Breuer, Josef

(b. Vienna, Austria, 15 January 1842; d. Vienna, 20 June 1925)

medicine, physiology, psychoanalysis.

Breuer’s father, Leopold (1791–1872), was a teacher of religion employed by the Jewish community of Vienna, and Breuer described him as belonging to “that generation of [Eastern European] Jews which was the first to step out of the intellectual ghetto into the air of the Western world.” Breuer’s mother died when he was about four, and he was raised by her mother. His father tutored him until he was eight, and he then entered the Akademisches Gymnasium of Vienna, from which he graduated in 1858. After a year of general university studies, Breuer entered the medical school of the University of Vienna in 1859 and completed his medical studies in 1867. In the same year, immediately after passing his doctoral examination, he became assistant to the internist Johann Oppolzer. When Oppolzer died in 1871. Breuer relinquished his assistantship and entered private practice.

In 1875 Breuer qualified as Privatdozent in internal medicine. He resigned the position on 7 July 1885, however, apparently because he felt he had been improperly denied access to patients for teaching purposes; he also refused to let the surgeon C. A. T. Billroth nominate him for the title of professor extraordinarius. His formal relationship to the medical faculty was thus tenuous and strained; yet he was considered one of the best physicians and scientists in Vienna. His practice was his chief interest, and although he once referred to himself as a “general practitioner,” he was that today would be called an internist. Some idea of his reputation can be gathered from the fact that among his patients were many of the professors on the medical faculty, as well as Sigmund Freud and the prime minister of Hungary. He was elected to the Viennese Academy of Science in 1894 upon the nomination of three of its most distinguished members: the physicist Ernst Mach and the physiologists Ewald Hering and Sigmund Exner.

Breuer married Matilda Altmann on 20 May 1868, and she bore him five children: Robert, Bertha Hammerschlag, Margaret Schiff, Hans, and Dora. When faced with deportation by the Nazis, Dora committed suicide; she did not kill herself in the United States as stated by Ernest Jones. Breuer’s granddaughter Hanna Schiff was killed by the Nazis. The remainder of his descendants live in England, Canada, and the United States.

Breuer was a skeptic in matters of religion. In espousing the views of Fechner and Goethe, he referred to himself as one of “the many intellectuals who have religious needs and find themselves utterly unable to satisfy them within the faith of popular religion.” In his will he expressed the wish (which was followed) that he be cremated, a wish inconsistent with conventional Jewish religious practices.

Breuer was one of the great physiologists of the nineteenth century. He had no pupils and no permanent affiliation with a university or institute, which may explain why his fame today is not in proportion to his achievements. His first major scientific study led to the discovery of the reflex regulation of respiration. The work was conducted at the military medical school of Vienna (the Josephinum) in collaboration with its professor of physiology, Ewald Hering, and the results were published in 1868. By the very simple device of occluding the trachea at the end of an inspiration or expiration, Breuer and Hering were able to show that the lung contains receptors that detect the degree to which it is stretched. When the lung is distended by inspiration, nerve impulses arise in the lung and are transmitted to the brain via the vagus nerve; these impulses reflexly initiate expiration. When the lung is deflated, other receptors are stimulated and their impulses, also arriving in the brain via the vagus nerve, reflexly initiate the next inspiration. The whole mechanism, called by Hering and Breuer the “self–regulation” of respiration, was one of the first “feedback” mechanisms to be demonstrated in the mammal. Writing thirty years later, E. H. Starling said that these experiments caused “a complete revolution in our idea of the relationship of the vagus to the respiratory movements.” At the time Starling wrote, doubt had been cast on the existence of the receptors that respond to deflation of the lung, but the existence of such receptors was demonstrated by A. S. Paintal in the 1950’s. The picture of the reflex regulation of respiration drawn by Hering and Breuer remains in all essentials the view held today, and the underlying reflex is still known as the Hering–Breuer reflex.

After completing his work with Hering, Breuer began his long series of investigations of the function of the labyrinth, remarkable for their importance and even more remarkable because he conducted them privately, working in his own home and supported only by fees from his medical practice. We now know that the inner ear is a double organ, part of which is the organ of hearing and part of which detects movement of the head and its position in space. The structures of the inner ear are small and delicate, and are placed deep within the skull, which makes them inaccessible to easy experimental investigation. Breuer’s first studies of the labyrinth were concerned with the semicircular canals. These canals, three on each side of the head, are filled with fluid (endolymph). The angular position of the canals suggests that they might have something to do with the detection of movement; crude experiments carried out in the 1820’s by M. J. P. Flourens showed that injury to them produced disturbances of motor function in animals. In 1870 Friedrich Goltz suggested that the semicircular canals were the sense organs that detect the position of the head relative to the gravitational field; he believed that the lowest part of each canal would, as the result of the weight of the endolymph, be stimulated by pressure.

