The importance of the case of Anna O for psychoanalysis

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The case of Anna O is an extremely famous case study in the history of psychoanalysis, the first one in the ‘Studies on Hysteria’ (Breuer and Freud, 1895). It concerns a patient, referred to as Anna O., treated by Breuer from December 1880 to June 1882 for hysteria. Freud referred to this case throughout his life, usually emphasising that the treatment method had been the ‘cathartic method’, and not yet psychoanalysis proper.  Gay (1988) called it ‘the founding case of psychoanalysis’. Later on it was combined with explanations that Breuer had not understood the sexual background of the case, and, in the Ernest Jones biography, that there was a crisis at the end of the treatment involving Anna O.’s hysterical (phantom) pregnancy.

The outcome of the treatment was described as follows: ‘She was […] free from the innumerable disturbances which she had previously exhibited. After this she left Vienna and travelled for a while; but it was a considerable time before she regained her mental balance entirely. Since then she has enjoyed complete health.’ (Breuer and Freud, 1895). Later Freud referred to the outcome as a ‘successful cure’ (Freud, 1916-17) and a ‘great therapeutic success’ (Freud, 1923).

New documentation

Since 1970 more documentation has come to light, which has been summarized in a number of books (e.g. Borch-Jacobsen, 1996;  Ellenberger, 1970; Brentzel, 2004; Guttmann, 2001; Skues, 2006) In my brief summary I rely substantially on Borch-Jacobsen, as I find him far more convincing than the revisionism of Skues. I also use Hirschmüller (1978) concerning Breuer. The new evidence and reconstructions put what happened in a very different light.

Anna O's real name was Bertha Pappenheim. She was born in 1859 and died in 1936.  Her name was disclosed by Ernest Jones in 1953 under protest by her family.​

Anna O.'s treatment(s)​

Breuer’s treatment was not the only one received by Anna; instead of moving to the country, she was in a sanatorium from June ’81 to November ’81. In June ’82 Anna was far from cured. She was left with severe facial neuralgia (psychosomatic facial pain), her language problem was not cured, and she was addicted to morphine and to chloral (an early sleeping drug). She spent three periods of several months in sanatoriums, from July ’82 until October ’82 in Bellevue, arranged by Breuer, and again in ’83, ’85 and ’87. It is known that the ’82 period in Bellevue did not cure her addiction or the facial neuralgia. The reason for entry to the sanatorium was every time listed as hysteria. Freud was aware of these sanatorium visits; in fact Pappenheim visited the Freud home a number of times during the 80s.

The fake pregnancy was probably an embellishment by Freud; there is no evidence that it ever happened. Breuer continued to do psychotherapeutic work with patients.

The treatment method used by Breuer and many of his interpretations are less novel than indicated in the version of ‘Studies on Hysteria’. The behaviour of Anna is quite similar to that of a number of patients in famous hypnotic case studies. There had been a stage hypnotist visiting Vienna early in 1880, Carl Hansen, who is likely to have influenced Breuer as well as Anna. The influence of the French hypnotists on Breuer is also clear from the terminology used in the ‘Studies’, which uses a range of French terms in the original French (most of this omitted in Gay’s Freud reader). The word and idea of the cathartic method were not new. There were 80 books in print in Vienna in 1880 about catharsis.

Why is the "Anna O. case" so prominent?

It leaves the question, if the case was not a success, and the method was not psychoanalytic, why Freud continued to give it such prominence in the course of his lifetime. The only explanation I can see is that this was an issue of ‘scientific’ priority, that Freud was very aware of his ‘competitors’ having mostly published in the 1880s rather than in the 90s, and that using this case so extensively connected him, via Breuer, to a supposed breakthrough achieved as early as 1881-82.

References

  • 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.