The Freud Files

by Mikkel Borch-Jacobsen

  Proving the first point did not, in itself, present any difficulties, since Freud always knew that the treatment of Bertha Pappenheim (the actual ‘Anna O.’) had not been an unmitigated success, contrary to what he and Breuer had claimed in Studies on Hysteria.170 At the end of treatment, far from being ‘free from the innumerable disturbances which she had previously exhibited’,171 she was committed by Breuer to a private clinic in Kreuzlingen, Switzerland, suffering from facial neuralgia (trigeminal neuralgia), severe convulsions, morphine addiction and a ‘slight hysterical insanity’.

  Report sent by Breuer to Robert Binswanger, Director of the Bellevue Clinic, mid-June 1882: Today, the patient is suffering from slight hysterical insanity, confessing at the moment to all kinds of deceptions, genuine or not, occasionally still seeing bits of nonsense such as people spying on her, and the like, and exhibiting perfectly odd behavior on visits. She is receiving daily 0.08–0.1 morphine by injection.172

  Breuer hadn’t mentioned his patient’s very painful neuralgia in his 1895 case history, nor the morphine addiction that had resulted from his efforts to calm her convulsions. Nevertheless, the neuralgias figured prominently among the symptoms that he and Freud, in their ‘Preliminary communication’, claimed to have been able to trace back to traumas.173 It would have been interesting for their colleagues in neurology and psychiatry to learn that the cathartic cure of Breuer’s paradigm patient had not eliminated this symptom.

  Furthermore, once at Bellevue, Bertha Pappenheim had developed the habit each evening of losing the ability to speak her native language.

  Albrecht Hirschmüller: Mention of this last symptom in the Kreuzlingen report is particularly surprising since Breuer states in 1895 that this symptom had been removed at one stroke – and once and for all – with the narration of that first crucial experience.174

  Bertha Pappenheim subsequently had three other stays at a clinic, each under a diagnosis of hysteria. It was only near the end of the 1880s, six or seven years after the conclusion of her treatment with Breuer, that she began to recover – this recovery having nothing to do with the famous talking cure.175

  Hirschmüller: What is certain is that the impression [Breuer] gives in Studies on Hysteria that the patient was completely cured does not square with the facts.176

  Freud could therefore have revealed these secrets and thereby undermined the origins of the Forelian’s psychanalysis. Indeed, he didn’t waste any opportunities to tell the insiders of the psychoanalytic movement, as we know from their various and subsequent ‘leaks’, or else from recently exhumed archival documents.

  Poul Bjerre (1916): I can add that the patient [Anna O.] was to undergo a severe crisis in addition to what was given out in the description of the case.177

  Jung (1925): There is then a certain untrustworthiness about all these earlier cases [of Freud]. Thus again, the famous first case that he had with Breuer, which has been so much spoken about as an example of a brilliant therapeutic success, was in reality nothing of the kind. Freud told me that he was called in to see the woman the same night that Breuer had seen her for the last time,178 and that she was in a bad hysterical attack, due to the breaking off of the transference.179

  Jung citing Freud (1953): At the end [of Breuer’s case history] it is said: She was cured – through the chimney sweeping – it is said that she was cured. But she wasn’t cured at all! When she came under my hands [Freud’s hands] she had a great hysterical attack, as when Breuer let her go.180

  Ferenczi, Clinical Diary, 1 May 1932: [Freud] must have been first shaken and then disenchanted, however, by certain experiences, rather like Breuer when his patient had a relapse.181

  Freud to Sir Arthur Tansley, 20 November 1932: In Breuer’s case-history, you will find a short sentence: – ‘but it was a considerable time before she regained her mental balance entirely’ (Studien über Hysterie, p. 32). Behind this is concealed the fact that, after Breuer’s flight, she once again fell back into psychosis, and for a longish time – I think it was of a year – had to be put in an institution some way from Vienna.182

  The problem was that Freud couldn’t use this argument publicly without calling into question the historical foundation of the talking cure (cathartic and analytic) and revealing that he had been complicit in Breuer’s dubious declarations of therapeutic success in Studies on Hysteria. For that matter, nowhere in Freud’s published works do we find the miraculous ‘healing’ of Anna O. drawn into question.183 On the contrary, what we do find, beginning in 1914 with the ‘History of the psychoanalytic movement’, is the assertion that this otherwise spectacular healing was incomplete: Anna O. was to have developed a ‘transferential love’ for Breuer, who had failed to recognise and analyse the sexual nature of the ‘rapport’ that he had used to make the symptoms disappear (this is a summary of the published versions).

