In detail

The case of Anna O. and the origin of Psychoanalysis

The case of Anna O. and the origin of Psychoanalysis

Anna O. was the pseudonym of a patient of Dr. Josef Breuer, who published the study of her case in the book “Studies on hysteria”, Written in collaboration with Sigmund Freud. Her real name was Bertha Pappenheim (1859-1936), an Austrian-Jewish feminist woman and founder of the Jüdischer Frauenbund (League of Jewish Women).


  • 1 Start of treatment of Anna O.
  • 2 Stages of Anna O's disease.
  • 3 Symptoms of Anna O.
  • 4 Breuer's treatment
  • 5 The recovery

Start of treatment of Anna O.

Anna O. was treated by Breuer due to a severe cough condition, paralysis of the limbs on the right side of her body and vision, hearing and speech disorders, as well as hallucinations and loss of consciousness. Anna was diagnosed with hysteria. Freud argued that his illness was a consequence of resentment over his father's real and physical illness that later led to his death.

Its treatment is considered as the principle of psychoanalysis..

Breuer observed that while Anna experienced her "absences" (with radical personality changes accompanied by confusion pictures), she muttered words or phrases to herself. In his treatment he carried out various hypnosis works to find out more about his disorder and found that these words were, according to him, "deeply melancholic fantasies ... sometimes characterized by a poetic beauty." This is how the "free association" emerged, where the hypnosis sessions with Breuer, Anna focused on talking, letting thoughts flow, saying anything that came to mind.

Anna had a younger brother, Wilhelm Pappenheim, and two older sisters. In 1867, when he was only 8 years old, his sister, Henriette, died from tuberculosis.

At the time and the society in which Anna grew the opportunities for women were very limited, and she had to leave school to undertake other activities such as sewing, instead of continuing her education.

Josef Breuer

In 1880, Anna's father contracted tuberculosis and Anna dedicated herself to taking care of him while in bed. Unfortunately, his father's illness was fatal and he died in April of the following year. However, it was while he had been sick his daughter also fell ill, although with different symptoms. That was when Anna began consulting Josef Breuer for symptoms related to her illness.

Freud noted that, before her illness, Anna had lived a healthy life and was a very intelligent woman, with an active and dreamy imagination. However, his dedication to caring for his sick father began to make a dent in her to the point that Anna also became ill.

Stages of Anna O's disease.

Breuer summarizes Anna O.'s disease in four stages:

1. Latent incubation

This stage goes from July 1880 and until approximately December 10 of that same year, at which time Anna's disease begins to emerge clearly. Freud states that in other patients the signs of disease onset would not be noticeable, but the exceptional symptoms seen in Anna result in this phase being clearly observable by others.

2. The manifest disease

Here the symptoms are at their peak, but in parallel Anna begins to show a certain recovery thanks to the treatment, unfortunately this recovery was interrupted in April 1881, when her sick father dies. This fact affected Anna seriously and on June 7, 1881 begins to show suicidal tendencies.

3. Intermittent sleepwalking

Between April and December 1881, Anna begins to experience periodic sleepwalking, but her behavior is apparently normal.

4. Recovery

Breuer states that, after her treatment, Anna makes a slow recovery from her illness, which lasts until June 1882.

Symptoms of Anna O.

The symptoms exhibited by Anna herself during the entire process were very varied, from a cough to various behavioral symptoms, including sleepwalking. These are some examples:

  • Paralysis: paralysis in the right arm and leg.
  • Involuntary eye movements: Including vision problems and, in December 1881, a strabismus.
  • Hydrophobia: An aversion to food and water (hydrophobia), which left Anna barely able to drink for days.
  • Lethargy: In the afternoon she fell asleep and then presented an opposite state of great excitability. Between December 11, 1881 and April 1 of the following year, Anna remained confined to her bed.
  • Language difficulties: In the middle of a sentence, Anna would repeat the last word and pause before finishing it. She was a polyglot, and began speaking in several languages, including English to her caregivers, to her confusion. However, Anna herself did apparently without realizing it, and was finally unable to speak for two weeks.
Sigmund Freud

Anna was diagnosed with hysteria, and spent much of her life in a state of anxiety and experiencing hallucinations, such as seeing skeletons and black snakes, possibly as a result of seeing her own confusional state. During the day he was usually in a state of discomfort, crying and mental "tormenting."

Freud observed that when she was in a state of deep hypnosis, she was able to describe daily hallucinations through this trance state, and on the days she was able to show them, she slept better at night and was able to wake up more quietly.

Breuer's treatment

Realizing the benefits that the release of anxious thoughts had on Anna, Breuer used this treatment on a regular basis, becoming described as "speech therapy or cure," prompting Anna to participate in conversations about her daily life and her problems. , in search of a psychological basis for hysteria.

This custom of telling Anna's stories provided Breuer an intriguing idea about her mood. These fairy tales, as he called them, because they reminded him of Hans Christian Anderson's work and were generally unhappy, seemed to echo Anna's experiences in caring for his father.

He also transmitted a dream about a black snake that was approaching a sick man's bed and how she felt paralyzed and was unable to protect the patient from the terrible creature. Freud concluded that the paralysis she experienced was actually linked to what she had experienced in her state of anxiety during sleep.

During her meetings with her therapist, Anna also remembered an occasion when she was younger and had a glass of water. She explained seeing her babysitter's dog, which she didn't like, approaching her drinking from her glass, causing her to feel repulsion at the idea of ​​sharing her glass with the dog. Breuer attributes this traumatic experience to his subsequent inability to drink water; Anna had formed an association between water and the negative event earlier in her life.

The recuperation

Breuer and Freud believed that reliving unconscious anxieties, such as hallucinations and traumatic experiences, and making them aware, could help Anna overcome the symptoms related. Over time, his problems ceased and a gradual recovery was achieved, he was given a pet dog to care for and participated in charities helping other sick people.

Bertha Pappenheim's disease (Anna O) generated a medical history that was going to greatly influence Breuer and Freud's ideas, in particular, in their psychodynamic approach.

Anna's treatment emphasized both the impact of previous traumas and the subconscious ideas of the mind, which resulted in the use of "speech cure," along with hypnosis and regression, to identify possible causes of disease. Mental

Later in his life, Anna became a prominent figure in the feminist movement in Austria and Germany, and founded the League of Jewish Women in 1904 and was an active defender of the cause until she died in 1936.

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