HILDA REILLY
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Research invitation

2/2/2023

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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 (see below). 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.
 
ABSTRACT
This project is inspired by the work of Roy Porter (1985), who draws attention to the patient-shaped gap in medical history, and Rita Charon (2006), who emphasises the need to bring the patient’s narrative to the fore in the practice of medicine. The principal aim of the project was to devise a means of accessing the lived experience of a patient who is no longer alive in order to gain an understanding of her narrative.
Anna von Lieben was identified as a suitable subject as she wrote a substantial quantity of autopathographical poetry suitable for analysis and her status as Freud’s patient makes her a person of significant interest to the history of medicine.
The poems were analysed using Interpretative Phenomenological Analysis (IPA), an idiographic and inductive method of qualitative research, based on Heideggerian hermeneutic phenomenology, which explores the lived experience of individuals and is committed to understanding the first-person perspective from the third-person position.
The main findings from the IPA study reveal that Anna experienced a prolonged period of malaise, starting in late adolescence which she believed to result, at least partly, from a traumatic experience which occurred at that time. The analysis also indicates that Anna suffered from deep and lasting feelings of guilt and shame.
The discovery of a significant quantity of additional family documentation enabled me to contextualise and give added substance to the findings of the IPA study. The diaries which Anna’s husband kept throughout their marriage reveal that:
  • she had a severe and longstanding gynaecological disorder
  • she suffered from severe morphinism
  • she did not benefit from Freud’s treatment which seemed neither to ease her symptoms nor identify any cause
  • she was treated in Paris, not by Charcot as previously supposed, but by a French hydrotherapist, Theodore Keller, who appears to have become a person of considerable significance in her life.
The above findings led me to investigate Anna’s comorbidities (gynaecological disease and morphinism) and to show how those could be responsible for much of the symptomatology identified by Freud as ‘hysteria’. I then explore the possibility that her psychotic-like experiences could have been iatrogenically induced by her treatment first by Keller and then by Freud. Finally, I propose a fourfold set of hypotheses as an alternative to Freud’s diagnosis of hysteria.
The study overall presents a three-stranded account of the illness and treatment of one of Freud’s patients, combining the narratives of the patient herself, her husband, and Freud. As such, this study is likely to be the first of its kind.
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A personal conduit to bertha pappenheim

2/12/2015

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I recently received an email from someone in the US who told me that she helped to look after a 96-year-old German lady, Estelle, a holocaust survivor, who had known Bertha Pappenheim when she was a child. She said that they had come across my website and that Estelle would like very much to talk with me about Bertha.
I was thrilled to bits. It had never occurred to me that I would ever be able to speak with anyone who had personal recollections of her. Bertha, who died at the age of 77 in 1936, had no children, no nephews or nieces, and none of her friends or colleagues was likely to be still alive almost 80 years later.
Estelle, her carer told me, had been looked after by Bertha for some time when she was a child. Her mother was a friend of Bertha’s and as Estelle was in a state of chronic ill-health she was sent to stay with Bertha in the Home for Wayward Women which she had set up for unwed mothers and their children.
I was curious to know what sort of impression Bertha had made on Estelle. Although most of the action of Guises of Desire takes place when Bertha was in her early twenties, the last chapter fast-forwards to 1925 and is set in the Home. I wondered how close to reality my portrayal of Bertha at that stage in her life would be. Opinions about her among those who knew her at the time were at odds with each other. Some seemed to idolise her while others were highly critical, one person referring to her as ‘nothing but a nut and a lesbian’.
When I was in the early stages of working on the novel someone asked me if I liked Bertha. I’d never really thought about it but when I tried to answer this question I realised that I would probably have found the older Bertha somewhat daunting and forbidding.  
From the age of about 30 Bertha started to leave a copious paper trail behind her in the form of articles, letters and stories – even a play – and she is the subject of several biographies. It was from these that I developed my idea of Bertha as she was in later life. As regards the younger Bertha, the one I focused on, there was no background information other than her doctor’s report, so I was free to create this personality myself, on the basis of what was likely given her background, and it was one which I felt more positive about.
I phoned Estelle and had a tantalising conversation with her. She was eager at first to talk about Bertha. She had clearly felt cherished by her; in fact, she claimed to be her favourite. At the same time she described an imposing, authoritative presence – “You knew she was somebody” – and a strict disciplinarian attitude. On one occasion when Estelle had been disobedient Bertha punished her by giving her nothing to eat but oatmeal for three days.
I asked how the girls in the Home had felt about her. ‘They were in awe of her,’ she replied. When I pressed her as to whether they liked her she seemed unwilling to answer and would only repeat that they were in awe of her. ‘I never saw her smile,’ she said. ‘Something in her life was not right.’
I would have liked to find out more about Estelle’s impressions of Bertha but she started to talk about later events in her life, her experiences during the war and her escape from Germany. It was impossible to get her back on track. But at least I felt that the little she had said corresponded to my own impression of her.
Perhaps there are other people still alive who were children in the Home, or descendants of its residents.  I’ll put out some feelers on social media to see if I can track them down. 

