The case of Anna O. and the emergence of psychoanalysis – 07/13/2023 – Mental Health

Bertha Pappenheim, known by the pseudonym Anna O., was a patient seen by Sigmund Freud (1856-1939). Her case became famous for having started the psychoanalysis developed by the Austrian doctor.

Initially translated by Josef Breuer (1842-1925), the 21-year-old girl had paralysis of the upper and lower limbs, muscle contractures, sleepwalking, hallucinations and loss of language, and even began to communicate only in English —her mother tongue was German.

The symptoms, at the time, were associated with hysteria, a diagnosis that is currently called dissociative or conversion disorder.

Breuer asked Freud to follow Anna’s case. The symptoms had appeared after the death of her father, whom she was very close to and had helped to care for during his illness.

Anna was encouraged by Freud to remember traumatic events. After remembering and talking about these situations, the symptoms disappeared. The young woman herself called this method “healing through the word”.

“The case of Anna O. is of fundamental importance for psychology and psychoanalysis because it shows us how often our body ‘speaks’ about something that has remained alien, apart from our consciousness, that is, it speaks about emotional inscriptions that somehow way they still haven’t been intermediated by the word and, when they are, they acquire a new status, a new form”, says Ana Gabriela Andriani, psychologist specialist in couple and family therapy, master and doctor from Unicamp (State University of Campinas) and member of the Brazilian Society of Psychoanalysis.

The therapeutic method created by Freud consists of the interpretation, by a psychoanalyst, of the unconscious contents of words and actions. Psychoanalysis emphasizes the importance of delving into the analyzed subject’s unconscious to overcome psychiatric disorders such as depression.

In the following text, written for the Saúde Mental blog, Andriani explains the importance of Anna O.’s case for the emergence of psychoanalysis.

The Anna O. case: the service that Freud considered the first of psychoanalytic treatment and its contributions to psychology

By Ana Gabriela Andriani

Freud, an Austrian neurologist, began his work by dedicating himself to the study and production of knowledge about the psychic apparatus. In 1895, he published “The project for a scientific psychology”, based on concepts of evolutionary biology and physics, which aimed to attempt to build a qualified science on the nervous system. Thus, at the time he developed the “project”, he was deeply and meticulously studying the functioning of neurons (anticipating future discoveries in neurology about neural synapses, including) for the production of sensations of pain, pleasure, memory production, desire, among others. others, in addition to the behavior and functioning of people who had aphasias and hysteria.

When the study of the symptoms experienced by hysterics was deepened (a large number of women were affected by this psychopathology at the time), an important transformation took place in the way Freud had been thinking and formulating his clinical practice.

From the observation and care of hysterics, especially in the clinic where he worked with the physician Jean-Martin Charcot, he began to see that the physical symptoms experienced by these women, such as, for example, blindness, limb paralysis, memory loss and the loss of of the ability to speak, were not related to any disease of organic cause.

In 1880, the neurologist is called by Josef Breuer —a psychiatrist who also treated hysterics and with whom he became a friend— to accompany him in the treatment of a 21-year-old patient, called Bertha, but called by Breuer Anna O.

The young woman, who had a vigorous intellect and, according to Freud himself, endowed with “remarkable intelligence, intuition and a surprising ability to apprehend things”, at a certain point in her life, began to show symptoms that were quite frightening and challenging to be understood at time, such as paralysis of upper and lower limbs, muscle contractures, sleepwalking, hallucinations, loss of language, even starting to communicate only in English, a non-native language.

The emergence and intensification of the symptoms coincided with the death of her father, with whom Anna O. had a very intense bond.

The treatment consisted of Anna being hypnotized —a practice later abandoned by Freud— and, during hypnosis, she was encouraged to remember facts and situations that had been traumatic in her life. After remembering such situations and reliving them emotionally, the symptoms disappeared.

At this moment, Freud began to realize that the remembered traumatic scenes had been repressed so that suffering could be avoided, but, when repressed, they ended up appearing in another way, through motor, linguistic and neurological symptoms.

The beauty of this case lies in the fact that it is from it that Freud becomes aware of the existence of contents that are, by our defense mechanisms, removed from consciousness, that is, from the possibility of being thought and elaborated. At this time, he began to develop his theory about the psychic apparatus that would be composed of the conscious / preconscious / unconscious dynamics, called the First Topics.

It is also interesting to know that, over time, Anna O. herself called the method used for her treatment the “talking cure”, that is, “cure through words” —which can be understood as resulting from the development of the capacity for representation , of thought and, therefore, of construction of language about what was experienced.

It was at this moment that Freudian psychoanalysis was born and, along with it, the entire theoretical framework that influenced both psychology and the other psychoanalyses that were built over time, such as Kleinian, Bionian, Lacanian, Winicottian, among others.

Anna O.’s case is of fundamental importance for psychology and psychoanalysis because it shows us how often our body “speaks” about something that has remained alien, apart from our consciousness, that is, it speaks about emotional inscriptions that in some way have not yet been intermediated by the word and, when they are, they acquire a new status, a new form. This is the function of analysis, where we find ourselves with who we are and expand our capacity to think about ourselves, our history and the world.

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