My recently completed PhD explored the illness experience of Freud’s patient Anna von Lieben, using a qualitative research methodology – Interpretative Phenomenological Analysis – to analyse her previously undiscovered autopathographical poetry. The analysis, supplemented by a reading of her husband’s diaries and other family documentation, indicated that the patient’s pathology was due primarily to a longstanding gynaecological condition, possibly endometriosis. The overall findings led to the identification of several new avenues of research which I would like to offer for the consideration of researchers in the field of Medical Humanities/Narrative Medicine. My proposals also draw on the work of Nezhat, Nezhat and Nezhat (2012)* who suggest that, throughout history, many of the women diagnosed with hysteria were in fact suffering from endometriosis, or something similar.
On this basis, I have formulated the following ideas:

• a study of ‘hysterical’ patients of the 19th century to identify and further explore those with gynaecological co-morbidities 
• a qualitative analysis comparing the lived experiences of 19th-century ‘hysterical’ patients manifesting gynaecological symptoms and those of present-day endometriosis sufferers  
• a historical investigation over several millennia designed to find evidence in support of the Nezhat theories.

A project based on any of the above might serve as a topic for doctoral or postdoctoral research. It might equally be possible to investigate all three suggestions for an interdisciplinary team-based project. It could also be of interest to language scholars, both modern and classical.
The amount of new primary material which I obtained from the von Lieben family archive would in itself be sufficient for a number of researchers. Added to this is the substantial bank of archival information which I have built up in the course of my own research. I would like therefore to offer the above ideas as a ‘provocation’ to stimulate further investigation. I will not be undertaking any more substantial academic activity myself, but I would be happy to act as a facilitator for others, putting my knowledge and resources at their disposal, and passing the baton on to the next generation of researchers.
My methods and findings are summarised in the Abstract of my doctoral thesis, In her own words: Exploring the subjectivity of Freud’s ‘teacher’ Anna von Lieben. The thesis itself can be accessed at https://theses.gla.ac.uk/82795/
If you would like further information, or to engage in some exploratory discussion, please contact me at hilda.reilly@glasgow.ac.uk
*Nezhat, C., Nezhat, F., & Nezhat, C. (2012). Endometriosis: Ancient disease, ancient treatments. Fertility and Sterility, 98(6), 1-62.

Feminists are keen to claim Bertha Pappenheim as one of their own, and rightly so. She would be happy to consider herself such. After recovering from her illness she was active for the rest of her life in the field of women’s rights – a prolific feminist writer and polemicist, the founder of the League of Jewish Women, and a pioneering social worker, fighting against white slavery and founding a home for Jewish prostitutes and unmarried mothers. As well as all this she even found time to translate Mary Wollstonecraft’s A Vindication of the Rights of Woman into German and to write a play called Women’s Rights.

Perhaps she would not be so happy, though, with the lengths to which some feminists go in justifying their claim.

In Hysteria Beyond Freud, Elaine Showalter tells us that ‘In her hysterical seizures, Anna became unable to speak her native German, and instead spoke either Yiddish, which she called “the woman’s German,” or a jumble of English, Italian and French.’ While it is true that Bertha’s aphasic disturbances resulted in her being unable to speak German, resorting instead to English, Italian and French, nowhere in the case reports does Breuer mention her speaking Yiddish.

Showalter uses this claim about Bertha’s Yiddish to bolster up a feminist theory about ‘the repression of women’s language or its impossibility within patriarchal discourse’. She quotes psychoanalyst Juliet Mitchell who calls hysteria ‘"the daughter's disease," a syndrome of physical and linguistic protest against the social and symbolic laws of the Father’. Then, in an egregious example of post hoc, ergo propter hoc thinking, she states that in the case of Bertha Pappenheim ‘the connections between hysteria and feminism seemed particularly clear because after her analysis with Breuer in 1882, she went on to become a feminist’.