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hysteria - signpost to the solution of the mind-body problem

4/9/2015

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I’ve recently become aware that the current incidence of the hysteria diagnosis is even more common than I had once thought. When I was writing Guises of Desire my thinking was along the lines of the ideas discussed in Eliot Slater’s classic paper of 1965 which dismissed the hysteria label as a ‘disguise for ignorance’. Now, while researching the case of another patient from the early history of psychoanalysis, I’ve discovered a slew of articles in medical journals which indicate that about a third (figures vary) of patients referred to neurological clinics with suspected epilepsy suffer from what is now called psychogenic nonepileptic seizures (PNES) or sometimes nonepileptic attack disorder (NEAD). 
To be more specific, PNES represent a sub-category of conversion disorder, the name which replaced hysteria. The striking thing about PNES is that for most people, even doctors, the symptoms are virtually indistinguishable from epilepsy and patients can often be treated with epilepsy medication for years before it becomes evident that their condition is not epileptic. The main differentiating characteristic is that epilepsy is associated with abnormal electrical discharges in the brain; in the case of PNES there are no such discharges and it is generally believed to be caused by some kind of psychological stress, although this is by no means certain – or at least not in all cases. 
This doesn’t in any way undermine Guises of Desire as a novel as such diagnostic issues don’t enter into it. The narrative merely dramatises Bertha Pappenheim’s symptoms and those symptoms would remain the same, whether she suffered from a form of epilepsy or from PNES.
One of the difficulties for people affected by psychogenic disorder is the often implicitly critical nature of the discourse around the subject. A recent book on PNES, written by a neurologist, is subtitled Real Stories of Imaginary Illness, a description which homes right in on the problem. Apart from the offence it gives to patients, it suggests that there is nothing medically or physically wrong.
Such thinking reinforces the kind of dualistic approach which is so unhelpful in these cases – the idea that mental phenomena and physical phenomena are quite distinct. This can further lead to the idea that you are somehow the willing agent of your own mental phenomena, in contrast to physical phenomena which happen to you whether you like it or not.  
All experience – motor activity, emotional and physical sensations, and cognitive processes – is associated with neurophysiological substrates and if we could identify all the neural mechanisms involved in PNES we might at last be heading towards a solution to the mind-body problem – an exciting prospect. 

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on The ease of misremembering

12/11/2013

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I have a confession to make. I have misattributed a quote to medical historian Roy Porter.

 In a previous post, and elsewhere on the internet, I have referred to “what [Roy Porter] calls a ‘patient-shaped gap’ in the history of the case study”. Recently I was rereading the article from which I thought I’d taken the expression (The Patient’s View: Doing Medical History From Below) and was surprised to find no mention of the words. Odd, I thought. It must have been another article by Roy Porter. I checked the other Porter articles I’d used in my research for Guises of Desire. No sign of them there either. In that case, it must have been in the writing of some other author, I concluded. No problem. A Google search for the words would soon track the source down. I typed in the words, complete with quote marks. The only items which Google threw up were from material I had written myself.

I was beginning to feel embarrassed. I’m meticulous about accuracy (even though some might say that, as a biographical novelist, invention is part of my stock-in trade). Reading the original Porter article again, I felt that perhaps it didn’t really matter. The gist of what he was saying in the article could pretty well be summed up by that expression – a patient-shaped gap. But this didn’t satisfy me. I had no business putting words into someone else’s mouth, even if I believed these words corresponded to his meaning.

But where had this expression come from, if not from Roy Porter or some other medical historian? Had I made it up myself? It didn’t seem likely. I just felt that it wasn’t an expression I would have thought of.

I’d first used the phrase in my MA thesis, when I would have been certain to have checked and double-checked what I was writing as well as any references I was citing. So I dug out the thesis and sure enough, there was the expression - but without the quote marks (although I linked the idea to the Porter article and included a genuine quote from it).

