The case of Anna O (real name Bertha Pappenheim) marked a turning point in the career of a young Viennese neuropathologist named Sigmund Freud. It even went on to influence the future direction of psychoanalysis.
Anna O. was a highly intelligent and intuitive woman who fell ill during her father’s final illness and after his death.
She sought treatment for various symptoms, including visual disturbances, hallucinations, partial paralysis, and speech problems.
Her doctor (and Freud’s teacher), Josef Breuer, diagnosed her with hysteria, in which the patient exhibits physical symptoms (e.g., paralysis, convulsions, hallucinations, loss of speech) without an apparent physical cause.
Josef Breuer, succeeded in treating Anna (from December 1880 to June 1882) by helping her to recall forgotten memories of traumatic events. This process would later be called psychoanalysis.
Breuer’s treatment of Anna O. developed through three stages. Initially, he noticed that she could relieve her distress by allowing Pappenheim to talk freely about whatever came into her mind, which she called “chimney sweeping” or her “talking cure.”
At first, she would only speak in fairy tales, making up stories about her thoughts and feelings. This is considered the term’s origin for all later forms of psychotherapy and counseling.
In the second stage, Breuer hypnotized Anna O. every morning to help her remember some painful emotions she experienced when her father died.
In the final stage, Anna talked freely about the various occurrences that had triggered each of her hysterical symptoms during the previous year. As she did so, the relevant symptom itself would disappear.
Anna O’s treatment is considered the beginning of psychoanalysis. Breuer found that her symptoms seemed lessened when Anna was encouraged to talk freely about her experiences and feelings.
During discussions with her, it became apparent that she feared to drink when a dog she hated drank from her glass. Her other symptoms originated when caring for her sick father.
She would not express her anxiety about hir illness but did express it later during psychoanalysis. As soon as she had the opportunity to make these unconscious thoughts conscious, her paralysis disappeared.
Influence on Psychoanalysis
Breuer discussed the case with his friend Freud. These discussions revealed the germ of an idea that Freud would pursue for the rest of his life.
It’s important to note that Freud never actually treated Anna O. himself, but her case greatly influenced his work and the development of his theories. Freud believed that her symptoms were the result of repressed memories and traumas, a theory that formed the basis of psychoanalysis.
Freud and Breuer co-authored a book, Studies on Hysteria (1895), in which they discussed Anna O’s case in detail. Freud proposed that physical symptoms are often the surface manifestations of deeply repressed conflicts.
However, Freud was not just advancing an explanation of a particular illness. Implicitly he was proposing a revolutionary new theory of the human psyche itself.
Freud believed that Anna O’s symptoms, which included hallucinations, partial paralysis, and speech problems, resulted from repressed memories and traumas.
This theory formed the basis of psychoanalysis. Freud was particularly interested that her symptoms seemed to lessen when Anna O. was encouraged to talk freely about her experiences and feelings.
This method, which Anna O. referred to as “chimney sweeping,” was the precursor to what is now known as free association, a key component of psychoanalytic therapy.
Anna’s case also introduced the concept of transference, where a patient’s feelings for a significant person in their life are redirected onto the therapist.
During her treatment, Anna developed feelings for Breuer, imagining herself pregnant with his child. This led to the end of her treatment with Breuer.
Freud’s Interpretation
Freud criticized Breuer for ignoring Anna’s obvious sexual feelings toward her physician. Breuer seems to have been drawn into a kind of ‘folie à deux’, accepting her behavior and her self-prescribed cures at face value and discounting the effect of his intense interest on her performance.
Freud claimed that Bertha’s heartbreak over her father’s death was actually because of an Electra complex, incestuous sexual fantasies she had towards her father.
She transferred these fantasies to Breuer as the new authority figure in her life. According to Freud, Breuer had told him of an episode later in the treatment where he had fled her home after finding his patient in the throes of hysterical and false childbirth. She had become convinced that she was pregnant with Breuer’s child.
What Happened to Anna O?
Despite the initial belief that Bertha had been cured through the “talking cure,” records indicate that she became progressively worse and was eventually institutionalized.
However, she eventually recovered from her illness and made significant contributions to social work in Germany. In 1954, Germany issued a postal stamp bearing her image in recognition of her many accomplishments.
In summary, Freud used Anna O.’s case as a foundation for his theories on psychoanalysis, particularly the concepts of free association and transference. He believed her symptoms resulted from repressed memories and traumas and that talking about these experiences could alleviate the symptoms.
Sources
- Borch-Jacobsen, M., 1996. Remembering Anna O. A Century of Mystification. New York: Routledge.
- Brentzel, M., 2002. Sigmund Freud’s Anna O. Das Leben der Bertha Pappenheim. Leipzig: Reclam.
- Breuer, J. and Freud, S., 1895. Studies on Hysteria. Standard Edition, Volume 2. London: Vintage The Hogarth Press.
- Ellenberger, H.F., 1970. The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York: Basic Books. A Member of the Perseus Books Group.
- Freud, S., 1916-1917. Introductory Lectures on Psycho-Analysis. Standard Edition, Volume 15-16. London: Vintage The Hogarth Press.
- Freud, S., 1923. Two Encyclopaedia Articles. Psychoanalysis. Standard Edition, Volume 18. London: Vintage The Hogarth Press.
- Gay, P., 1998 / 1988. Freud: A Life for Our Time. New York: W W Norton & Company.
- Guttmann, M.G., 2001. The enigma of Anna O.: A Biography of Bertha Pappenheim. London: Moyer Bell.
- Hirschmüller, A., 1978/1989. The Life and Work of Josef Breuer: Physiology and Psychoanalysis. New York: New York University Press.
- Schweighofer, F., 1987. Das Privattheater der Anna O.: Ein psychoanalytisches Lehrstück. Ein Emanzipationsdrama. München: Ernst Reinhardt Verlag.
- Skues, R.A., 2006. Sigmund Freud and the History of Anna O.: Reopening a Closed Case. Basingstoke: Palgrave Macmillan.
