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 to a certain extent 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 of the intervention that made Freud famous, even without having participated in it, may be useful to reconceptualize certain misconceptions about psychoanalysis that continue to burden the progress of clinical psychology today.

The famous case of Anna O.

Josef Breuer was a doctor 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 nature (i.e. generated by autosuggestion).

Other relevant signs of the case include the presence of language disorders similar to aphasia, dissociative amnesia, food refusal 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.

Breuer’s records also describe von Pappenheim as a case with similar characteristics to what we know today from the label “dissociative identity disorder. According to the physician, the patient had a mainly sad and fearful personality, but also one with childlike and impulsive traits ; both were exacerbated by treatment.

The birth of the cathartic method

Von Pappenheim and Breuer noticed that the symptoms were temporarily relieved if the patient talked about them, about her dreams and about her hallucinations and managed to attribute a cause to them, especially while she was 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 sweeping” and “speech cure”. It was the latter term that became more popular, together with the one given by Breuer and Freud: “cathartic method”, which consists basically in attributing certain 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 “Hysteria Studies”), but she was eventually hospitalized; however, she eventually 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. Probably 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 help write it. 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 that dated back to traumatic experiences in childhood, while Breuer argued that the hysteria could be due to organic causes. Both positions coexist in “Studies on Hysteria”, although the one that became consolidated in the field of psychoanalysis was Freud’s.

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 a 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 made most people 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 disprove Freud’s story, including some of his disciples, such as Carl Gustav Jung, who would play a fundamental role in distancing many practitioners of psychoanalysis from Freud’s ideas.

Years after Anna O.’s treatment, several experts have analyzed the available evidence in order to evaluate the causes of her disorders. 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.