Anna O's Life and Impact on Psychology

Anna O., aka Bertha Pappenheim, was the pseudonym given to one of the patients of physician Josef Breuer. Her case was described in the book that Breuer wrote with Sigmund Freud, Studies on Hysteria.

Bertha Pappenheim (February 27, 1859 - May 28, 1936) was her real name, and she had initially sought Breuer's help with a series of symptoms that included visual disturbances, hallucinations, partial paralysis, and speech problems. Breuer diagnosed the young woman with hysteria and later discussed her case with Freud, who developed his own ideas of what lay at the root of Anna O.'s condition.

Her treatment played an important role in the establishment and development of psychoanalysis.

Anna O's Significance in Psychology

Bertha Pappenheim, referred to as Anna O. in the case history, came to Josef Breuer for treatment for what was then known as hysteria.

While Freud never actually saw her as a patient, her case had a significant impact on the development of psychoanalysis. Freud was fascinated with her case and consulted with Breuer during her treatment.

Anna O.'s Symptoms

While caring for her dying father, Pappenheim experienced a range of symptoms, including:

• Partial paralysis
• Blurred vision
• Headaches
• Hallucinations
• Mood swings
• Eating disorders
• Amnesia
• Facial pain
• Language aphasia

Impact on Freud

While Freud never actually met Pappenheim, her story fascinated him and served as the basis for Studies on Hysteria (1895), a book co-written by Breuer and Freud. Breuer’s description of her treatment led Freud to conclude that hysteria was rooted in childhood sexual abuse.

Freud’s insistence on sexuality as a cause eventually led to a rift with Breuer, who did not share this view on the origination of hysteria. "The plunging into sexuality in theory and practice is not to my taste," Breuer explained. While the friendship and collaboration soon ended, Freud would continue his work in the development of talk therapy as a treatment for mental illness.

Freud himself once described Anna O. as the true founder of the psychoanalytic approach to mental health treatment. Five years later, Freud published his book The Interpretation of Dreams, which formalized much of his psychoanalytic theory.

What Happened to Anna O?

While Breuer and Freud may have painted the picture that Breuer's treatment cured Anna O. of her symptoms, records indicated that she became progressively worse and was eventually institutionalized. 

"So the famous first case he treated together with Breuer and which was vastly praised as an outstanding therapeutic success was nothing of the sort," Carl Jung, a former Freud disciple, noted in 1925.

In 1954, Germany issued a postal stamp bearing her image in recognition of her many accomplishments.

Researcher Mark J. Blechner suggests that Pappenheim was eventually healed thanks to three cures: the talking cure, the writing cure, and the social cure. "She was cured not just by her psychoanalytic treatment, but also by realizing her intellectual gifts via her writing and by changing the society that was making her ill," he writes.

It is unclear whether Pappenheim felt that Breur's treatment was helpful or successful. She left no records of her treatment by Breuer. In her own work with patients as a social worker, however, she reportedly opposed any use of psychoanalytic treatment for those under her care.

Contemporary Views

How would Anna O.'s condition be diagnosed and treated today? Hysteria is no longer seen as a valid condition. Today, people exhibiting such symptoms might be diagnosed with some type of dissociative or somatic disorder. Such disorders include dissociative identity disorder or somatic symptom disorder.

However, some experts suggest that her condition wasn't psychological at all, and instead may have resulted from some type of physical or neurological illness. Some have suggested she may have had neurotuberculosis or some type of brain inflammation. Others have suggested that her symptoms stem from a complex partial seizure worsened by substance dependence.