The Birth of Psychoanalysis, and the Erasure of a Life

​In the summer of 1883, Sigmund Freud was a semi-employed twenty-eight-year-old medical researcher, still living in a crowded apartment with his immigrant parents and sisters. He had recently become engaged to Martha Bernays, the fatherless granddaughter of a famous scholar and rabbi. When he confided the news of his engagement to his supervisor, Ernst Brücke, Freud was perhaps hoping he might get a promotion and a raise in salary, but Brücke—“my teacher for whom I felt the highest esteem”—told Freud it was time to leave his position in neurological research at Vienna Hospital, “strongly advising me, in view of my bad financial position, to abandon my theoretical career.” It was the era of the so-called “anti-vitalists;” physicians who believed that the psyche could only be understood in terms of the function of the brain cells and nerves. The historian of psychoanalysis George Makari writes, “For leading researchers, therapeutics were at best worthless and at worst dangerous.”

​On July 12, Freud went to visit his mentor, Josef Breuer. Perhaps because he was Jewish, Breuer had been excluded from a position at the hospital. Nevertheless, he had managed a career both as a researcher and as a practicing physician. He treated many of the wealthiest families in Vienna, and he was the co-discoverer of, among other things, what is still called the “Herring-Breuer reflex,” the autonomic exhale response.

​The two men ate dinner and according to Freud “there was a long medical conversation about medical insanity and nervous illnesses and strange cases.” Breuer talked about his former patient, Martha’s friend, Bertha Pappenheim.

​From December 1880 to May 1882, Breuer had treated Pappenheim for “hysteria.” She had been bedridden, suffering seizures and periods of paralysis, distortions in her vision, and most peculiarly, the loss of her language. Breuer had understood these physical symptoms as psychological in nature, and he and Pappenheim had developed together a form of treatment that she called “the talking cure,” a cathartic process through which she unburdened herself by telling stories to her physician, and so found relief from her symptoms.

Freud was fascinated by “the talking cure,” but Breuer was unsure of its value.

“I vowed at the time,” Breuer wrote later, “that I would never go through such an ordeal again.”

After dinner with Breuer, Freud wrote a letter to Martha, stating that Breuer had confided in him something unspeakable about Pappenheim, something “I am to repeat only when I am married to Martha.” What that unspeakable thing was, we will never know. Freud destroyed all his early papers and journals.

On July 30, a little more than two weeks after Freud’s meeting at Breuer’s house, Pappenheim was in a sanitarium, being treated for hysteria. Freud wrote to Martha, saying that Pappenheim was “quite deranged,” and that Breuer wished his former patient might die “so that the poor soul could be released from her suffering.” Whatever the course of the mysterious “talking cure,” it had not apparently saved Pappenheim from her misery.

In 1885, three years later, Freud traveled to Paris to study in the Salpêtrière Hospital to work in a laboratory dissecting the brains of dead infants. He saw the director of the Salpêtrière, Jean-Martin Charcot, lecture on hypnosis and hysteria. Charcot argued that hysteria—symptoms of the kind Pappenheim had suffered—were the result of “dynamic lesions in the brain,” but Freud was beginning to develop a different conception, and, as he wrote later in his autobiography, he kept thinking about Pappenheim; that case, for him, had “accomplished more toward any understanding of neurosis than any previous observation.” When he returned to Vienna, Freud set up a practice of his own. He was beginning to specialize in the treatment of neurotics, and he advertised that he used “the cathartic method of J. Breuer.” Years later, Ernest Jones, Freud’s acolyte and first biographer would write that it was Pappenheim who deserved credit for bringing the concept of catharsis to psychoanalysis—that she was the one who found value in unburdening herself to a doctor.

In 1887, Sigmund and Martha Freud, now married, attended a dinner party hosted by Bertha’s cousin, Emma Pappenheim. The Freuds were seated at the same table as Bertha. “Bertha is quite like herself before in her essential character,” Martha wrote to her mother, but “in her appearance, she has changed very much, her hair is almost completely gray, and the sparkle has entirely gone from her eyes.”

Miserable, Recovered, Reinvented
Later that year, Pappenheim stopped by the Freud apartment when Martha was pregnant. She was “quite miserable again,” Martha confided to her mother. “That is so sad isn’t it?” By the summer of 1887, Pappenheim was back in a sanitarium, anorexic, insomniac, hallucinating, and insane. It wasn’t until the end of the decade, when she had moved with her mother to Frankfurt, that Pappenheim recovered and reinvented herself: working as a social worker, then a journalist, then becoming the leading Jewish feminist in the German-speaking world. All her adult life, she devoted herself to combatting the Mädchenhandel, the sex trade in young girls, many of them poor Jews from Eastern Europe. She never revealed her connection with Freud, hysteria, or psychoanalysis.

Meanwhile, Freud and Breuer kept on discussing her case. “Freud’s intellect is soaring,” Breuer wrote, “I struggle behind him like a hen behind a hawk.” But he did not want to publish Pappenheim’s case history. He referred patients diagnosed with “hysteria” to Freud, and his own research was physiological, focused chiefly on the anatomy of the inner ear; he was making important breakthroughs on the nature of balance.

