Freud: A Modern Reader

There appears to be something so basic in this case that it appeals to later generations of analysts. Michael Balint for example turns to the case of Anna O. in order to describe malignant regression (Balint, 1968 pp. 139-147). Freud obviously repeatedly revisited this case in his mind when thinking of his theories and he commented, twenty years on, that anyone who reads Breuer’s account “will at once perceive the sexual symbolism in it and “a complete prototype of what we call ‘transference’ today” (Freud 1914 p.12). There were two other important changes in Freud’s theories twenty years on from Studies in Hysteria. Then he had traced all hysterical phenomena to a recollected scene, a trauma. Twenty years later he wrote, “If hysterical subjects trace back their symptoms to traumas that are fictitious, then the new fact which emerges is precisely that they create such scenes in phantasy, and this psychical reality requires to be taken into account alongside practical reality!
” (Freud 1914 p.17/18).

Another new discovery gained since 1895 was of the ubiquity of infantile sexuality and also that an inherited disposition in some individuals made traumas out of commonplace developmental experience (ibid p.18). So two of the cornerstones of psychoanalysis, psychic reality and infantile sexuality, were discovered after the early accounts of hysteria and both can be found in a re-examination of the case of Anna O. When we look at Breuer s account through the eyes of modern analysis we see something very different than he did, but we also recognize what he went through because the phenomena remain the same and it is because his careful account enables us to look at it independently of his conclusions.

So when we revisit the case will we be able to make more out of it? We have two advantages over earlier readers of the text; one, obviously, is the further development of psychoanalytic ideas in recent years another is the greater knowledge we have about the actual case. The more we know of what was not disclosed about that treatment in the book, the clearer it is how much it influenced Freud in later years. The story as it was known to Freud is not fully told in Breuer’s case study of Anna O. What we know about it now makes better sense in terms of modern psychoanalysis. I want to emphasize that the details that are not included in Breuer’s account were known to Freud and that he knew the subsequent development of Bertha Pappenheim’s life as his wife was a friend of hers. At the time of their joint publication in 1895, thirteen years after the end of her treatment, both Breuer and Freud knew she was reasonably well and in Frankfurt.

In November 1882 Freud, when he was a newly qualified doctor of twenty six, heard clinical details of this case from Breuer, five months after the treatment ceased. If this had remained his only knowledge of the case it would have provided him with the material that he needed for his early theories of unconscious mental life, repression, and conversion. However we now know that in one hot summer evening of 1883 and whilst he and Breuer dined alone together in relaxed mood he was told another much more unbuttoned, informal and intimate account of the case. This revealed the erotic psycho-drama that took place within Breuer s treatment and potentially gave Freud raw material for his theories of the Oedipus complex, identification, transference, counter-transference, repetition compulsion and acting-out. Freud in his summarizing part of Studies on Hysteria makes his first statement on the psychoanalytic phenomenon of ‘transference’ (Ubertragung) “the patient is frightened at finding that she is transferring on to the figure of the physician the distressing ideas which arise from the content of the analysis”(Freud 1995 p.302). In that passage he makes no reference to Anna O. treatment but it is now clear this was in his mind. Sadly it gave Breuer no such potential insight as he seems to have remained severely traumatized by the experience and unable to profit from it. In a letter written in 1907 Breuer explained to an enquirer why after Anna O. he did not pursue an analytic method with neurotic cases but referred them to Freud:

“I at that time learned a great deal – much that was of scientific value, but also the important practical lesson that it is impossible for a ‘general practitioner’ to treat such a case without his activity and the conduct of his life thereby being completely ruined. I vowed at the time never again to subject myself to such an ordeal” (Grubrich – Simitis I. 1997 p.26-7).