The physician and physiologist Josef Breuer is best known for using the cathartic method for the first time in the famous case of Anna O., which would inspire his disciple Sigmund Freud to create psychoanalysis. However, Breuer’s conceptions differed from Freud’s in central aspects.
Breuer is a relevant figure in the history of neurophysiology and psychoanalysis. In this article we will review his biography, his contributions to these two fields and his relationship with Freud; to this end it is also necessary to describe the outstanding role of Anna O. in the field of hysteria .
Biography of Josef Breuer
Josef Breuer (1842-1925) studied medicine at the University of Vienna and during his first years of professional practice worked as an assistant to Johann von Oppolzer and later to Karl Hering, a physiologist known for his studies of visual perception and eye movements.
Breuer made important contributions in the field of neurophysiology . During his collaboration with Hering he described the role of the vagus nerve in the respiratory response; this would lead to the concept of the “Hering-Breuer reflex”, which is still in use today.
He was also one of the first to propose that balance depends on the movement of fluid in the semicircular canals of the inner ear and the information the brain receives in relation to these movements.
For much of his life Breuer worked as a family doctor and as a personal physician to many intellectuals living in Vienna, including the philosopher and psychologist Franz Brentano. He was also a professor of physiology at the University of Vienna, where he instructed Sigmund Freud, with whom he would later collaborate .
The case of Anna O.
In 1880 Breuer began treating Bertha von Pappenheim, a hysteria patient who played a major role in the emergence of psychoanalysis. She would go down in history as “Anna O.” since this was the pseudonym Breuer and Freud gave her in their joint work Studies on Hysteria , the cornerstone of early psychoanalysis.
According to Breuer, Pappenheim had two personalities that became increasingly different as treatment progressed. While the first was sad and apprehensive, the second was more childish and explosive. This case is one of the earliest recorded examples of dissociative identity disorder (or “multiple personality”).
Breuer noticed that Pappenheim’s symptoms, which consisted mainly of partial paralysis, dumbness and blindness, temporarily receded when he talked about them under hypnosis and attributed a cause to them . The patient was also relieved when she spoke about her dreams or hallucinations, and it was her own preferences that guided Breuer.
Pappenheim called this type of intervention “speech cure” or “chimney sweep” ; thus was born the cathartic method, consisting in hypnotizing the patient to remember the traumatic event that triggered the symptom (or to invent such a memory) and thus eliminate the associated negative emotions, and consequently the symptom.
Freud and the “Studies on Hysteria”
The case of Anna O. inspired Sigmund Freud to write the book Studies on Hysteria in collaboration with his teacher Breuer. This work, which appeared in 1895, describes the treatment of Bertha von Pappenheim and four other women through hypnosis and the cathartic method.
On a theoretical level, Freud and Breuer defended two different hypotheses in the book: while the first thought that hysteria was always due to traumatic memories related to sexuality, according to Breuer there could also be neurophysiological causes.
Contrary to what is reported in “Hysteria Studies”, Anna O. did not fully recover from Breuer’s treatment but was eventually admitted to hospital. However, in time her symptoms subsided and she became a leading figure in German feminism at the time, as well as a firm opponent of psychoanalysis.
The relationship between Breuer and Freud deteriorated rapidly. Freud not only showed a confidence in the cathartic method that Breuer considered unjustified, but he mitigated Anna O.’s case in order to promote what would become psychoanalysis. Towards the end of his life, Breuer saw Freud in the street and made a gesture of greeting him, but his disciple ignored him.
The “speech cure” that Breuer developed with the invaluable collaboration of Bertha von Pappenheim would become the seed of Freud’s psychoanalysis and, consequently, of the conventional psychotherapy of the following century.
Breuer’s hypotheses regarding the case of Anna O. triggered interest in unconscious processes, especially around the aetiology of hysteria and other neuroses . However, Breuer distanced himself from Freud because he did not agree with his emphasis on psychosexual trauma as the sole cause of these disorders.
Breuer considered that hypnosis and the cathartic method could facilitate the creation of false memories , even if these were felt by the patients as true. Many later critics of Freud would agree with Breuer and his more cautious approach.
- Breuer, J. & Freud, S. (1893-1895). Studies on hysteria. In Collected Works, volume II. Buenos Aires: Amorrortu.
- Leahey, T. H. (2004). History of Psychology, 6th Edition. Madrid: Pearson Prentice Hall.