Sigmund Freud and the History of Anna O. Sigmund Freud and the History of Anna O

Sigmund Freud and the History of Anna O. Sigmund Freud and the History of Anna O. Reopening a Closed Case

Richard A. Skues © Richard A. Skues 2006 Softcover reprint of the hardcover 1st edition 2006 978-0-230-00530-3 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The author has asserted his right to be identified as the author of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 2006 by PALGRAVE MACMILLAN Houndmills, Basingstoke, Hampshire RG21 6XS and 175 Fifth Avenue, New York, N.Y. 10010 Companies and representatives throughout the world PALGRAVE MACMILLAN is the global academic imprint of the Palgrave Macmillan division of St. Martin’s Press, LLC and of Palgrave Macmillan Ltd. Macmillan® is a registered trademark in the United States, United Kingdom and other countries. Palgrave is a registered trademark in the European Union and other countries. ISBN 978-0-230-22421-6 ISBN 978-0-230-62505-1 (eBook) DOI 10.1057/9780230625051 This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Skues, Richard A., 1953- Sigmund Freud and the history of Anna O : reopening a closed case/ Richard A. Skues. p. cm. Includes bibliographical references and index. 1. Hysteria--Case studies. 2. Psychoanalysis--Case studies. 3. Freud, Sigmund, 1856-1939. 4. Pappenheim, Bertha, 1859-1936. 5. Breuer, Josef, 1842-1925. Studien über Hysterie. I. Title. RC532.S48 2006 616.85’24--dc22 2006045226 10 9 8 7 6 5 4 3 2 1 15 14 13 12 11 10 09 08 07 06 For Susie, without whom… The relevant methodology can be summed up in four principles: (1) Never take anything for granted. (2) Check everything. (3) Replace everything in its context. (4) Draw a sharp line of distinction between the facts and interpre- tation of the facts. Henri F. Ellenberger, introduction to The Discovery of the Unconscious (1970)

Alle Männer vom Fach sind darin sehr übel dran, daß ihnen nicht erlaubt ist, das Unnütze zu ignorieren. (All specialist scholars are at a great disadvantage in that they are not allowed to ignore what is useless.) J. W. von Goethe, Maximen und Reflexionen (Posth.) Contents

Preface viii Introduction: The Changing History of a Case History 1

Part I The Evolution of the Case 13 1. The 1882 Documents 15 2. Subsequent Evidence 33 3. The Publication of the Case Study 38 4. Freud’s Account: Reconstructions 54 5. Defence and Sexuality 69 6. Transference and the Faustian Imperative 80

Part II The Evolution of the Legend 91 7. The Birth of the Legend: Ernest Jones 93 8. The Development of the Legend: Henri Ellenberger 111 9. The Maturation of the Legend: The Derivative Literature 124 Conclusion 151 Appendix: Chronology 168 Notes 174 References 194 Index 199

vii Preface

Die größten Schwierigkeiten liegen da, wo wir sie nicht suchen.1 J. W. von Goethe, Maximen und Reflexionen (1829)

This book is intended as an attempt at historical demystification: the deconstruction of a legend of psychoanalysis. The legend concerns Anna O., the patient whose real name was Bertha Pappenheim and whose case study stands at the head of Freud and Breuer’s Studies on Hysteria, first published in 1895. Josef Breuer treated Bertha Pappenheim from the end of 1880 until June in 1882, but it was not until ten years later and after considerable pressure from Freud that he agreed to pub- lish an account of it in their joint work, first in a Preliminary Communication at the beginning of 1893, and then more fully two years later. In 1895 Breuer and Freud used this case as an illustration of their success in the alleviation of hysterical symptoms by means of a new method of treatment. This method, it was claimed, had been elaborat- ed by Breuer in the course of the treatment of his patient when he dis- covered that her hysterical symptoms disappeared once she had related all the circumstances of their occurrence right back to the event that precipitated them. Once the emotions attached to this original experi- ence had been allowed free expression through being articulated in speech, then the affect would no longer constitute the energy base that sustained the hysterical symptom in question. Although this ‘talking cure’ had been initiated by his patient, Breuer began to apply it system- atically to relieve her symptoms one by one, and then Freud himself, having heard about the case directly from Breuer shortly after its con- clusion, tried the method on patients of his own several years later. The case histories of Anna O. and four patients of Freud’s own formed the backbone of the Studies on Hysteria, which also included a theoretical chapter by Breuer, and one on psychotherapy by Freud. For Freud this work was to become one of the foundation stones of psy- choanalysis. It represented the first faltering steps towards the full elabo- ration of the discipline that was to become almost synonymous with his own name, and the basis of everything that came after. Freud’s relation- ship with Breuer did not survive the completion of their book, and even at its publication he had a very clear view about its inadequacies. Yet at

