he now classic early psychoanalytical publication Studien über Hysterie (Studies on Hysteria) of 1895 had as joint-authors, Breuer & Freud. Josef Breuer, 1842-1925, is to be considered the first to have employed proto-psychoanalytic technique therein, a compliment paid him by co-author Freud in the "Studies" and in the later (1925) An Autobiographical Study and elsewhere. Breuer's contribution had come from the opening case-history, that of "Fräulein Anna O." Four further case-histories were presented by Freud, and all five are here briefly detailed below.
"Fräulein Anna O.": this highly intelligent twenty-one-year old patient had, from 1880-82, proven resistant to suggestion in the "hypnoid" state, and her many distressing symptoms persisted. One day when Breuer called to treat her with text-book hypnosis and suggestion, she had apparently just awoken from an autonomous hypnotic state of her own, and the classic "reminiscences" were partially still with her. As she related fresh material to Breuer, he noted her reduced anxiety state [owing to catharsis, the term coined by Breuer for emotional release and "abreaction" of anxiety], and he decided to call regularly at a time suitable to profit from his new observation. As the patient became more adept at the treatment, one day Breuer heard her describe the very first occurrence of one of her hysterical symptoms, upon which the symptom disappeared never to return [though there were relapses with alternative symptoms, and she even required temporary internment at a Clinic in Gross Enzerdorf]. "Anna O." called the new procedure her "talking cure" or "chimney-sweeping", and she thus deserves credit for the discovery of this, the cathartic method. Eventually she was able to relate the reminiscence of having been at her dieing father's bedside, and holding his hand as he died, whereupon her arm had become (hysterically) paralysed. With the memory returned, the paralysis disappeared. Breuer was unable or unwilling to link the observations to any sexual aetiology [in a repressive society], nor was he equipped to forge a new psychology of Unbewussten Denken(Unconscious Mind). Enter Sigmund Freud, as Breuer's younger colleague and co-author.
"Frau Emmy von N.": this middle-aged woman's treatment with Freud for tics and hallucinations began in May 1889, with Freud still a relative novice of less than two years as a hypnotherapist. Freud"s new observations here were largely such as undermined the existing procedures, for example when he discovered that his patient tended to appear to accept the physician's suggestions, though in fact merely as a pretence to please him. With a relatively poor performance as a hypnotist - and quickly recognising the unproductive nature of endlessly repeated suggestion - Freud remained primed for new avenues, in addition to his insights into Breuer's "Anna O." case. From "Frau Emmy" - and also another patient ["Cäcilie M.," who suddenly flung her arms around his neck and demonstrated a desire to hug him] - Freud perceived the emotional importance of the growing bond between patient and therapist [later termed "transference" relationship, though shunned by Breuer, especially with regard to the reciprocal notion, of a "counter-transference" of the therapist for the patient].
"Fräulein Elisabeth von R.": in the autumn of 1892 Freud undertook this case, which proved to be yet another resistant to hypnosis. Here for the first time Freud dispensed with any attempt at hypnosis, and employed what he would later call his "concentration technique" or "psychical analysis." The patient would lay down, close her eyes and attempt to concentrate on a particular symptom and its associated memories. With the passage of sessions, he also introduced the new injunction to "tell all" and ignore any censorial thoughts, which latter he had frequently become aware of in his patient's reports. "Free association" was probably first conceptualised in this case, and again, as with the earlier case of Frau Emmy von N., the credit was partly due to the clever patient.
"Miss Lucy R.": an English governess in Vienna, this patient (also in 1892) was eventually seen to have a forbidden attachment to her employer, and the symptoms of her neurosis were the result of strong contrary psychological forces attempting to hide/remove the forbidden truth. It is here that Freud, for the first time, introduces notions of the importance of repressing forces in the mind. See: Biographer Ernest Jones (1953, Chap. 11, "The Breuer Period, 1882-94"). Jones (1953, Chap. 12) would go on to identify here Freud's first use of the term verdrängt (repressed). On a technical level, the "Lucy R." sessions also taught Freud the importance of every trivial symptom, even the smell of a burnt pudding, which could be tracked back to significant associations in the patient's past and (internal) present.
"Katharina": an eighteen-year old serving girl/daughter of inn-keeper, who Freud met whilst on holiday in the Alps in the early 1890s. Having noted Freud"s "Dr." in the inn register, the "well built girl with her unhappy look" waylaid him with a request for help with nervous and breathless symptoms. Freud decided to ignore hypnosis/analysis, and to try "a simple talk" with the hope of "a lucky guess," albeit based upon his extensive previous experience with "breathless young women" and their "virginal mind ... when faced for the first time with the world of sexuality," ("Studies on Hysteria," Case 5). The girl's symptoms had first occurred two years earlier, whilst she was living away at the inn of her aunt and uncle. Freud's method would today fall foul of the later injunction to not lead the patient's train of thought - "Perhaps you saw something naked?" - he enquired when the uncle's room entered the story. But these were pioneering times, and Freud's "guess" appears to have been correct. There had indeed been a "scene of discovery" of a sexual act; it had made a traumatic impact upon the unprepared teenaged girl, and the "simple talk" appears to have been therapeutic [and pro bono].
A final chapter of the "Studies," also provided by Freud, was on "Psychotherapy." This surveyed the various new developments in technique, from hypnosis and suggestion, to instruction and listening; the insisting on full disclosure of memories, uncensored/free association; and also introduced the new theoretical insights. These now gave attention to "defence" against anxiety; the role of repression of traumatic experiences, and the conversion of psychic energy/anxiety to unconscious/somatic symptoms. The [unwelcome] new emphasis on a sexual aetiology, and on the possibility of "transference relationships" between patient and therapist, was wholly anathema to the elderly and culturally more conservative Breuer, and made final the break between the two colleagues and friends. Thirty years later, in 1925, the death of Breuer would coincide with Freud's An Autobiographical Study, in which he would accord full honours to his old colleague and to the crucial case of "Fräulein Anna O."
Breuer, J. and Freud, S.Studien über Hysterie (Studies on Hysteria). Fischer-Taschenbuch Verlag. 1973.
Freud, S.An Autobiographical Study. S. E., Vol. XX.
Jones, Ernest,The Life and Work of Sigmund Freud. Vol. 1, Chap. 11, "The Breuer Period, 1882-94"; Chap. 12, "Early Psychopathology, 1890-97". London: Hogarth Press, 1953. Abridged edn. 1 vol. New York: Basic Books, 1961. Pelican Books Paperback. 1964, 1993.
Created 25 February 2021