Josef Breuer
Josef Breuer was born in Vienna on 15th January 1842. His father, Leopold Breuer, taught religion in Vienna's Jewish community. Breuer's mother died when he was quite young, and he was raised by his maternal grandmother. He graduated from the Akademisches Gymnasium in 1858 and passed his medical exams in 1867.
Breuer, working under Ewald Hering at the military medical school in Vienna, was the first to demonstrate the role of the vagus nerve in the reflex nature of respiration. This changed the way scientists viewed the relationship of the lungs to the nervous system. The mechanism is now known as the Hering–Breuer reflex.
Breuer became a general practitioner in Vienna who specialised in treating patients who suffered from hysteria. Breuer was a friend of Ernst Wilhelm von Brücke and he introduced him to one of his research students, Sigmund Freud. As Peter Gay has pointed out: "Joseph Breuer, a successful, affluent, highly cultivated physician and eminent physiologist fourteen years his senior. The two men were were soon on the best of terms; Freud adopted Breuer as one in a succession of fatherly figures, and became a regular in the Breuer household, in some ways as good a friend to Breuer's charming and maternal wife Mathilde as to Breuer himself." (1)
Josef Breuer and Anna O
Breuer became a general practitioner in Vienna who specialised in treating patients who suffered from hysteria. In December, 1880, Bertha Pappenheim, aged 21, became Breuer's patient. She had been very close to her father who had become seriously ill. Breuer used the pseudonym, Anna O, for his patient who was suffering from a series of health problems. This included paralysis of three limbs, severe and complicated disturbances of sight and speech, inability to take food, and a distressing nervous cough. "More interesting, however, was the presence of two distinct states of consciousness: one a fairly normal one, the other that of a naughty and troublesome child. It was a case of double personality." (2)
Josef Breuer came to the conclusion that her illness was linked to her "strong intellect" that was not being used to its maximum capacity. He wrote in his case-notes that Anna was "physically healthy... intelligence considerable, excellent memory, astonishingly acute gift for combinations and keen intuition". He added that her "strong intellect" could "digest solid nourishment" but she had not received this since she left school. Anna was therefore condemned to a dull existence amidst her strait-laced Jewish family. Anna had "a very monotonous life, wholly restricted to her family". She had a "passionate love for her father, who spoils her" and this had resulted in her being "sexually undeveloped". (3)
Anna‘s father died on 5th April 1881. As a result, she did not eat for days. Her symptoms continued to get worse and on 7th June she was admitted to a sanatorium, where she remained until November. After returning she continued to be treated by Breuer. He discovered that if he could persuade Anna to talk about her most innermost feelings, she felt better. Breuer likened the process to "chimney-sweeping". Breuer used the technique of "free-associating" to "clean out the mind". This involved "saying whatever came into one's mind, however ridiculous, apparently meaningless or shameful". By analysing the connections made by the patient it became possible to trace the symptoms from which they are suffering back to the source of the problem. (4)
Josef Breuer told Sigmund Freud about the case for the first time in November, 1883. Freud was fascinated by the case and had several long conversations with Breuer about this young woman of "exceptional cultivation and talents". Freud was especially interested in the methods he had used to help Anna. Breuer rightly claimed a quarter century later that his treatment of Anna contained "the germ cell of the whole of psychoanalysis." (5)
Sigmund Freud
Breuer suggested that Freud should also be a general practitioner specialised in treating patients who suffered from hysteria. In April 1886, Freud rented rooms at 7 Rathausstrasse. He paid eighty gulden (£6) a month for it. It had a hall and two large rooms. One of them was divided by a curtain, so that the far half could be used as a bedroom. The flat was elegantly furnished, and all he had to buy was a medical couch. His friend, Josef Breuer, promised he would send him some of his patients. He also advised to "take low fees, treat a good many people gratis, and count on earning only five gulden a day for the first two years". (6)
Freud had very few patients during the first few years of his married life. His first patient was suffering from depression and Freud prescribed electrical treatment. He also gave lectures to young doctors on a wide variety of topics, including clinical neurology and medical uses of electricity. Freud took a close interest in Charcot's "latest investigations upon hysteria... He had proved, for instance, the genuineness of hysterical phenomena and their conformity to laws... the frequent occurrence of hysteria in men, the production of hysterical paralyses and constructures by hypnotic suggestion." (7)
Freud discussed these issues with Josef Breuer. Both men began to use hypnotic suggestion to treat patients suffering from hysteria. This was a term used at the time that meant "ungovernable emotional excess" in women. This included anxiety, nervous coughs, shortness of breath, migranes, contorted facial muscles, paralyzed limbs, tics, muteness, fainting, insomnia, irritability and promiscuity. Charcot believed hysteria to be a disturbance of the nervous system and claimed both men and women could suffer from hysteria. (8)