So the words were mine. Problem solved – but it is an indicator of the ease with which ‘facts’ can be misremembered and misreported, a caution of particular importance to the Bertha Pappenheim case. 


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Freud's hypnotic adventures

26/10/2013

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Researching the Bertha Pappenheim case has kindled in me an interest in related subjects. This is why I’m currently reading The Complete Letters of Sigmund Freud to Wilhelm Fliess, described in the introduction as ‘probably the single most important group of documents in the history of psychoanalysis’.

The relationship between the two men was a strange one but I’ll leave that for another post. Today I want to talk about hypnosis.

Freud first became convinced of the genuineness of hypnotic phenomena when he attended a public performance by the famous Danish hypnotist Carl Hansen in Vienna in 1880. His belief in its efficacy was further bolstered when he witnessed the work of French doctors Ambroise Liebeault and Hippolyte Bernheim who treated patients by putting suggestions to them while hypnotised.

Freud, who had a large number of ‘nervous’ patients, was keen to adopt the practice. As he said himself quite frankly, the therapeutic arsenal for treating such patients consisted only of electrotherapy, hydrotherapy and hypnosis. He had lost confidence in electrotherapy and saw hydrotherapy as financially unrewarding for the doctor as it generally involved referring the patient on to a hydropathic establishment after a single consultation. So he turned to hypnosis, finding it gratifying to have a technique which overcame his sense of therapeutic impotence and also flattering as it allowed him ‘to enjoy the reputation of being a miracle-worker’.

Freud adapted his technique after hearing how Josef Breuer had apparently helped Bertha Pappenheim by probing the origins of her symptoms while she was in a hypnotic state. He later abandoned hypnosis altogether, finding it just as effective to do the probing and eliciting of memories while the patient was in a state of normal consciousness. 

All this we know from Freud’s An Autobiographical Study, published in 1925.

But what has this got to do with The Complete Letters of Sigmund Freud to Wilhelm Fliess, you might ask.

Here is the connection. In a letter to Fliess dated 28 May, 1888, Freud begins by writing about a patient who was suffering from cerebral neurasthenia. He then goes on: “I have at this moment a lady in hypnosis lying in front of me and therefore can go on writing in peace.” The rest of the letter is taken up with details of his family life, his practice – which had been waning of late – and his writing and translating activities. He finishes with: “The time for hypnosis is up. I greet you cordially, in all haste, your Dr Freud.”

Had Freud by this time decided that neither suggestion nor questioning was necessary, that being in a hypnotic trance in and of itself was sufficient to achieve a therapeutic effect? If so, why no mention of it in An Autobiographical Study?

Just asking. 


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Hysteria - the illness that won't go away

27/9/2013

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The diagnosis applied to Bertha Pappenheim – hysteria – is no longer in use. Many of the patients labelled as hysterical in the past would now be found to have an organic illness such as multiple sclerosis, epilepsy or brain tumour. Yet there still remain cases of patients whose symptoms defy all physical investigation. These patients are diagnosed as suffering from ‘conversion disorder’, ‘somatisation syndrome’ or ‘functional neurological disorder’  – in other words, hysteria under  less pejorative names. Although, as with many of the 19th century hysterics, a possible physical cause for these conditions may be uncovered in the future there is a hard core of cases for which this is considered unlikely. The following are some of the criteria used to identify these ‘hard cases’:

Anatomical impossibility

An example of this is ‘glove anaesthesia’ where a patient complains of numbness in the hand, stopping at the wrist. This is invariably diagnosed as conversion syndrome because the sensory nerve that supplies the hand also supplies the arm and would not allow for this specific area of anaesthesia. Other localised areas of numbness occurring in the foot or leg (‘shoe anaesthesia’ and ‘stocking anaesthesia’) encounter the same problem.

Include symptoms which are known to occur in given circumstances

A classic example of this is whiplash injury, the neck injury often related to vehicle accidents. This is found to be more prevalent in countries where people are aware of the condition and how you are likely to get it. It is also found that membership of a support group or engaging in compensation claims for the injury tends to make it harder to get better, possibly because the symptoms are then constantly on the patient’s mind.  

Susceptible to the placebo effect

Muscle cramping resulting in limb contracture (dystonia) can be treated with Botox injections. These take about 24 hours to have an effect. Sometimes, however, the Botox is found to work immediately, indicating a case of functional dystonia.