  Freud, however, took great care to present this belated revelation as a reconstruction – made sometime afterwards – of what had really occurred. In the ‘History’, he spoke of ‘conjecture’ and ‘interpretation’ and of ‘suspicions’ based on ‘indications’ or ‘clues’ provided by Breuer, who ‘never said this to me in so many words’.184 In his autobiographical study and Breuer’s obituary, he declared that it was a matter of ‘reconstruction’ and ‘suppositions’:

  Freud: I found reason later to suppose that a purely emotional factor, too, had given him an aversion to further work on the elucidation of the neuroses. He had come up against something that is never absent – his patient’s transference onto her physician, and he had not grasped the impersonal nature of the process.185

  Freud: The patient had recovered and had remained well and, in fact, had become capable of doing serious work. But over the final stage of this hypnotic treatment there rested a veil of obscurity, which Breuer never raised for me; and I could not understand why he had so long kept secret what seemed to me an invaluable discovery instead of making science the richer by it . . . It was easy to see that he too shrank from recognizing the sexual aetiology of the neuroses. He might have crushed me or at least disconcerted me by pointing to his own first patient, in whose case sexual factors had ostensibly played no part whatever. But he never did so,186 and I could not understand why this was, until I came to interpret the case correctly and to reconstruct, from some remarks which he had made, the conclusion of his treatment of it. After the work of catharsis had seemed to be completed, the girl had suddenly developed a condition of ‘transference love’; he had not connected this with her illness, and had therefore retired in dismay.187

  In a letter from Freud to his fiancée dating from this period, though, we find a different story.

  Freud to Martha Bernays, 31 October 1883: Breuer too has a very high opinion of her and has given up her care because his happy marriage threatened to come unstuck on account of it. The poor wife could not bear it that he devoted himself so exclusively to a woman, about whom he obviously spoke with much interest, and was certainly jealous of nothing else but the engrossment of her husband by a stranger. Not in the ugly, tormenting way, but in the quietly resigned manner. She fell ill, lost her spirits, until it dawned on him and he learned the reason for it, which of course was a command for him to withdraw completely from his activity as physician of B.P. Can you be silent, Marthchen? It is nothing dishonorable, but rather something very intimate and that one keeps to oneself and one’s beloved. I know it of course from him personally.188

  Here, Freud makes a point of mentioning Breuer’s ‘esteem’ for and ‘interest’ in Bertha Pappenheim (what he termed in his obituary of Breuer ‘a large amount . . . if the phrase can be allowed, of medical libido’).189 In his published ‘reconstructions’, however, he speaks of a transferential love of Bertha Pappenheim for Breuer. Nothing in the letter to Martha or in any other document, supports this version, which is contradicted by all sorts of information.190 This appears to be an interprefaction of Freud; while in accordance with psychoanalytic theory, it doesn’t tally with
what is known about the life of Bertha Pappenheim. All the accounts agree on this subject and they corroborate Breuer’s version: Bertha Pappenheim was asexual and remained that way for the rest of her life. But this too, of course, is precisely what the psychoanalytic rewriting of the history was intended to deny, over the objections of Breuer and the Forelians.

  As John Forrester and Laura Cameron have rightly emphasised, the case of Anna O. had become for Freud ‘a potential experimentum crucis’ on which the ‘correctness of psychoanalytic theory’ depended.191 It was necessary for him to establish that Anna O.’s asexuality, far from ‘falsifying’ his theory, was only superficial. The legendary interprefaction of the end of Anna O.’s treatment satisfied this exigency: in attributing to Anna O./Bertha Pappenheim a ‘transferential love’ which Breuer ignored, Freud made her fate as a spinster appear to be a residual symptom of her unanalysed transference. As he was to write to Sir Arthur Tansley, the talking cure had been ‘a cure with a defect’. In short, Breuer had botched the treatment, and those who took his side exposed themselves to the same disappointment.