Hypnosis is a state of human consciousness involving focused attention and reduced peripheral awareness and an enhanced capacity to respond to suggestion. Charcot's idea was you could use hypnosis not only to replicate the hysterical attack but to introduce suggestions to the hysteric that might enable a cure. Freud initially hypnotised patients by pressing his hand on their foreheads. However, Freud found, however, that he was not always able to induce hypnosis, either at all or deeply enough for his needs. (9)
In the autumn of 1892 Ilona Weiss became one of Freud's patients. To protect her identity, Freud always referred to her as "Elisabeth von R". The twenty-four year old daughter of a wealthy Hungarian family was suffering from pains in the legs and had difficulty in walking. Her doctor had examined her and could not find anything physically wrong with her legs and decided she was suffering from hysteria and she was sent to Freud. He decided to use a different method to treat her. Freud asked Elisabeth to lie down on his couch and close her eyes. Applying pressure to her forehead, he asked her to report faithfully whatever came into her mind. (10)
Elisabeth admitted that she was in love with her brother-in-law. However, she was able to suppress these feelings but did seek out his company and enjoyed long walks together. Her troubles began when her sister died and she developed the idea that he could become her husband. This "unacceptable thought" challenged everything that she believes about herself as a moral and loyal person. She resisted it and tried to force it out of her consciousness. It was because of these feelings that caused the pain in her legs. Freud believed the symptom can be traced back to the very walks that she had enjoyed with her brother-in-law before the death of her sister. Freud argues that far from being the degenerate fiends of popular myth, invariably the hysteric is too moral, punishing herself for her unacceptable desires. Elisabeth's treatment involved recovering her guilty thoughts from her unconscious and accepting it. This resulted in a full cure and in the spring of 1894 he attended "a private ball" where he saw "my former patient whirl past me in a lively dance". (11)
Sigmund Freud continued to experiment with encouraging patients to talk freely, without censorship or inhibition, about whatever ideas or memories occurred to them. Freud then used these comments to help discover the link with other events and feelings. During this process it was for the doctor to "decide what is and is not relevant: the patient must shape the discourse". This approach, "if it is to be effective, has to be understood as a partnership". (12)
Studies on Hysteria (1895)
In 1895 Josef Breuer and Sigmund Freud published their book, Studies on Hysteria. It consists first of a reprint of the joint paper they had written, then five case histories, a theoretical essay by Breuer, and a concluding chapter on psychotherapy by Freud. The first case history, by Breuer, is that of Anna (Bertha Pappenheim). Freud contributed the other four cases, including Ilona Weiss (Elisabeth) and Fanny Moser (Emmy).
The book received mainly hostile reviews. The best one appeared in the Neue Freie Presse, the leading daily newspaper of Vienna, by Alfred von Bergner, Professor of the History of Literature in the University of Vienna. He said he read the case histories with admiration and understanding, and then added the significant prediction: "We dimly conceive the idea that it may one day became possible to approach the innermost secret of human personality... The theory itself is in fact nothing but the kind of psychology used by poets." (13)
Havelock Ellis, a doctor working in London, and a founder member of the Fabian Society, also praised the book, and agreed with Freud's views about the sexual cause of hysteria. However, most people were shocked by the idea and it took over thirteen years to sell 626 copies of the book. It was not a very profitable exercise and the authors only received 425 gulden between them (£18 each). During the writing of the book the two men disagreed about the role that sexual impulses played in hysteria. (14)
David Stafford-Clark has pointed out: "Despite the comparative success of their joint publication, Breuer and Freud never collaborated in any further published material.... This in fact heralded not only the break with Breuer but the beginning of the independent emergence of Freud's own concept of psychoanalysis. The basic difference of opinion between the two authors, upon which Freud was later to lay considerable emphasis, concerning the part played by sexual impulses in the causation of hysteria." (15)
Josef Breuer died on 20th June 1925.
Primary Sources
(1) Peter Gay, Freud: A Life for Our Time (1989)
Joseph Breuer, a successful, affluent, highly cultivated physician and eminent physiologist fourteen years his senior. The two men were were soon on the best of terms; Freud adopted Breuer as one in a succession of fatherly figures, and became a regular in the Breuer household, in some ways as good a friend to Breuer's charming and maternal wife Mathilde as to Breuer himself.
