The 'case of Anna O.' and Sigmund Freud

The case of Anna O., described by Sigmund Freud and Joseph 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 Bertha von Pappenheim's treatment 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 for reconceptualize certain misconceptions about psychoanalysis that continue to hinder the progress of psychology to this day clinic.

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. Her main symptoms consisted of paralysis, blindness, deafness and dumbness of a possibly psychogenic character (ie generated by autosuggestion).

Other of the most relevant signs of the case include the presence of language alterations similar to aphasia, dissociative amnesia, rejection of food and emotional instability. Von Pappenheim also had facial pain of neurological origin that was treated with morphine, which caused her 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 she had a sad and fearful main personality, but also another of childish and impulsive traits; both were exacerbated by treatment.

The birth of the cathartic method

Von Pappenheim and Breuer noted that the symptoms were temporarily relieved if the patient talked about them, about her dreams and hallucinations about her and she was able to attribute a cause to them, especially while she was subjected to hypnosis. Since von Pappenheim was satisfied with the procedure, Breuer decided to focus on this one.

Von Pappenheim herself gave this method the names "chimney sweep" and "speech cure." It was this last term that achieved the greatest popularity, along with the one given to it by Breuer and Freud: “method cathartic”, which basically consists of attributing certain causes to the symptoms in a state of hypnosis in order to delete them.

Von Pappenheim's symptoms did not subside with Breuer's treatment (he and Freud lied about this when documenting the case in "Studies on Hysteria"), but she was eventually admitted; 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 the most remembered student of his today was Sigmund Freud, considered the father of psychoanalysis. It was precisely the case of Anna O. the one who 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 writing it. In addition to Anna O. -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. 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 was invaluable -in the that he trusted much more than Breuer-both through his writing and thanks to the support of high-ranking society.

Breuer disagreed with the attitude adopted by Freud, who magnified the real events of the case of Anna O. systematically until popularizing the legend and getting most people to ignore Breuer's version. In all probability Freud's aim was to consolidate his position as a clinician.

However, there were many who tried to deny Freud's account, including some of his disciples, such as Carl Gustav Jung, who would play a fundamental role in the distancing of Freud's ideas carried out by many practitioners of the psychoanalysis.

Years after the treatment of Anna O. Various experts have analyzed the available evidence in order to assess the causes of their alterations. Many agree that the origin seems organic and not psychogenic, and may explain the symptoms from disorders such as encephalitis, temporal lobe epilepsy, or meningitis tuberculosis