Freud, Murder, and Fame: Lessons in Psychology’s Fascinating History

by Todd C. Riniolo

  I have destroyed all my notes of the past fourteen years, as well as letters, scientific excerpts, and the manuscripts of my papers. As for letters, only those from the family have been spared. Yours, my darling, were never in danger. … I couldn’t have matured or died without worrying about who would get hold of those old papers. … As for the biographers, let them worry, we have no desire to make it too easy for them. Each one of them will be right in his opinion of “The Development of the Hero,” and I am already looking forward to seeing them go astray.

  Since historians only have access to selected materials about Freud and psychoanalysis, what is accessed remains a biased sample which can ultimately mislead when trying to accurately recreate the past. In some instances, the lack of historical record makes approximating the truth virtually impossible. One of the unfortunate consequences of a biased sample of materials is that it can become difficult to differentiate what actually happened, from what is simply a legendary retelling. Fortunately, Freud was not able to destroy all relevant materials, and one of the things that I attempt to do in subsequent chapters is compare Freud’s later interpretations with historical data fragments that survived. One of the consistent findings is that Freud attempted to present himself in an idealized light, whereas the surviving historical documents often point to a different interpretation (see Sulloway, 1979, for many examples).

  A limited access to historical materials is another way in which historical interpretations can be biased. Unfortunately, Freud’s estate has continued the tradition of biasing the historical materials that researchers have access to by restricting what materials are made available to scholars. As Schultz and Schultz (2008, p. 9) point out, “one letter to Freud from his eldest son is sealed until the year 2013, another until 2032. A letter from one of Freud’s mentors will not be released until 2102, some 177 years after the man’s death, leaving us to wonder what could be so remarkable about that letter as to require such secrecy for such a long period of time.” Until all of the available data fragments relevant to Freud are made available for study, there is no way to tell if current interpretations are accurate or need modification because researchers have been restricted to form opinions based upon a biased set of materials.

  In summary, the purpose of this chapter was to emphasize that there exist many potential pitfalls (e.g., personal biases, preconceived views, biased data fragments) that can interfere with an objective interpretation of the past. Thus, there always exists the possibility that a specific historical interpretation is flawed.

  Chapter 4: SEPARATING HISTORICAL FACTS FROM HISTORICAL FICTION (PART 1): THE CASE OF ANNA O.

  The case of Anna O. is important for this book in a variety of ways. First, the case continues to this day to be the founding myth of the effectiveness of psychoanalysis in the treatment of mental illness. The case provides for us a prime example of the significance of evaluating the accuracy of historical claims, and the importance of digging for additional data fragments. Because we have to rely upon incomplete data fragments, the case of Anna O. is still open to different interpretations of some of the specific details (the book, Anna O: Fourteen Contemporary Reinterpretations, helps to emphasize this point). As a reminder from Chapter 2, the notion that history is solely made up from rock solid fact is not true. The case will also be part of a recurrent theme in this book: sometimes there exists a difference between the “legend” of Freud, and what the historical record shows. For those readers who are familiar with just the version of Anna O. that was perpetuated by Freud, you may be surprised at what the historical record shows. For readers unfamiliar with the case, I believe you will find this also to be another example that counteracts the history is boring stereotype.

  Background Information

  Here is the important background information. The physician Joseph Breuer had developed an impressive reputation as both a medical doctor and researcher (he was the personal physician of several medical school professors). As a researcher, Breuer discovered, along with Ewald Hering, the self-regulation mechanism involved in respiration by the vagus nerve, the Hering-Breuer reflex. Later, Breuer would discover the importance of the semicircular canals in the ears for maintaining balance.

  Breuer and Freud developed a very close friendship shortly before Freud obtained his medical degree. Breuer offered his friend who was 14 years younger advice. The two men frequently discussed patients, Breuer lent him money, and the Breuer and Freud families frequently socialized. As Freud would later recount in An Autobiographical Study (1925, p. 34), Breuer “became my friend and helper in my difficult circumstances. We grew accustomed to share all our scientific interests with each other. In this relationship the gain was naturally mine. The development of psychoanalysis afterwards cost me his friendship. It was not easy for me to pay such a price, but I could not escape it.” Breuer would not be the last close friend that Freud would lose because of disagreements related to Freud’s theories.

  It was Breuer’s treatment of one specific patient who was suffering from a severe case of hysteria, Anna O., which was the bedrock case that had been used to provide evidence of the effectiveness of psychoanalysis. The patient’s real name was revealed as an unauthorized disclosure by Freud’s biographer Ernest Jones in 1953 as Bertha Pappenheim (see Jones, 1953, p. 223). As Kimball writes (2000, p. 20), “As a mature adult she became a leading social worker, writer, and feminist activist in the German Jewish community.” Because of Bertha’s many outstanding accomplishments, the West German government issued a postage stamp of her in 1954, an impressive achievement (Images of this stamp are widely available on the internet). With such an accomplished life, it surely does seem as though Bertha must have had a successful outcome as the result of Breuer’s treatment, but historical data fragments point to a very different interpretation.

