Freud's Patients

A Book of Lives

Mikkel Borch-Jacobsen

• Editorial: Reaktion Books
• Año: 2021
• ISBN:
  9781789144543
• Categoría: History
• Categoría: World History

Portraits of the thirty-eight known patients Sigmund Freud treated clinically—some well-known, many obscure—reveal a darker, more complex picture of the famed psychoanalyst. Everyone knows the characters described by Freud in his case histories: "Dora, " the "Rat Man, " the "Wolf Man." But what do we know of the people, the lives behind these famous pseudonyms: Ida Bauer, Ernst Lanzer, Sergius Pankejeff? Do we know the circumstances that led them to Freud's consulting room, or how they fared—how they really fared—following their treatments? And what of those patients about whom Freud wrote nothing, or very little: Pauline Silberstein, who threw herself from the fourth floor of her analyst's building; Elfriede Hirschfeld, Freud's "grand-patient" and "chief tormentor;" the fashionable architect Karl Mayreder; the psychotic millionaire Carl Liebmann; and so many others? In an absorbing sequence of portraits, Mikkel Borch-Jacobsen offers the stories of these men and women—some comic, many tragic, all of them deeply moving. In total, thirty-eight lives tell us as much about Freud's clinical practice as his celebrated case studies, revealing a darker and more complex Freud than is usually portrayed: the doctor as his patients, their friends, and their families saw him.

1

BERTHA PAPPENHEIM (1859–1936)

Bertha Pappenheim, always presented under the name of ‘Anna O.’ as the original patient of psychoanalysis, was actually never treated by Freud himself but by his friend and mentor Josef Breuer. If we are to believe Freud, however, she rightfully belongs in the history of psychoanalysis. In 1917 he recalled how ‘Breuer did in fact restore his hysterical patient Anna O., that is, freed her from her symptoms . . . This discovery of Breuer’s is still the foundation of psycho-analytical therapy’ (18th Introductory Lecture on Psychoanalysis). Whether Bertha Pappenheim can be reduced to Anna O. is another story.

She was born on 27 February 1859 in Vienna to Jewish parents. Her father, Siegmund Pappenheim, was a millionaire who had inherited a grain trading company. Her mother, Recha Goldschmidt, came from an old Frankfurt family. The Pappenheims were strictly Orthodox and Bertha received the traditional education of a höhere Tochter (a girl of the upper middle class waiting to enter the ‘marriage market’): religious education (the study of Hebrew and biblical texts), foreign languages (English, French, Italian), needlepoint, piano, horse riding. Bertha, who was a lively and energetic young girl, felt suffocated in this confined life, which she was later to denounce in the article ‘On the Education of Young Women in the Upper Classes’ (1898). As Breuer was to reveal in a medical report sent to his colleague Robert Binswanger, she was also secretly in revolt against her religious upbringing: ‘She is not at all religious; the daughter of very orthodox, religious Jews, she has always been accustomed to carry out all instructions meticulously for her father’s sake and is even now disposed to do so. In her life religion serves only as an object of silent struggles and silent opposition.’

So Bertha took flight, first in a fantasy world she called her ‘private theatre’ and then in illness. The earliest symptoms appeared in the autumn of 1880, at a time when Bertha looked after her beloved father, who had fallen ill with a pleurisy that was to prove fatal. Bertha had a persistent cough, and at the end of November Josef Breuer was called upon. Breuer, a well-respected internist, was the physician of the Jewish high bourgeoisie and aristocracy in Vienna. He diagnosed a hysteria, upon which Bertha took to her bed and developed ‘in rapid succession’ an impressive array of symptoms: pain in the left side of the occiput, blurred vision, hallucinations, various contractures and anaesthesias, trigeminal (or facial) neuralgia, ‘aphasia’ (from March 1881 onwards she spoke only in English), split personality and altered states of consciousness (‘absences’) during which she threw tantrums that she could not remember afterwards.