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It wasn’t until 1892—years after Pappenheim had moved away from Vienna—that Breuer finally agreed to collaborate with Freud and to write about hysteria. Their work together was fraught and fitful. In 1894, Freud declared in a letter, “The scientific contact with Breuer has stopped.” Finally, in 1895, Studies in Hysteria appeared, an elaboration of the “cathartic method of J. Breuer,” and Freud’s first book on psychology. The book’s thesis is expressed succinctly, “hysterics suffer for the most part from reminiscences.”

The first case study in the book is Breuer’s. Pappenheim is renamed “Anna O.” and in Breuer’s description of her “talking cure,” Pappenheim speaks her forgotten memories, and when she gives voice to these “reminiscences,” her hysterical symptoms—her inability to hear, to use her arms, to use her legs, to speak her native language—all vanish. Breuer writes that after the talking cure, her “hysteria was resolved in its entirety,” and that since the time of treatment, “she has enjoyed perfect health.” Her decade of misery is elided.

Soon after, Breuer and Freud parted ways, socially and professionally. Freud revised his view of hysteria, arguing contrary to Breuer that the symptoms of hysteria “cannot be devoid of sexual significance.” In the famous “Dora” case, for instance, Freud argued that his patient’s “hysterical” difficulties in speech were the result of a repressed desire to fellate her father. Breuer did not concur with this kind of sexual reductivism, and Freud would brook no disagreement. The story is that when they crossed paths in Vienna, Breuer reached out his arms to embrace his old friend, and Freud walked by coldly. Still, when Freud first came to the US in 1910, he credited Breuer with the discovery of the therapeutic method upon which psychoanalysis is based. Pappenheim went unmentioned.

Coincidentally, in 1910, she was also in the United States, raising money and describing her fight against the Mädchenhandel. Pappenheim was, at the time, better known than Freud. Never in her adult life did she publicly discuss her personal relation to psychoanalysis, but she seems to have disapproved of Freud’s theory. The home she ran in Frankfurt taught vocational skills to vulnerable Jewish girls, so that they would have options other than sex work, and Pappenheim is reported to have said, “Psychoanalysis will never penetrate my establishment.”

The Women Question
She and Freud never addressed each other publicly but in the German press’s wide-ranging arguments about sexual mores and “The Women Question” they played for opposing teams. Pappenheim believed that with education and Jewish values, she could combat sexual promiscuity in young girls. Freud believed the opposite, that anti-sexual childhood socialization was devastating to the ego. He never stopped revising the story of “Anna O.” and the birth of psychoanalysis. Over the years he changed it, making it conform to his increasingly rigid theories of psychosexuality. It is impossible to believe that he did so without thinking about the woman at the center of that story.

In 1924, Bertha Pappenheim attended the First World Conference on Jewish Women in Vienna. In 1928, Pappenheim was back in the city, to argue for voting rights for women. It was in this period, when Freud was at the height of his prestige and powers, that he began to reimagine “Anna O.” After Breuer died in 1925, Freud claimed to have “suddenly remembered” something that Breuer had told him, in the 1880s: that at the end of their work together, Anna O. had suffered a hysterical pregnancy, calling out “Dr. B.’s baby is coming,” and that Breuer, unable to master his feelings of sexual attraction to his patient, fled the scene.

In 1932, when Freud was in his seventies, he put this “reconstruction” down on paper: “On the evening of the day when all her symptoms had been disposed of [Breuer] was summoned to his patient again, found her confused and writhing in abdominal cramps. Asked what was wrong, she replied ‘Dr. B.’s Baby is coming.’” He continued to rework the story of the hysterical pregnancy, telling and retelling it, even when cancer had taken out the top of his mouth, and he wore an uncomfortable prosthesis in place of his soft palate. “Freud gave me two versions of the story,” wrote Jones, one version with a mention of Breuer’s hat, one version without. In a letter to Jones, Freud’s English translator James Strachey wrote, “Freud told me the same story with a good deal of dramatic business. I remember very well his saying, ‘So he took up his hat and rushed from the house’—but I’ve always been in doubt that it was a story that Breuer told Freud.”

A hat is the first example of a phallic symbol in The Interpretation of Dreams. In the story of the hysterical pregnancy, Breuer has lost his, and with it, any claim to the authority over psychoanalysis. So the invention of psychoanalytic theory goes not to him (and certainly not to his patient) but to Freud himself.

The story Freud told was inscribed into the history of psychoanalysis. It’s reported as if it were fact in Peter Gay’s monumental 1988 biography of Freud, and again in Melinda Given Guttmann’s 2001 Pappenheim biography. It’s even there in Elaine Showalter’s Hystories, probably the most widely read US feminist book on hysterical disorders. In When Nietzsche Wept, a 2007 film starring Ben Cross as Breuer and Michal Yannai as Pappenheim, Bertha, with exotic-dancer orange hair, falls into her phantom pregnancy, laughing demonically, right in front of Breuer’s wife.

Pappenheim, a towering figure of early twentieth-century feminism and a woman who helped invent talk therapy, was largely forgotten, and replaced by a figure conjured by Freud. He transformed her into Anna O., one of psychoanalysis’s most compelling ghouls, first name a palindrome, last name an orifice. She has haunted the offices of psychotherapists ever since.

​(Excerpted from The Secret Mind of Bertha Pappenheim: The Woman Who Invented Freud's Talking Cure.)