Can any of this help to throw light on the Bertha Pappenheim case?

The question of what is anatomically impossible is relevant to Bertha’s first visual disorder, a convergent squint. An eye specialist diagnosed this as due to a paresis of the abducens(sixth cranial nerve). Breuer discounted this, putting it down rather to hysteria. It has been suggested* that a psychogenic explanation would be impossible. As the abducens controls the external rectus muscle of the eye, a lesion to it makes it impossible to turn the eye outwards. At the same time, the now unopposed internal rectus muscle pulls the eye inward, causing the squint.  This could not occur psychogenically as the voluntary motor pathways operated by the upper motor neurons govern entire movements and not individual muscles. So here it is the psychogenic explanation rather than the physical one which is an anatomical impossibility.

On the basis of the ‘whiplash’ scenario, we might expect hysterical symptoms to correspond with symptoms which the patient is already familiar with. It’s interesting to consider Bertha’s prosopagnosia (inability to recognise people’s faces) in relation to this criterion. Although now, thanks to Oliver Sacks, most people know what prosopagnosia is, there was so little awareness of it in the 1880s that not even Bertha’s doctor recognised it. It’s not likely then that she did and therefore even less likely that her subconscious would manage to conjure it up.

There’s no evidence that Breuer ever tried placebos with Bertha. But for contractures of the limb, use of a placebo is not the only means of revealing whether or not the problem is physical. In functional dystonia the muscles will usually relax  during sleep or sedation. In a report discovered almost a century after the events, Josef Breuer describes Bertha’s contracture of the arm and leg. They would, he wrote, ‘relax neither when she was asleep nor under intoxication with 5.00 chloral’.

Three more nails in the coffin of Bertha’s hysteria diagnosis, I think. 


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A feminist TAKE ON the anna o case

20/9/2013

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“HYsteria is not a pathological phenomenon, and can, in all respects, be considered as a supreme means of expression.”
Sigmund Freud, Studies in Hysteria, 1895


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.
 

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Diagnosing Bertha

27/8/2013

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    A recent Good Reads reviewer wrote that she had some problem with the ending of Guises of Desire. Her difficulty was that, although the Author’s Note at the end had explained what my thinking had been regarding the causes of Bertha’s illness, the explanation had not been clear in the novel itself. In other words, she felt that readers would not be able to work out a diagnosis for themselves, or guess at the kind of diagnosis I had based my interpretation on. 

    I can understand why the reviewer felt this and I’ve been wondering what I could have done to avoid this kind of dissatisfaction – if dissatisfaction it is. 

    Perhaps the explanation can be found in the views of another reader who has commented that I never slip into a contemporary frame of reference, that the setting is pre-Freudian and that nothing of Freudian theory creeps into my character’s words or reflections. I would add that the setting is also pre-modern-neurology and that the kind of diagnosis I have in mind would not form part of it. It’s difficult therefore to see how, while remaining resolutely in the 19th century and with the narrative perspective being that of the characters rather than omniscient, I could have created a picture which would have led the reader, unless a medical professional, to think: Oh yes, Bertha Pappenheim clearly has such and such a condition. As it is, readers are drawn rather into the world of Bertha herself, experiencing the same confusion as Bertha, her family and her doctors, totally perplexed as to what’s going on and trying to figure out their own explanation. 

    Of course, I could have written a different kind of book, one which would have demonstrated quite clearly where I was coming from. I’d thought, for example, of doing one of those split-time novels which are popular now in historical fiction, with perhaps the parallel story of a modern neurological researcher working on the Anna O case, or something similar. Or I could have done something more avant-garde, interspersing the narrative with fragments of contemporary analysis of the case, with excerpts from case studies of later patients displaying similar syndromes, and so on.

    It’s interesting to compare Guises of Desire with the novel Lying Awake by Mark Salzmann which tells the story of a contemplative Catholic nun who has mystical experiences associated with temporal lobe epilepsy. Because the setting is a contemporary one, a full depiction of her condition, both subjective and medical is possible. Of course, this could give rise to a whole new set of questions. Does the corresponding electrical activity of the brain create the content of the mystical experiences or does it provide a conduit to a supernatural dimension. The answer to this is likely to depend on the religious views, or lack thereof, of the reader. And it’s still pretty much true that one’s interpretation of the Bertha Pappenheim case depends on which school of psychological thought one subscribes to.
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Anna O - Whose patient was she?