Breuer, who came to see her every day, noticed that her condition improved each time he let her tell, during her ‘absences’, the sad stories of her private theatre – a process she termed (in English) a ‘talking cure’ or again ‘chimney sweeping’. However, her condition worsened after the death of her father on 5 April 1881. She refused to eat and told no more fairy tales à la Hans Christian Andersen, but instead related morbid ‘tragedies’. She also had negative hallucinations: she did not see the people around her and recognized only Breuer. On 15 April Breuer called upon his colleague the psychiatrist Richard von Krafft-Ebing for a second opinion. Unconvinced of the authenticity of the patient’s symptoms (she claimed to be unaware of his presence), Krafft-Ebing blew into her face the smoke of a piece of paper that he had ignited. This caused an explosion of anger on the part of Bertha who began to beat Breuer violently. Finally, on 7 June, Breuer forcibly placed her in an annexe to a clinic for nervous disorders run by his friend Dr Hermann Breslauer at Inzersdorf. There she was quieted with the help of large doses of chloral hydrate, the sedative of choice at the time. As a result, Bertha developed an addiction to chloral.

Once the patient was stabilized, the talking cure could resume. Bertha’s stories had changed. During her altered states, she no longer told imaginary tales or tragedies: ‘What she reported was more and more concerned with her hallucinations and, for instance, the things that had annoyed her during the past days.’ When she told of a frustration that had been the source of a particular symptom, it would disappear miraculously. Breuer therefore set out to eliminate her countless symptoms one by one (for example, the 303 instances of hysterical deafness). What followed was a therapeutic marathon that resulted – if we are to believe the case history published thirteen years later by Breuer in Studies on Hysteria, which he co-wrote with Freud – in complete recovery by 7 June 1882, the anniversary of her admission at the Inzersdorf clinic. This followed a final narration during which Bertha relived a scene at the bedside of her father that was supposed to have triggered her illness: ‘Immediately after its reproduction, she was able to speak German. She was moreover free from the innumerable disturbances which she had previously exhibited. After this she left Vienna and travelled for a while, but it was a considerable time before she regained her balance entirely. Since then she has enjoyed complete health.’ Freud would also always describe Anna O.’s talking cure as a ‘great therapeutic success’ (1923).

As the research of historians Henri Ellenberger and Albrecht Hirschmüller has established, the reality was quite different. Bertha Pappenheim’s treatment had in fact been a veritable ‘ordeal’ for Breuer, as he wrote later to his colleague the psychiatrist August Forel. The treatment had never shown any real progress and as early as the autumn of 1881 Breuer was thinking of placing Bertha in another clinic, the Bellevue Sanatorium run by the psychiatrist Robert Binswanger in Kreuzlingen, Switzerland. Moreover, as we know from a letter sent on 31 October 1883 by Freud to his fiancée Martha Bernays, Mathilde Breuer had become jealous of her husband’s interest in his attractive young patient and rumours had begun to circulate. So when Breuer terminated the treatment in June 1882, it was not because Bertha Pappenheim had recovered (in mid-June she was still suffering from a ‘slight hysterical madness’), but because he had decided to throw in the towel and transfer her to Bellevue. She was admitted there on 1 July 1882 after having ‘travelled’ briefly to visit relatives in Karlsruhe.

Founded in 1857 by Ludwig Binswanger (the grandfather of Ludwig Binswanger Jr, the promoter of existential psychoanalysis), the Bellevue Sanatorium was a renowned institution. Located in an idyllic park on Lake Constance the sanatorium hosted, with discretion and for a high fee, the elite of the mentally ill. It was a place where, as the Viennese novelist Joseph Roth wrote in The Radetzky March, ‘spoiled lunatics from rich homes receive onerous and cautious treatment, and the staff is as caring as a midwife.’ There was an orangery, chaises longues, a bowling alley, an outdoor kitchen, tennis courts, a music room and a billiard room. One could also go hiking and horse riding nearby (Bertha took advantage of this daily). Bellevue patients stayed in comfortable villas scattered throughout the park.

