The case of Anna O., Described by Sigmund Freud and Josef Breuer in “Studies on Hysteria”, has been described by Freud himself as the trigger for the emergence of psychoanalysis. The work of the father of this movement, and therefore in a way also of psychotherapy in general, cannot be explained if the treatment of Bertha von Pappenheim is not taken into account.
In this article, we will analyze the truths and myths surrounding the famous case of Anna O. Understanding the keys to the intervention that made Freud famous, even without having participated in it, can be useful to reconceptualize certain misconceptions about psychoanalysis which continue to this day to weigh on the progress of clinical psychology.
The famous case of Anna O.
Josef Breuer was a physician and physiologist who lived between 1842 and 1925. In 1880 Breuer accepted the case of Bertha von Pappenheim, a remarkably intelligent young woman who had been diagnosed with hysteria. Its main symptoms were paralysis, blindness, deafness and possibly psychogenic mutism (i.e. generated by auto-suggestion).
Other most relevant signs of the case include the presence of language disturbances similar to aphasia, dissociative amnesia, food rejection, and emotional instability. Von Pappenheim also had neurologically related facial pain which was treated with morphine, which led to him becoming addicted to the substance.
Breuer’s records also describe von Pappenheim as a case with characteristics similar to what we know today as “dissociative identity disorder.” According to the doctor, the patient he had a sad and fearful main personality, but also one of childish and impulsive traits; both were exacerbated by the treatment.
The birth of the cathartic method
Von Pappenheim and Breuer noticed that the symptoms were temporarily relieved if the patient spoke about them, their dreams and their hallucinations and succeeded in attributing a cause to them, especially during hypnosis. Since von Pappenheim was happy with the procedure, Breuer decided to focus on it.
Von Pappenheim herself gave this method the names of “fireplace cleaning” and “speech care”. It is this last term which gained in popularity, with what Breuer and Freud gave it: “cathartic method”, which consists mainly in attributing certain causes to symptoms in a state of hypnosis in order to eliminate them.
Von Pappenheim’s symptoms did not go away with Breuer’s treatment (he and Freud lied about this while documenting the case in “Studies on Hysteria”), but she was eventually hospitalized; But, over time he recovered and became an important figure in German society and an opponent of psychoanalysis..
Breuer, Freud and “Studies on Hysteria”
For much of his life, Breuer was professor of physiology at the University of Vienna. In all likelihood, his most remembered pupil today was Sigmund Freud, considered the father of psychoanalysis. This is precisely the case of Anna O. who propelled Freud to glory, Although he never met Bertha von Pappenheim.
The case inspired Freud when he heard Breuer’s account. Despite his initial reluctance, he managed to convince his teacher to allow him to be included in a book on hysteria and to collaborate on its writing. In addition to the pseudonym Anna O. created for this work, “Studies on Hysteria” included four other similar cases.
However, Freud was convinced that the symptoms had a psychosexual origin dating back to traumatic childhood experiences, while Breuer argued that the hysteria could be due to organic causes. The two positions coexist in “Studies on Hysteria”, although the one which is consolidated in the field of psychoanalysis is that of Freud.
What really happened? Invention of psychoanalysis
“Studies on hysteria”, and in particular the case of Anna O., were the seeds that allowed the psychoanalytic approach to germinate.. Of course, in this sense, Freud’s role as a promoter of the Cathartic Method – in which he relied much more than Breuer – was invaluable both through his written work and through the support of high society.
Breuer disagreed with Freud’s attitude, which systematically amplified the real events of the Anna O. case to popularize the legend and cause most people to ignore Breuer’s version. In all likelihood, Freud’s goal was to consolidate his position as a clinician.
However, many have tried to refute Freud’s account, including some of his followers, such as Carl Gustav Jung, who would play a key role in distancing Freud’s ideas from many psychoanalytic practitioners.
Years after Anna O.’s treatment, several experts analyzed the available evidence to assess the causes of her disorder. Many agree that the origin seems organic and not psychogenic, that symptoms of disorders such as encephalitis, temporal lobe epilepsy or tuberculous meningitis can be explained.