19/8/2013

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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’. 
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From Bertha Pappenheim to Paris Brown

14/6/2013

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Medical historian Roy Porter* draws attention to what he calls a 'patient-shaped gap' in the history of the case study, with accounts of illness being written invariably by doctors rather than patients. In discussing a research agenda to remedy this imbalance, he claims that ‘its real challenges lie in reconstructing patterns of consciousness and action’. For the historical novelist, this involves trying to think oneself into the mindset of the character. 

One of the cultural sources I turned to in trying to 'reconstruct the consciousness' of Bertha Pappenheim was The Girl's Own Paper, a magazine first published in 1880, the year in which Bertha's story began. Reading it brings one to the inescapable conclusion that the past is indeed a foreign country. I feel that I could more easily understand a present-day Zulu or Maori than any young 19th-century woman whose mind was formed by the principles governing those moralising texts.


Feminism was still only a speck on a distant horizon, at least as far the GOP was concerned. An article titled The Girls of Today, written by 'One of Them', while advocating a degree of working activity for women, concluded: '…. there is plenty of work to do, not only for our fathers and brothers but for us girls also. Out of this work we will select that which we can do best, whether it be nursing, teaching, book-keeping, mending, lamp-cleaning, dressmaking, or anything else. At the same time we will endeavour to hold fast by those attributes of modesty, gentleness and patience which belong to good women, and while we enrich the home with our earnings, we will try to be its sunlight and its ornament.' As for a career in journalism, anyone considering it was advised that the job might require her to be out and about late at night, which would not be seemly, and that she would need 'a bold mien' to work with male reporters 'on whose province she is encroaching'. As a final word of warning GOP cautioned that 'it is not an occupation that tends to the development of feminine graces.' On a more positive note, the newly invented typewriter was promoted as a solution to the problem of finding employment for ladies, it being 'peculiarly fitted for their nimble fingers'. 

Beauty, just as much as health, was considered to be a matter of mens sana in corpore sano. 'Health can make the plainest girl pleasant to behold, if her mind be pure and innocent,' exhorted Medicus in 1884. Readers were encouraged to believe that a good head of hair could be obtained by cultivating 'a calm and unruffled frame of mind'. A daily bath, 'as cold as can be borne', and exercise were judged ideal beauty aids. Powder and 'paint' were anathema, a sign of loose morals. 

Overall the texts were saturated with religiosity. An article titled What Shall We Do With Our Sundays? was accompanied by a poem by Yeats suggesting that the answer was church attendance: 'She prays for father, mother dear, To Him with thunder shod. She prays for every falling tear, In the holy church of God. 'Middle-class girls were encouraged to procure copies of 'the Holy Gospels' and other 'nice little books' and to leave them in appropriate places, such as under the seat cushion in a hired vehicle, where they could be found by 'the lower orders'. Acting was disapproved of. 'Once on the stage, those wishing to leave it and live religious lives find much prejudice from prospective employers.' The writer wasn't thinking of women wanting to enter a convent, but simply leading a life that wasn't immoral. 

Replies to readers' letters were tart and bracing. A reader with academic aspirations was advised: 'The subjects to be avoided, save in an elementary manner, are mathematics, and possibly science - certainly, however, the former.' A young woman enquiring about a career as a governess in 1884 was told: 'You seem to think that we keep a registry office. You are not sufficiently educated to take a place as nursery governess. You cannot write; and do not express yourself properly.' But this was nothing to the scolding doled out to a correspondent from Canada: 'This is the last notice that we shall take of your silly letters. Learn your lessons, read your Bible, and make and mend your own clothes and waste no more time in writing such rubbish.'

It's difficult to believe that only 130 years separates this kind of thing from the tweets of Paris Brown, the seventeen-year-old who has just had to resign from her police job after it was discovered that she had posted homophobic and racist rants and boasted about her binge drinking, drug taking and sex life on Twitter.  But then, much as I said at the beginning, I might find it easier to understand a Zulu or a Maori than Paris Brown. 

*Porter, Roy, ‘The Patient’s View: Doing Medical History from Below’, Theory and Society, 14 (March, 1985), 175-198

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    hilda reilly

    This blog discusses my research on two of Freud’s patients: Bertha Pappenheim, aka Anna O, and Anna von Lieben, aka Cäcilie M. For Bertha Pappenheim, the posts focus on questions related to Guises of Desire, my biographical novel about Pappenheim which I developed for an MA in Creative Writing.  For Anna von Lieben the posts are linked to my PhD research. 



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