viii Preface ix the same time the systematic attempt to make the hysterical symptom intelligible, and thus to attain control over it, was what marked the new method as the embryonic form of psychoanalysis. Seen in this light, Anna O. becomes the first psychoanalytic patient, even though her treat- ment was to predate the nominal birth of Freud’s new science by some 15 years or so. When Freud in later years was to credit Breuer with having inaugurated psychoanalysis in all but name, it was his treatment of Anna O. that justified this. Both within Freud’s lifetime and ever since, there are few histories of psychoanalysis that do not begin by mentioning Breuer’s treatment of Anna O. as the event that stands at its origins. Yet if for psychoanalysis the Anna O. case was one of its earliest tri- umphs, there are today few historically informed commentators on the discipline who do not regard it with considerable scepticism, and this sometimes amounts to a claim of outright fraud on the part of Breuer and Freud. Since Ernest Jones recorded in the first volume of his biography of Freud in 1953 that Freud had told him that there were aspects of the con- clusion of the case that had not been published, that Breuer brought the treatment to an end prematurely as a result of an emotional entangle- ment between himself and his patient, and that she herself suffered relapses that necessitated her institutionalisation, other accounts have compiled on these foundations a case which makes it appear that Breuer’s treatment was little short of catastrophic. In the early 1970s the pioneer- ing historian of dynamic psychology, Henri Ellenberger, discovered that shortly after the ending of her treatment with Breuer, Bertha Pappenheim had gone to stay in a sanatorium in Switzerland. He discovered an origi- nal report by Breuer and supplementary case notes by a doctor at the sanatorium which indicated that Bertha was still suffering considerably. Building on this, Breuer’s biographer, Albrecht Hirschmüller, also found out that Bertha was repeatedly hospitalised in Vienna during the suc- ceeding five years. All these circumstances, along with a number of com- ments that came to light in Freud’s correspondence with various of his followers over the years, conspired to paint a picture of the Anna O. case that was radically at odds with the received version that had engrained itself in conventional psychoanalytic history. There are few writers nowadays who make more than a passing refer- ence to the case of Anna O. without also mentioning this body of evidence and commentary that has come to the fore in the last 50 years and which seems to cast such doubt not only on the original treatment of the patient but also on the integrity of both Breuer and Freud in their sustained asser- tion that this treatment was a success. Freud’s own position is perhaps even more precarious than Breuer’s in that even though he seemingly x Preface knew the case was highly problematic, and revealed as much in private to several of his followers over the years, he also apparently continued to maintain in public the façade that represented Anna O. as the founding patient of psychoanalysis. To the extent that this case is now thought to be a dramatic failure, Freud’s testimony rebounds back ironically as an astringent commentary on the value of the science and therapy that was his life’s work. The substantive thesis to be argued in this book is that this picture of the Anna O. case, constructed by the last 50 years of Freud scholarship, is in all fundamentals wrong and itself represents a modern-day fiction about the origins of psychoanalysis. To that extent the burden of this thesis signifies not so much a rewriting of history, as almost an attempt to reverse it. To many, this may seem at the outset to be not just a mon- umental but a hopeless task, for the modern story of Anna O. is deeply rooted in the critical literature on psychoanalysis and appears to be so well founded in contemporary historical scholarship as to be almost beyond correction, let alone radical rejection. Yet such an undertaking is necessary. Conventional histories of psychoanalysis have been sub- ject to harsh criticism, and often not without justification, by those who have seen them as little more than apologies for a discipline that needs to bury the realities of its past and to replace them with reassur- ing myths about its origins. Yet there is no point in substituting one set of comfortable fictions for another, for this is what recent histories of the Anna O. case have become. There is no single author of these fic- tions, but in the accretions of the myth over the last few decades the new tale of Anna O. has evolved to become the story that many – particularly critics of psychoanalysis – wish to retell and to hear retold. It will be argued here that this is a story that does not withstand close scrutiny. It is now necessary to reassess the evidence and to try to recapture what we can of the Anna O. case as it took shape and played its leading role in the development of psychoanalysis in the 1880s and 1890s. This must be done by examining this evidence as far as possible in its origi- nal setting and with an awareness that the case can properly be evaluat- ed only when one is sensitive to the historical circumstances that gave rise to it and to the nature and purpose of the documents that constitute its legacy. This book will therefore present an historical reconsideration of the case and its data, concentrating particularly on the circumstances surrounding the ending of the treatment and its aftermath, for this is the key battleground marked out by the case’s critics. It is therefore hoped that it will be by the persuasiveness of the historical reconstruction and Preface xi its consequences for our reading of the case that the book’s success or failure will be judged. This project has been several years in the making and could not have been completed in its present form without the support and assistance of a number of friends, colleagues and acquaintances. The late and much-missed Terry Tanner was the first to hear an outline of the thesis, and his encouragement was an important stimulus to its elaboration in print. To Dr Sonu Shamdasani grateful thanks are due both for being the first reader of an early draft of this book and for his incisive comments and criticisms which helped immeasurably to clar- ify and strengthen its argument. Anthony Stadlen and Peter Swales have not only assisted on specific points but also provided a constant background of discussion, stimulation and support both for this proj- ect and in the field of Freud studies in general, which has been of incalculable benefit. Dr Wilhelm Hemecker gave invaluable assistance with some difficult issues of translation, and comparable help was also provided on particular points by Dr Ernst Falzeder, Professor Johannes Reichmayr and Julia Swales. Professor George Makari and Professor Peter Rudnytsky both provided valuable comments on the penulti- mate draft of the book as a whole. Dr Gerald Kreft was exceptionally accommodating in assisting with the illumination of the ‘Edinger con- nection’, while Dr Michael Schröter provided indispensable help with elucidating aspects of Max Eitingon’s paper on Anna O. Thanks are also due to Professor Stephen Frosh for his supportive comments on an earlier draft of the text and likewise to Professor Edward Timms for helping to highlight the particular pitfalls that await the non-special- ist historian in this domain. Julia Brown’s consummate skill and pro- fessionalism helped in no small way with the completion of this whole project. While this book would not have been published in its final form without the assistance of all those named above, responsi- bility for its shortcomings remains solely with the author.