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The 'case of Anna O.' and Sigmund Freud

The 'case of Anna O.' and Sigmund Freud

April 28, 2024

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 in a way also of psychotherapy in general, can not be explained without taking Bertha von Pappenheim's treatment into account.

In this article we will analyze the truths and myths about 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 to reconceptualize certain false ideas about psychoanalysis that continue to weigh on the progress of clinical psychology to this day.


The famous case of Anna O.

Josef Breuer was a doctor and physiologist who lived between 1842 and 1925 . In the year 1880 Breuer accepted the case of Bertha von Pappenheim, a young woman of remarkable intelligence who had been diagnosed with hysteria. Its main symptoms consisted of paralysis, blindness, deafness and muteness of a possibly psychogenic character (that is, generated by auto-suggestion).

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 pains of neurological origin that were treated with morphine, which caused him to develop an addiction to this substance.


Likewise, Breuer's records describe von Pappenheim as a case with characteristics similar to what we now know by the label "dissociative identity disorder". According to the doctor, the patient he had a sad and fearful main personality, but also another one of infantile and impulsive traits ; both were exacerbated with the treatment.

The birth of the cathartic method

Von Pappenheim and Breuer noticed that the symptoms were relieved temporarily if the patient talked about them, about their dreams and about their hallucinations and was able to attribute a cause to them, especially while undergoing hypnosis. Since von Pappenheim was satisfied with the procedure, Breuer decided to focus on it.

Von Pappenheim herself gave this method the names "chimney cleaning" and "speech cure". It was the latter term that achieved greater popularity, along with the one given to him by Breuer and Freud: "cathartic method", which consists mainly of attributing determined 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 "Studies on Hysteria"), but was eventually hospitalized; but nevertheless, over time he 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 likelihood his most remembered student today was Sigmund Freud, considered the father of psychoanalysis. It was precisely the case of Anna O. who catapulted Freud to fame , although he never got to know Bertha von Pappenheim.

The case inspired Freud when he heard Breuer's story about it. Despite his initial reluctance, he managed to convince his teacher to allow him to include him in a book on hysteria and to collaborate in its writing. 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 went back to childhood traumatic experiences, while Breuer argued that hysteria could be due to organic causes. 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-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 magnified the real events of the case of Anna O. systematically to popularize the legend and get most people ignore Breuer's version.In all likelihood Freud's goal was to consolidate his position as a clinician.

However, many people tried to deny the story of Freud, 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 psychoanalysis.

Years after the treatment of Anna O. several experts have analyzed the available evidence to evaluate the causes of their alterations. Many agree that the origin seems organic and not psychogenic, and the symptoms can be explained by disorders such as encephalitis, temporal lobe epilepsy or tuberculous meningitis.


Studies in Hysteria - Sigmund Freud and Josef Breuer (April 2024).


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