  Let’s continue with more relevant background information before the treatment of Bertha’s hysteria is discussed. Bertha was born in Vienna on February 27, 1859, into a very wealthy orthodox Jewish home. She was the third of four children. Unfortunately, her oldest sister died before Bertha was born, and her other sister died when she was just 7 years old. The deaths of her sisters likely contributed to her parents being extremely overprotective of their only remaining daughter. By all accounts Bertha was both exceptionally attractive and very bright, as she received a good education up to a point. Women did not have the same educational opportunities as men in the 1800s. Her life as it existed did not permit her to pursue an independent or professional career, in contrast to her younger brother who would study law.

  While on a family vacation in July 1880, her father became ill (he would die in April, 1881). Both Bertha and her mother became responsible for his care as was typical of the times. While helping to care for her father, Bertha stayed up during the night and rested during the day, but ultimately became exhausted as she had difficulty sleeping. During this time, she developed a variety of symptoms associated with hysteria, but her family did not seek help until she developed a severe dry cough that persisted. Breuer would describe this period as the first of several clearly identifiable phases of her illness (latent incubation; see description of all of the phases below).

  Martha Bernays, Freud’s fiancée and eventual wife (they had a long engagement and eventually married in 1886), was not only friends with Bertha, but had family connections to the Pappenheim family. When Martha’s father died in 1880, her mother appointed Bertha’s father as the legal guardian of her own children (Appignanesi & Forrester, 1992). This information is important because Martha was able to keep informed about Bertha’s condition from a friend who also lived in Vienna, who was the wife of Bertha’s first cousin. Martha would ultimately share what she learned of her friend’s condition with Freud after Bertha’s treatment with Breuer had ended (this will be important later in this chapter). I mentioned in a previous chapter that Freud destroyed much of his personal correspondence. However, a large amount of his correspondence with Martha during their court
ship remains, and is worth reading for a personal side of Freud that is not typically shown.

  Important Historical Documents

  Initially, there were two important documents which detailed the case of Anna O. (Bertha will be referred to as Anna for this portion of the discussion for consistency with the documents). First, Breuer and Freud’s Studies on Hysteria, published in 1895. Studies on Hysteria (http://www.archive.org/details/studiesonhysteri037649mbp) is available online at the Internet Archive homepage (http://www.archive.org/). The first section of Studies on Hysteria included a “Preliminary Communication” (On the Psychical Mechanism of Hysterical Phenomena), which was published two years earlier in 1893 and marks the first time the concept of “catharsis” is used. Section two consisted of 5 case histories. The first one was Anna O. (written by Breuer), while the additional four were credited to Freud (Emmy von N., Lucy R., Katharina, Elisabeth von R.). The second document was “The Origin and Development of Psychoanalysis” which was based upon Freud’s lectures given at the 20th Anniversary of Clark University’s opening and subsequently published in the highly prestigious and widely read The American Journal of Psychology (1910; more details will be provided about Freud’s only trip to America in Chapter 6). I will rely upon these two documents to tell the initial version of Anna’s treatment because those documents have been largely responsible for creating the “legend” of the miracle cure eventually known as psychoanalysis. Be forewarned, evidence has been discovered that is inconsistent with the version presented by Breuer and Freud.

  The Case of Anna O.

  Freud (1910, p. 182), when first presenting this case to an American audience, describes Anna in the following manner:

  Dr. Breuer’s patient was a girl of twenty-one, of a high degree of intelligence. She had developed in the course of her two years’ illness a series of physical and mental disturbances which well deserved to be taken seriously. She had a severe paralysis of both right extremities, with anesthesia, and at times the same affection of the members of the left side of the body; disturbance of eye-movements, and much impairment of vision; difficulty in maintaining the position of the head, an intense Tussis nervosa, nausea when she attempted to take nourishment, and at one time for several weeks a loss of the power to drink, in spite of tormenting thirst. Her power of speech was also diminished, and this progressed so far that she could neither speak nor understand her mother tongue; and, finally, she was subject to states of “absence,” of confusion, delirium, alteration of her whole personality.

  As Breuer (1895, p. 22) notes in Studies on Hysteria, Anna’s conditions were characterized by several clearly separable phases, the first of which was mentioned above:

  (A) Latent incubation. From the middle of July, 1880, till about December 10. This phase of an illness is usually hidden from us; but in this case, owing to its peculiar character, it was completely accessible; and this in itself lends no small pathological interest to the history. I shall describe this phase presently.

  (B) The manifest illness. A psychosis of a peculiar kind, paraphasia, a convergent squint, severe disturbances of vision, paralyses (in the form of contractures), complete in the right upper and both lower extremities, partial in the left upper extremity, paresis of the neck muscles. A gradual reduction of the contracture to the right-hand extremities. Some improvement, interrupted by a severe psychical trauma (the death of the patient’s father) in April, after which there followed

  (C) A period of persisting somnambulism, subsequently alternating with more normal states. A number of chronic symptoms persisted till December, 1881.