Bertha Pappenheim had a two-room apartment and brought with her a lady companion who spoke English and French. Indeed, she was still partly ‘aphasic’ in German and plagued by more or less the same symptoms as before. In addition to her addiction to chloral hydrate, she was now also addicted to morphine due to Breuer’s efforts to calm her painful facial neuralgia. Her stay in Kreuzlingen lasted four months and brought little progress as far as her neuralgia and her dependence on morphine were concerned. The register at the time of Bertha’s release on 29 October 1882 mentions that she was ‘improved’, but a letter she sent to Robert Binswanger on 8 November tells a different story: ‘As for my health here, I can tell you nothing which is new or favourable. You will realize that to live with a syringe always at the ready is not a situation to be envied.’

Bertha Pappenheim in riding costume during her stay at the Bellevue Sanatorium.

Breuer declined to resume treatment when Bertha returned to Vienna in early January 1883 after a detour in Karlsruhe. From 1883 to 1887 Bertha was readmitted to Breslauer’s clinic three times. Each time the diagnosis by doctors was the same: ‘hysteria’. This is confirmed by the correspondence between Freud and his fiancée Martha Bernays. Bernays knew Bertha personally (Bertha’s father had been her legal guardian after the death of Bernays’s own) and Freud kept her informed of her friend’s condition. On 5 August 1883 he wrote: ‘Bertha is once again in the sanatorium in Gross-Enzensdorf, I believe [Inzersdorf, in fact]. Breuer is constantly talking about her, says he wishes she were dead so that the poor woman could be free of her suffering. He says she will never be well again, that she is completely shattered.’ In two letters to her mother, dated January and May 1887, Martha wrote that her friend Bertha continued to suffer from hallucinations in the evening. Thus, five years after the end of Breuer’s treatment and multiple stays at clinics, Bertha Pappenheim had still not recovered.

In 1888 Bertha moved to Frankfurt, where most of her relatives on her mother’s side lived. There, probably at the instigation of her cousin the writer Anna Ettlinger, she published anonymously a collection of some of the same fairy tales she had narrated to Breuer during her ‘hypnoid’ states, under the title Short Stories for Children. This writing cure seems to have been far more therapeutic than the talking cure. Two years later Bertha published a second collection of stories, In the Second-hand Shop, under the pseudonym P. Berthold. In addition to these early literary essays, she began to get involved in Jewish social work in Frankfurt, volunteering in soup kitchens for immigrants from Eastern Europe and at an orphanage for Jewish girls, of which she became house-mother in 1895.

In this, Bertha Pappenheim was playing her role as a prominent member of the Jewish community. It seems that she had eventually reconciled with religion (when and why, we don’t know), and she clearly conceived of her social work as a mitzvah, a good deed. (This is why she was always opposed, in the organizations to which she belonged, to any remuneration for their members.) However, she did not limit herself to traditional charities. She not only participated in practical tasks, which was unusual for a lady of the upper middle class, but applied to Jewish social work the principles and methods of the German feminist movement, to which she had been introduced by Helene Lange’s periodical Die Frau.

In 1899 she translated into German Mary Wollstonecraft’s A Vindication of the Rights of Woman (1792) and published a play entitled Women’s Rights, in which she criticized the economic and sexual exploitation of women. From a severely disturbed hysteric and addict, Bertha Pappenheim had morphed within a few years into a writer and a leader of Jewish feminism. In 1900 she wrote The Jewish Problem in Galicia, a book in which she attributed the poverty of the Jews of Eastern Europe to their lack of education. In 1902 she set up the Women’s Relief (Weibliche Fürsorge), which provided shelter, counselling, job training and referral services for Jewish women. She also launched a campaign to denounce prostitution and white slavery in the Jewish communities of Russia and Eastern Europe, an undertaking which drew criticism from the rabbis who feared that bringing these practices into the open would strengthen antisemitic stereotypes. Bertha Pappenheim was not impressed (little appears to have been likely to impress her). In her view, defending the rights of Jewish women amounted to defending Judaism as such by bringing these alienated women back into the fold of the community.

Bertha Pappenheim dressed as her ancestor Glückel von Hameln.

In 1904 she founded the League of Jewish Women (Jüdischer Frauenbund, or JFB), of which she was elected president. It was to become under her leadership the largest Jewish women’s organization in Germany (in 1929 it had no fewer than 50,000 members). The JFB opened centres offering vocational guidance and training to encourage women to work and gain independence.

