A famous patient who is studied in all the faculties of Psychology.
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 without taking into account the treatment of Bertha von Pappenheim.
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 to this day they continue to weigh down 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 young woman of remarkable intelligence who had been diagnosed with hysteria. Its main symptoms consisted of paralysis, blindness, deafness and muteness of a possibly psychogenic character (that is, generated by autosuggestion).
Other of the most relevant signs of the case include the presence of language alterations similar to aphasia, dissociative amnesia, refusal to eat 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 now know by the label “dissociative identity disorder”. According to the doctor, the patient had a sad and fearful main personality, but also another with childish and impulsive traits ; both were exacerbated by treatment.
The birth of the cathartic method
Von Pappenheim and Breuer noted that symptoms were temporarily relieved if the patient talked about them, her dreams, and her hallucinations and was able to attribute a cause to them, especially while under hypnosis. Since von Pappenheim was satisfied with the procedure, Breuer decided to focus on it.
Von Pappenheim herself gave this method the names “chimney cleaning” and “speech cure.” It was this last term that achieved greater popularity, along with the one that Breuer and Freud gave it: “cathartic method”, which consists fundamentally in attributing specific causes to 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 in documenting the case in “Studies on Hysteria”), but she was eventually admitted; however, over time she recovered and became a prominent 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 likelihood 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, despite the fact that 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 its writing. In addition to 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, which magnified the actual events of the Anna O. case in a systematic way, popularizing the legend and causing most people to ignore Breuer’s version. In all probability Freud’s goal was to consolidate his position as a clinician.
However, there were many who tried to deny Freud’s story, including some of his disciples, such as Carl Gustav Jung, who would play a fundamental role in distancing himself from 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 assess the causes of her alterations. Many agree that the origin seems organic and not psychogenic, and the symptoms can be explained by disorders such as encephalitis, temporal lobe epilepsy or tuberculous meningitis.