In Hysteria, Psychoanalysis, And Feminism: The Case Of Anna 0, Dianne Hunter expresses similar views. Although she makes no mention of Yiddish she still puts a feminist gloss on Bertha’s linguistic difficulties. Bertha, she says, refused to speak German because to do so would mean that she accepted ‘integration into a cultural identity [she] wished to reject’ and concludes that her hysteria was a ‘discourse of femininity addressed to patriarchal thought’. Hunter also reads a psychological significance into Bertha’ agrammatism, in particular the fact that she ceased for a while to conjugate verbs, using only infinitives or past participles which, she points out do not specify a person. She seems not to be aware that this is typical of people suffering from Broca’s agrammatic aphasia, often found in people suffering from strokes or other damage in the left cerebral hemisphere. The condition is characterised by, among other things, an inability to inflect verbs or to use subject pronouns.

Hunter goes on to analyse Breuer’s own use of language:  ‘Breuer refers to the pauses in Pap-penheim's speech by the French term absence.’ Not quite. Breuer was not referring to her aphasic symptoms when he used this term, but rather to the petit mal seizures which she experienced (although he did not recognise them as such). For Hunter, however, Breuer’s use of this term ‘suggests that for Breuer as well as for Pappenheim, the abnormal states of consciousness represented foreign parts of the self. Parts of Anna O were alien to signification in her native tongue.’

As for Bertha’s Yiddish, given that this would have been one of the languages with which she, as an Orthodox Jewish woman, must have been familiar, it’s perhaps of significance that she didn’t resort to it in her aphasia. But the explanation is more likely to lie in neural disturbances in the speech centres of her brain than in any kind of gender frustration.  

There is no record of Sigmund Freud ever having met Bertha Pappenheim, certainly not in a professional capacity. However, this has proved no obstacle to the common misapprehension that she was his patient. 

Often when I mention that I’ve written a book about Anna O, people will say something along the lines of: ‘Oh, yes, she was one of Freud’s patients, wasn’t she?’ This isn’t really surprising as she is so intimately connected with the history of psychoanalysis. In a sense, she was, as she is sometimes described, ‘Freud’s Anna O’. Her case is the foundation stone on which Freud started to build his theories; and without Freud, Bertha Pappenheim would be known only for her later success as a pioneering feminist and social worker. 

Some people may think that it doesn’t matter whether or not Freud was her doctor, in the same way that some people think that it doesn’t matter whether Shakespeare or someone else wrote his plays and sonnets. It matters very much, in fact, and this is why it’s surprising that the misconception about Anna O even extends to the psychotherapy community.

A cursory Google search threw up a few interesting items. 

A webpage titled Student Resources in Context has Bertha being treated by both Freud and Breuer simultaneously. In this version the collaboration starts with Breuer telling Freud about Bertha. It goes on to say that ‘during daily visits to Freud and Breuer, the doctors discovered that some of her symptoms were alleviated merely by discussing her memories and the feelings they created in her’. Finally, Freud alone is given credit for the cure with the claim that: ‘When Freud encouraged Anna O to recall a given situation and express the reaction she had earlier repressed, her symptoms vanished.’

Psychotherapist Humair Hashmi goes further. Anna O, he claims, began to express affection for Breuer and tried to put her arms round him. This so alarmed Breuer that he passed the case on to Freud. Nothing daunted, Freud, ‘the fearless pioneer that he was’, regarded this as a challenge and interpreted it as a manifestation of transference which could be used as a means of effecting a cure. Hashmi goes on to say:‘This is what Freud did in Anna’s case.’

An even more surprising misrepresentation is one I discovered when I came across a Wall Street Journal review of a show called Dr Freud’s Cabaret in which Freud takes to the boards with a number of his most famous patients. The show starts with an Anna O number called Chimney Sweeping (Bertha Pappenheim’s term for the talking she did with Breuer) and the review describes how ‘Anna O would hold Freud’s hand while she told him fairy stories and dark fantasies that helped alleviate her psychosis.’ Investigating this further I found that the idea for the show had germinated when the writer was readingStudies in Hysteria as research for a novel. So far so good, but the fact that she had done this research makes it even more puzzling that she could then flout the truth by portraying Anna O’s treatment as being with  Freud rather than with Breuer. Artistic licence, you might say. Perhaps. But what really takes the biscuit is that the show was put on at the Freud Museum in London which seems to have been quite comfortable with helping to perpetuate the myth that Freud was Anna O’s patient. It would all be so much neater if she had been, after all. The fact that she was not is possibly, for them, what Al Gore might term ‘an inconvenient truth’.