In addition to her work as head of the JFB, which led her to travel in North America, the Soviet Union, the Balkans and the Middle East, Bertha Pappenheim created in 1907 a home for unwed mothers and illegitimate children at Neu-Isenburg, which she considered the work of her life. She also found time to translate from Yiddish the Tsenerene (a seventeenth-century women’s Bible comprising the Pentateuch, the Megillot and the Haftarot), the Mayse Bukh (a collection of medieval Talmudic tales and stories for women) and the famous diary of Glückel von Hameln (1646–1724), a distant ancestor of hers. To this should be added countless articles, poems, stories and plays for children, as well as some beautiful prayers that were published after her death in 1936 to comfort Jewish women under Nazism: ‘My God, you are not a god of mellowness, of the word and of incense, not a god of the past. An all-present God you are. A demanding God you are to me. You have sanctified me with your “You shall.” You expect my decision between good and evil; you demand that I prove to be strength of your strength, to strive upwards to you, to carry others away with me, to help with everything in my power. Demand! Demand! So that with every breath of my life I feel in my conscience: there is a God’ (‘Anruf’, 14 November 1934).

In 1920 she was recruited by Martin Buber and Franz Rosenzweig to teach at the Freies Jüdisches Lehrhaus, a centre for Jewish studies that the two men had founded in Frankfurt, where she mingled with Siegfried Kracauer, Shmuel Yosef Agnon and Gershom Scholem.

Meanwhile, Bertha Pappenheim pursued a parallel career as First Patient of Psychoanalysis under the name of Anna O. Publicly, Freud continued to present the talking cure of Anna O. as the origin of psychoanalytic therapy. Privately, though, he confided to his disciples that Breuer’s treatment had in fact been a fiasco, all the while adorning this revelation with an even more sensational story. In 1909 his disciple Max Eitingon had proposed in a lecture to interpret Anna O.’s symptoms as an expression of incestuous fantasies towards her father, including a fantasy of pregnancy that she supposedly transferred onto Breuer, taken as a father figure. Freud, who had long since broken with Breuer and was irritated that opponents such as August Forel and Ludwig Frank invoked his former mentor against him, took up this interpretation and ended up presenting it to his audience as fact. After the end of Anna O.’s treatment, he claimed, Breuer had been called back and found her in the throes of a hysterical childbirth, ‘the logical termination of a phantom pregnancy’ (Ernest Jones) for which he was supposed to be responsible. Unnerved by the sudden revelation of the sexual nature of his patient’s hysteria, Breuer then fled hurriedly, taking his wife on a second honeymoon to Venice, where he made her pregnant with a real child.

Bertha Pappenheim presumably never heard of this wicked tale, which was long confined to the inner circle of Freud’s followers. No doubt she would have rejected it with horror, as she rejected psychoanalysis as a whole. According to her friend and close collaborator Dora Edinger, she had ‘destroyed all documents referring to her early breakdown and requested her family in Vienna not to give out information after her death’; ‘Bertha never spoke about this period of her life and violently opposed any suggestion of psychoanalytic therapy for someone she was in charge of, to the surprise of her co-workers.’

Bertha Pappenheim, who opposed Zionism and the emigration of Jews out of Germany, only belatedly realized the seriousness of the Nazi threat. It was discovered that she had a tumour in the summer of 1935, just before the promulgation of Hitler’s Nuremberg Race Laws. In the spring of 1936, already very ill, she was summoned by the Gestapo regarding some anti-Hitler statements made by one of the residents at her Neu-Isenburg home. Upon her return, she took to her bed and never left it. She died at NeuIsenburg on 28 May 1936, just in time to escape the Nazis. In her will, she asked those who would visit her grave to leave a small stone ‘as a quiet promise . . . to serve the mission of women’s duties and women’s joys, unflinchingly and courageously’.

In 1953 Ernest Jones revealed the identity of Anna O. in the first volume of his Freud biography, adding for good measure the story of Bertha Pappenheim’s alleged hysterical preg...