would shut down completely. What would often happen is I would experience a difficult situation and, rather than processing the situation, anxiety would kick in and become overwhelming, and the anxiety would then be replaced with a depressed state. Both the anxiety and the depressed state served as sorts of defense mechanisms to help me escape situations and forms of processing for which I was not prepared. Through therapy, I was able to dig into these defense mechanisms, question why certain situations provoked them, and start facing that which would be emotionally debilitating for me.

I suspect that this type of failure of process, this third type of transference, is common for people with religious trauma, especially those from Christian backgrounds who struggle to accept, for example, same-sex desires. The rise of anxiety or depression when such desires arise can be away of avoiding such desires. Because of this, sexual desire is not really processed or developed. Instead, anxiety or depression serves to block development. The development of virtue is thus prevented, and one is stuck in an essentially hedonistic state.

It is important to note that psychological life is unique to each person. Lear notes that there are dangers associated with a psychoanalyst’s incorrect diagnosis. He uses Dora as an example. Freud has diagnosed Dora with a form of transference where Dora’s emotional responses arise because she has transferred the situation or role provided by Herr K onto Freud. But Lear insists that it is important to question whether the transference might be of the third kind, whether she responds this way, not because she has been conditioned to respond to certain persons or types of situations in a certain way, but as a way of avoiding having to give response to certain persons or situations. What if the slap isn’t about associating Freud with Herr K, but about trying to avoid facing her own feelings of anger and anxiety? Lear writes, “[T]here is a danger that, had Dora stayed in treatment [with Freud], the search for reasons would have facilitated the creation of a false sense of self.” And because of this creation, Dora would not have been cured and, worse than that, Freud would have given her the tools to permanently avoid cure. (We can see this dynamic at play today with the work of conversion therapists.)

The rape that made Theranos

In the final episode of The Dropout, we see the breakdown of Theranos but the surprising continued self-composure of Elizabeth Holmes. Even after the fraudulent activity of her company, and the actual harm it has caused to people, becomes public, Holmes does not seem to express any sorrow or regret. She remains incapable of apologizing. In the final scene of the show, when the company has collapsed and all of its employees have been terminated, Holmes has a brief dialogue with Theranos’s former general counsel Linda Tanner:

Tanner: You could go to jail for 20 years, but, yeah, just pretend what you did never happened.

Holmes: I was trying to help people.

Tanner: Do you really believe that?

Holmes: We had a clear purpose. Ultimately, the healthcare industry just was not ready for real innovation.

Tanner: Is there something wrong with you?

Holmes: The tech companies don’t have to work under these restraints and regulations.

Tanner: Do you have any idea of what you did?

Holmes: I failed… To deliver… I failed. But failure is not a crime.

Tanner: You hurt people.

Holmes: I actually have to go.

For Holmes, there appear to be two key motivations: success, and success as a woman. At the end of the show, her big failure is simply that she failed. In the external world, she at times will blame regulations. But a key source of blame for Holmes is sexism. In defending herself to her board members, she blames sexism for critical news coverage. When she struggles, she notes at times how difficult it is to succeed as a woman entrepreneur. And the sexism is real (as evidenced by the number of articles that focus on Holmes’s split ends). Actually, sexism might be the key to Hulu’s presentation of Holmes.

The Theranos leadership, at one point, has Holmes go on a TV interview to apologize to the public and promise to move forward with greater accountability. But all that Holmes can say is that the situation is “devastating.” She fails to take accountability herself. After the interview, she sits with her mother in her dressing room, and the two have an exchange.

Noel: I think I’m very angry at you. I am."

Elizabeth: You told me that, when you visited me at school, after everything that happened, you told me to just put it away and… forget it… If you choose to forget certain things, do you think that’s lying?"

Finally, near the very end, we get a real glimpse into the psyche and the motivations of Holmes. Throughout the show, various characters have been trying to figure out what is behind her, what drives her betrayal and lies and consequent lack of any sense of accountability. Her long-term partner, when they break up, says, "You're not real! You don't have feelings! You aren't a person. You're a ghost." Her former general counsel can't comprehend what's going on inside of Holmes's head. In the end, only her mother gets a glimpse into reality. And the reality is... there isn't really a reason.

If we read Holmes through the first form of transference, we might say that she has taken the figure of her rapist and transferred her emotions towards him onto others in her life when faced with difficulty. So whenever she feels attacked, she follows her mother's advice: “You just put it away and forget it. And then one day, one day, you’ll be fine again.” If we read Holmes through the second form of transference, we might say that her rapist is a key archetype in her experience of the world, and she is constantly on guard for others who might manifest that archetype. So she is constantly reading others through her mother's advice. And if we read Holmes through the third form of transference, we might say that she has internalized this advice as a way of avoiding facing hard situations at all. She can employ that advice as a defense mechanism, as a way of avoiding looking at or processing challenging situations. When she employs that advice, the hard situation simply disappears, and she moves on.

This third type of transference helps to explain why remorse is an emotion that Holmes appears incapable of manifesting, and why she has an unyielding orientation towards the future. She can't face her past failures, because, for her, they don't exist.

If this third type of transference, born out of her mother's advice after experiencing rape, most accurately describes Holmes's situation then, in an odd way, Holmes is right about the cause of her failures. That is, the irresponsible rise and terrible fall of Theranos is, in large part, a result of sexism, a result of the persistent demand for the silence of women. In her late teens, Holmes experienced a highly traumatic event which shaped her core identity and her dispositions towards the world. Because she could not integrate that traumatic event into her broader sense of self and experience of the world, she was rendered incapable of integrating future challenges. The expectation that she be silent and simply forget was magnified and became the source of further harms that she inflicted on others.

So, in a way, Holmes is right. But she lacks the moral and emotional resources to understand why.