(2) Beverley Clack, Freud on the Couch: A Critical Introduction to the Father of Psychoanalysis (2013)
Freud's work - first with his friend and mentor Josef Breuer and then in his own practice - formed the basis for a radically different approach to hysterical illness. Studies on Hysteria (1893-5) offers the case studies of five hysterics suffering a variety of physical symptoms for which no physical reason could be found. These symptoms included hydrophobia (the fear of water, accompanied by the inability to drink) and limb paralysis. As well as providing fascinating insights into the phenomena that accompany hysteria, the Studies also show Freud's personal and professional transition. He stops being a physician offering physiological accounts of neurotic illness and becomes one who bases his practice on the search for psychological causes and solutions. The research biologist becomes the psychologist. Engaging with these early reflections on neurotic illness also suggests something of the collaborative nature of psychoanalysis, for the experiences of the hysterics with whom Freud works comes to shape the development of his psychoanalytic practice.
The clinical practice detailed in the Studies on Hysteria stems from Breuer's "cathartic method". In this method, therapeutic suggestions were made to the hysterical patient whilst they were under hypnosis. Breuer builds upon Charcot's use of hypnosis. But Breuer went further: under hypnosis, symptoms were traced to their source. This was a significant development, for once the source of the symptom was identified, its power to affect the hysteric's actions was undermined and the symptom disappeared.
(3) Ernest Jones, The Life and Work of Sigmund Freud (1961)
Freud has related to me a fuller account than he described in his writings of the peculiar circumstances surrounding the end of this novel treatment. It would seem that Breuer had developed what we should nowadays call a strong counter-transference to his interesting patient. At all events he was so engrossed that his wife became bored at listening to no other topic, and before long she became jealous. She did not display this openly, but became unhappy and morose. It was a long time before Breuer, with his thoughts elsewhere, divined the meaning of her state of mind.It provoked a violent reaction in him, perhaps compounded of love and guilt, and he decided to bring the treatment to an end. He announced this to Anna O, who was by now much better, and bade her good-bye. But that evening he was fetched back to find her in a greatly excited state, apparently as ill as ever. The patient, who according to him had appeared to be an asexual being and had never made any allusion to such a forbidden topic throughout the treatment, was now in the throes of an hysterical childbirth (pseudocyesis), the local termination of a phantom pregnancy that had been invisibly developing in response to Breuer's ministrations. Though profoundly shocked,
he managed to calm her down by hypnotizing her, and then, fled the house in a cold sweat. The next day he and his wife left for Venice to spend a second honeymoon, which resulted in the conception of a daughter; the girl born in these curious circumstances was nearly sixty years later to commit suicide in New York.The poor patient did not fare so well as one might gather from Breuer's published account. Relapses took place, and she was removed to an institution in Gross Enzersdorf. A year after discontinuing the treatment, Breuer confided to Freud that she was quite unhinged and that he wished she would die and so be released from her suffering. She did, however, improve. A few years later Martha relates how "Anna O", who happened to be an old friend of hers and later related by marriage, visited her more than once. She was then pretty well in the daytime but still suffered from her hallucinatory states as evening drew on.
Anna O was not only highly intelligent but also extremely attractive in physique and personality; when removed to the sanatorium, she inflamed the heart of the psychiatrist in charge. Some years before she died she composed five witty obituary notices of herself for different periodicals. A very serious side, however, developed when she was thirty, and she became the first social worker in Germany, one of the first in the world. She founded a periodical and several institutes where she trained students. A major part of her life's work was given to women's causes and emancipation, but work for children also ranked high. Among her exploits were several expeditions to Russia, Poland, and Roumania to rescue children whose parents had perished in pogroms. She never married, and she remained very devoted to God.
References
(1) Peter Gay, Freud: A Life for Our Time (1989) page 32
(2) Ernest Jones, The Life and Work of Sigmund Freud (1961) page 202
(3) Josef Breuer, report on Bertha Pappenheim (1882)
(4) Beverley Clack, Freud on the Couch: A Critical Introduction to the Father of Psychoanalysis (2013) page 15
(5) Josef Breuer, letter to Auguste Forel (21st November, 1907)
(6) Ernest Jones, The Life and Work of Sigmund Freud (1961) page 141
(7) Sigmund Freud, Autobiography (1923) page 2
(8) Elisabeth Young-Bruehl, Freud on Women (2002) page 1
(9) Ernest Jones, The Life and Work of Sigmund Freud (1961) page 210
(10) Beverley Clack, Freud on the Couch: A Critical Introduction to the Father of Psychoanalysis (2013) page 38
(11) Sigmund Freud and Josef Breuer, Studies on Hysteria (1895) pages 160-161
(12) Beverley Clack, Freud on the Couch: A Critical Introduction to the Father of Psychoanalysis (2013) pages 39-40
(13) Alfred von Bergner, Neue Freie Presse (2nd December 1895)
(14) Ernest Jones, The Life and Work of Sigmund Freud (1961) page 224
(15) David Stafford-Clark, What Freud Really Said (1965) page 39