  Freud to Tansley, 10 November 1932: Subsequently [to Anna O.’s institutionalisation] the disease had run its course, but it was a cure with a defect. Today she is over 70, has never married, and, as Breuer said, which I remember well, has not had any sexual relations. On the condition of the renunciation of the entire sexual function she was able to remain healthy. Breuer’s treatment, so to speak, helped her over her mourning. It is of interest that, as long as she was active, she devoted herself to her principal concern, the struggle against white slavery.192

  Freud: Breuer’s first hysterical patient was . . . fixated to the period when she was nursing her father in a serious illness. In spite of her recovery, in a certain respect she remained cut off from life; she remained healthy and efficient but avoided the normal course of a woman’s life.193

  It is noteworthy that this entire construction is based on an interprefaction, and one which was forged without the acknowledgement of the principal parties, who undoubtedly would have vigorously protested had they been consulted (Breuer seems to have done precisely that).194 Forel, wanting to clarify for himself the episode of Anna O., had at least made the effort to collect Breuer’s actual testimony and evidence. As for Freud, he refrained from doing so, just as he refrained from contacting Bertha Pappenheim (which would have been very easy for him to do, since his wife knew her personally). Instead, he had them testify in absentia in support of his theory, without asking their opinion any more than he asked Leonardo, Shakespeare or Michelangelo for theirs. In these conditions, how would the jurors (readers, colleagues) have been able to question these accounts, since they were presented not as ad hoc interpretations, but as matters of fact, ‘historical’ events that actually took place?

  In his published versions, Freud insisted that Breuer hadn’t told him everything about what had happened between him and Anna O. In private, though, he claimed that he had received the story from Breuer himself, or else that the latter had at least confirmed his suspicions.

  Princess Marie Bonaparte, Diary of 17 October 1925: Breuer and Fräulein Anna O. Confession ten years later.195

  Bonaparte, Diary of 16 December 1927: Freud told me the Breuer story . . . Breuer’s daughter questioned her father about it. He confessed everything that Freud had written in the Selbstdarstellung. Br[euer] to Freud: ‘What have you got me into!’196

  Freud to Stefan Zweig, 2 June 1932: What really happened with Breuer’s patient I was able to guess later on, long after the break in our relations, when I suddenly remembered something Breuer had once told me in another context before we had begun to collaborate and which he never repeated . . . I was so convinced of this reconstruction of mine that I published it somewhere. Breuer’s youngest daughter (born shortly after the above-mentioned treatment, not without significance for the deeper connections!)197 read my account and asked her father about it (shortly before his death). He confirmed my version, and she informed me about it later.198

  Freud to Tansley, 20 November 1932: My guesses about what happened afterwards with Breuer’s first patient are certainly correct. He confirmed [them] in full to his daughter, who, on reading my Autobiographical Study, had questioned him about them.199

  The problem, though, is that the account Breuer is supposed to have ‘confirmed’ or ‘confessed’ is found nowhere in the Autobiographical Study, nor in any other text published by Freud.200 To Jung, to Marie Bonaparte, to Stefan Zweig and, it seems, to many other colleagues, Freud appears to have related an even more fabulous and explosive story than that of Anna O.’s supposed ‘transferential love’ for Breuer.

  Otto Rank, 1st American Lecture (1924): Psychoanalysis was born in the year 1881. Its father was the late physician, Dr. Josef Breuer, who for nearly ten years kept secret the birth of this illegitimate child.201 Dr. Breuer then abandoned the child because it might appear a bastard of scientific medicine, of which he himself was a representative, and of psychotherapy, which is still under suspicion at the present time . . . The story is this. As Breuer one day revisited his patient [Anna O.], at that time almost recovered, he found her again in bed, in a state of excitement accompanied by violent convulsions whose meaning he had not long to look for. His patient cried out to him that she was now bringing forth the child begotten by him. This was enough to horrify any respectable doctor. Consequently he, so to speak, forgot his cue, took the matter personally, declared the patient insane, and arranged for her to be put into a mental hospital . . . There, after some time, this acute condition died away of its own accord.202

