The case of Anna O, described by Sigmund Freud and Josef Breuer in “Studies on Hysteria”, was described by Freud himself as the trigger for the emergence of psychoanalysis. The work of the father of this movement, and therefore in a certain 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 false ideas about psychoanalysis that continue to hinder the progress of clinical psychology today.
Josef Breuer was a physician and physiologist who lived between 1842 and 1925. In 1880 Breuer accepted the case of Bertha von Pappenheim, a young woman of notable intelligence who had been diagnosed with hysteria. Her main symptoms consisted of paralysis, blindness, deafness and muteness of a possibly psychogenic nature (that is, generated by autosuggestion).
Other most relevant signs in the case include the presence of language disorders similar to aphasia, dissociative amnesia, food rejection, and emotional instability. Von Pappenheim also had facial pain of neurological origin that was treated with morphine, which caused him to develop an addiction to this substance.
Likewise, Breuer’s records describe von Pappenheim as a case with characteristics similar to what we know today by the label “dissociative identity disorder.” According to the doctor, the patient He had a sad and fearful main personality, but also another with childish and impulsive traits ; both were exacerbated with treatment.
Von Pappenheim and Breuer noted that the symptoms were temporarily relieved if the patient talked about them, her dreams, and her hallucinations and managed to attribute a cause to them, especially while she was undergoing hypnosis. Since von Pappenheim was satisfied with the procedure, Breuer decided to focus on it.
Von Pappenheim herself gave this method the names “chimney sweeping” and “speech cure.” It was this last term that gained greater popularity, along with the one given to it by Breuer and Freud: “cathartic method”, which basically consists of attributing specific causes to the symptoms in a state of hypnosis in order to eliminate them.
von Pappenheim’s symptoms did not subside with Breuer’s treatment (he and Freud lied about this when documenting the case in “Studies in Hysteria”), but she was eventually hospitalized; however, Over time she recovered and became a relevant figure in German society and an opponent of psychoanalysis.
Breuer, Freud and “Studies on Hysteria”
For much of his life Breuer was a professor of physiology at the University of Vienna. In all probability his most remembered student today was Sigmund Freud, considered the father of psychoanalysis. It was precisely the case of Anna O. that catapulted Freud to fame even though he never met Bertha von Pappenheim.
The case inspired Freud when he heard Breuer’s account of it. Despite his initial reluctance, he managed to convince his teacher to allow him to include it in a book on hysteria and to collaborate in writing it. In addition to that of Anna O. – a pseudonym 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 hysteria could be due to organic causes. Both positions coexist in “Studies on Hysteria”, although the one that was consolidated in the field of psychoanalysis was that of Freud.
What really happened? Invention of psychoanalysis
“Studies on hysteria”, and in particular the case of Anna O., were the seed that allowed the psychoanalytic approach to germinate. Of course, in this sense Freud’s role as promoter of the cathartic method – in which he trusted much more than Breuer – was invaluable, both through his written work and thanks to the support of high society.
Breuer disagreed with the attitude adopted by Freud, who systematically magnified the real events of Anna O.’s case until he popularized the legend and caused the majority of people to ignore Breuer’s version. In all likelihood Freud’s goal was to consolidate his position as a clinician.
However, there were many who sought to deny Freud’s story, including some of his disciples, such as Carl Gustav Jung, who would play a fundamental role in the distancing of Freud’s ideas that many practitioners of psychoanalysis carried out.
Years after Anna O.’s treatment, various experts have analyzed the available evidence in order to evaluate the causes of her alterations. Many agree that the origin seems organic and not psychogenic, and the symptoms may be explained by disorders such as encephalitis, temporal lobe epilepsy or tuberculous meningitis.