  (D) Gradual cessation of the pathological states and symptoms up to June, 1882.

  During the period from December 1880 to April 1, 1880 (“B”: manifest illness), Anna was seen by Breuer and bedridden. During this time Anna’s symptoms included visual hallucinations, she became unable to speak for several weeks, suffered memory loss, and she lost the ability to speak in German (i.e., her native language) and communicated only in English. Anna also suffered from altered states of consciousness which alternated without warning and on a frequent basis. As Breuer reports (1895, p. 24), “In one of these states she recognized her surroundings; she was melancholy and anxious, but relatively normal. In the other state she hallucinated and was ‘naughty’—that is to say, she was abusive, used to throw the cushions at people, so far as the contractures at various times allowed, tore buttons off her bedclothes and linen with those of her fingers which she could move, and so on.” While in the ‘naughty’ state, Anna would report losing time and would not remember the state. Anna did ultimately improve and was able to get out of her bedridden state on April 1, 1880, which marks the end of the manifest illness phase.

  On April 5 Anna’s father died (beginning of “C”: persisting somnambulism). Her condition deteriorated further at this point, as she was unable to recognize people except Breuer. Anna generally refused to eat, although she would allow Breuer to feed her, and she could not understand German, and would only speak in English. Furthermore, as Breuer notes in Studies on Hysteria, she had other problems with her vision as well. For example, “in a bunch of flowers which gave her much pleasure she could only see one flower at a time” (Breuer, 1895, p. 26). Breuer had to leave Vienna for a few days during this time and was unable to visit Anna. Upon his return, she had not eaten at all when he was away, and she was now prone to terrifying hallucinations (death’s heads, skeletons), which occurred during the day. At night, Anna would now go into a deep state of hypnosis. If she could narrate her hallucinations, it brought her some relief.

  Anna’s condition deteriorated further, as she was having suicidal impulses, and on June 7, 1881, Anna was taken—against her will—to a country house near a Sanatorium where Breuer would visit every few days. Eventually, Anna grew calmer and her symptoms now appeared on a regular cycle, frightening hallucinations during the day and a calmer mind at night. Breuer would arrive in the evening, when he knew he would find her in a state of hypnosis. If Anna was able to narrate her terrifying hallucinations, she would “wake up clear in mind, calm and cheerful” (Breuer, 1895, p. 27). Because Breuer was unable to visit her on a daily basis at this point, on the second day, she would become more moody and unpleasant, and this would become more pronounced on the third day. As Breuer (1895, p. 30) notes, Anna “aptly described this procedure, speaking seriously, as a ‘talking cure’, while she referred to it jokingly as ‘chimney-sweeping’.”

  On those nights in which Breuer (1895, p. 30) was unable to visit Anna and calm her by the talking cure, it became “necessary to fall back upon chloral. … I was obliged to give her 5 grammes… . I had been able to avoid the use of narcotics, since the verbal utterance of her hallucinations calmed her even though it might not induce sleep; but when she was in the country the nights on which she had not obtained hypnotic relief were so unbearable that in spite of everything it was necessary to have recourse to chloral.” Chloral is a nonbarbituate sedative. I will return to the statement that Breuer claimed to have avoided the use of narcotics in his treatment of Anna later, when discovered data fragments will be used to evaluate specific claims made by Breuer and Freud.

  After Breuer returned from a family vacation that lasted several weeks (no talking cure was performed at this time, as Anna would not let anyone but Breuer perform the method), he “found her in a wretched moral state, inert, unamenable, ill-tempered, even malicious” (Breuer, 1895, p. 31). He brought her back to Vienna for treatment and “the former rhythm was re-established: on the day after her giving verbal utterance to her phantasies she was amiable and cheerful, on the second day she was more irritable and less agreeable and on the third positively ‘nasty’” (p. 32). In December (end of persisting somnambulism phase and beginning of “D”: gradual cessation), Anna deteriorated further, and her states of consciousness altered in a very strange manner. In the normal state, she lived in the current time, but in the second state she lived exactly one year before (Breuer reported tha
t a diary kept by Anna’s mother confirmed the dates).

  During this time period, Breuer recorded the first time a verbal utterance made symptoms disappear:

  There was in the summer a time of intense heat, and the patient had suffered very much from thirst; for, without any apparent reason, she had suddenly become unable to drink. She would take a glass of water in her hand, but as soon as it touched her lips she would push it away as though suffering from hydrophobia. Obviously for these few seconds she was in her absent state. She ate only fruit, melons and the like, in order to relieve this tormenting thirst. When this had been going on about six weeks, she was talking one day in hypnosis about her English governess, whom she disliked, and finally told, with every sign of disgust, how she had come into the room of the governess, and how that lady’s little dog, that she abhorred, had drunk out of a glass. Out of respect for the conventions the patient had remained silent. Now, after she had given energetic expression to her restrained anger, she asked for a drink, drank a large quantity of water without trouble, and woke from hypnosis with the glass at her lips. The symptom thereupon vanished permanently (Freud, 1910, pp. 184-185).