  Abraham Arden Brill, Course of psychiatric psychoanalysis, 1924, the Pathological Institute, Ward’s Island: There was another and perhaps even more conclusive reason for Breuer’s ultimate retreat. [After her recovery] Anna O. kept coming to see him for advice and assistance with her problems; and Breuer, following his custom, used to hypnotize her. One day the young woman came to him in a hysterical state, and while he was going through the hypnotizing formulas she suddenly grabbed him, kissed him, and announced that she had become pregnant by him. Of course the old man was shocked. He decided that the girl must be crazy, or, at all events, that the treatment had its dangers. The experience was too much for Breuer. He had not been able to brave the world of prudery to begin with, and this final incident was the climax. There and then he decided to separate from Freud.203

  Bonaparte, Diary of 16 December 1927: Freud told me the Breuer story. His wife tried to kill herself towards the end of Anna–Bertha’s treatment. The rest is well known: Anna’s relapse, her fantasy of pregnancy, Breuer’s flight.204

  Freud to Stefan Zweig, 2 June 1932: On the evening of the day when all her symptoms had been disposed of, he was summoned to the patient again, found her confused and writhing in abdominal cramps. Asked what was wrong with her, she replied: ‘Now Dr. B.’s child is coming!’ At this moment he held in his hand the key that would have opened the ‘doors to the Mothers,’ but he let it drop.205 With all his intellectual gifts there was nothing Faustian in his nature. Seized by conventional horror he took flight and abandoned the patient to a colleague. For months afterwards she struggled to regain her health in a sanatorium.206

  Jung, citing Freud (1953): When [Anna O.] came into my care she had, she had the same as when Breuer left her as cured, she had a great hysterical attack, and cried, Now Breuer’s child is coming! We need the child, no? But that doesn’t feature in the case history! . . . he said, that makes a bad impression, and so on.207

  We know that on 20 June 1925, on the occasion of Breuer’s death, Freud sent a letter of condolence to his son Robert Breuer, who in response mentioned the esteem in which his father had held Freud’s recent works. This, Freud wrote back, ‘was like balm on a painful wound which had never healed’.208 In the polite exchange of letters which followed between Freud and the Breuer family,209 there is no trace of a ‘confirmation’ by Breuer of Freud’s allegations in the Autobiographical Study; and
we reflect that it is improbable that Dora Breuer would have confided such sensitive information to someone her father had been estranged from for almost thirty years and who had a very poor reputation in the family circle.210 Whatever the case, and even if we were to suppose that Breuer had indeed confirmed what Freud had written in his autobiography, such a confirmation at most could only have applied to the emotional imbroglio in which Bertha Pappenheim’s treatment was carried out, and not to the story of the hysterical childbirth Freud was spreading in private. Presenting this history as a corroborated fact seems to be the dramatisation of a tendentious and improbable interpretation, intended to discredit Breuer and his followers.

  The first to reformulate Bertha Pappenheim’s treatment in terms of the libido theory in public was not Freud, however, but Max Eitingon. Eitingon had begun corresponding with Freud in 1906, while he was at the Burghölzli hospital, and in 1907 he went to visit him in Vienna.211 In December 1910, at the moment when the Freudians were beginning to get nervous about Forel’s initiatives, Eitingon gave a talk on Anna O. (Breuer) considered from the psychoanalytic point of view,212 at a conference organised by Freud in Vienna on the theme ‘Theory of the Neuroses and Psychotherapy’. In this text, discovered by Albrecht Hirschmüller in the Archives of Erich Gumbel (director of the Max Eitingon Institute of Jerusalem213), Eitingon provided a critical revision of Breuer’s case history in which he emphasised its pre-psychoanalytic character, that is to say its incompleteness. Breuer had insisted on the ‘asexual’ character of Anna O.’s symptomology; Eitingon, though, retranslating Breuer’s report in the ‘language of psychoanalysis’, had no difficulty recognising the sexuality within it: Anna O., at the bedside of her ailing father, had nourished incestuous fantasies, as well as a fantasy of pregnancy which she subsequently repressed and transferred onto Breuer, who was transformed into a substitute for her dead father.