Our understanding of the function of the semicircular canals dates from the insight that it is not pressure but a tendency of the endolymph to flow within the canals during motion of the head that stimulates the receptors in the ampullae at the end of the canals. This insight was based on Goltz’s suggestion of 1870 and was reached essentially simultaneously by Breuer, Mach, and by the Edinburgh chemist A. Crum Brown. (Their initial communications were made on 14 November 1873, 6 November 1873, and 19 January 1874, respectively.) During movement of the head, the endolymph of the canals moves, but its angular rotation lags slightly behind that of the head and results in stimulation of the receptors at the ends of the canals. Thus, the semicircular canals respond to angular acceleration.

Breuer’s first article (printed in 1874) concerned mainly the explanation and interpretation of previous observation on animals and humans (thereby resembling Mach’s article); his second article, which appeared a year later, reported the results of many experiments, carried out chiefly on pigeons. In those experiments Breuer developed evidence for his theory, which has stood virtually unchallenged since that time. In addition he called attention to the importance of another receptor system connected with posture (also located in the inner ear), the otolith system. The otolith is a minute solid body whose movement stimulates receptors in the utricle, another part of the inner ear. Breuer suggested, and accumulated evidence to show, that the otoliths and the hair cells of the utricle are static position receptors that provide information about the orientation of the head in the gravitational field as well as information about linear acceleration. We are indebted to Breuer for the clear–cut analysis of the differing functions of the semicircular canals and the otoliths, as well as a clear–cut depiction of the relationship of the labyrinthine reflexes to optical nystagmus. His results were by no means immediately accepted and, in particular, his work on the otoliths was not generally known or accepted as late as 1900. Yet it was correct, and toady is recognized as the foundation of our knowledge of the sensory receptors for sensations of posture and movement.

Thus, Breuer deserves the credit for two fundamental and far–reaching advances in mammalian physiology: the Hering–Breuer reflex and the elucidation of the function of the labyrinth. His scientific techniques included mastery of physiological experiment and of delicate surgery, as well as the use of histological techniques. Above all, he was a remarkably patient and accurate observer. It must not be supposed that this means he was a passive recorder of events, for observation always implies full awareness of the relation of the facts observed to their meaning for theory and interpretation, as well as the ability to suspend judgment and retain a multitude of observations pending an intellectual survey and rearrangement of them. It has been suggested that Breuer was in some ways less scientific in his psycho–analytic reporting than in his physiological research, but the same sort of active observation, active accumulation of facts, and active suspension of final judgement until the facts arranged themselves into meaningful patterns is entirely characteristic of his investigations of psychopathology.

The general impression that Breuer published little and infrequently is true in the sense that he published relatively few major scientific articles at relatively long intervals; but quite apart from the importance of these articles, it should be noted that some of them were very long and detailed. His purely physiological articles, published over a forty–year period, numbered about twenty and comprised more than five hundred pages.

In the summer of 1880, while attending a man who was seriously ill with a peripleuritic abscess, Breuer observed the onset of a serious psychological disturbance in the man’s daughter, “Anna O.,” who was also his patient. Her symptoms were later summarized by Freud as follows:

Her illness lasted for over two years, and in the course of it she developed a series of physical and psychological disturbances which decidedly deserved to be taken seriously. She suffered from a rigid paralysis, accompanied by loss of sensation, of both extremities on the right side of her body; and the same trouble from time to time affected her left side. Her eye movements were disturbed and her power of vision was subject to numerous restrictions. She had difficulties over the posture of her head; she had a severe nervous cough. She had an aversion to taking nourishment, and on one occasion she was several weeks unable to drink in spite of a tormenting thirst. Her powers of speech were reduced, even to the point of her being unable to speak or understand her native language. Finally, she was subject to conditions of “absence,” of confusion, of delirium and of alterations of her whole personality… [The Complete Psychological Works of Sigmund Freud, XI, 10].

Breuer noted that Anna O. showed two markedly different states of consciousness each day: during one she seemed relatively normal, during the other she was “clouded.” He also found that if, during her normal state, she could be induced to tell him the fantasies that occupied her during her clouded state her restlessness was greatly reduced. To facilitate this “catharsis,” he began to hypnotize her. Far more importantly, he eventually noted that under special circumstances of recall she would trace a series of memoiresback over time until she reached the memory of a “traumatic” episode that had been transformed into a symptom. After seeing several of her symptoms vanish as the result of this sort of recall, Breuer began to visit her twice a day in order to have time for more intensive and frequent hypnosis. He gradually succeeded in relieving all of her symptoms by this process of catharsis.

From his treatment of Anna O. Breuer arrived at two conclusions of fundamental importance: (1) that the symptoms of his patient were the result of “affective ideas, deprived of the normal reaction” which remained embedded in the unconscious, and (2) that the symptoms vanished when the unconscious causes of them became conscious through being verbalized. These two observations form the cornerstone upon which psychoanalysis was later built.

Breuer did not publish or publicize the results of his treatment of Anna O. He did, however, discuss them with Freud, and the cathartic treatment resumed when Freud began to use it under Breuer’s guidance. For several years Breuer and Freud jointly explored this form of psychotherapy. Only Freud treated patients, but he and Breuer continually discussed the results and implications of the treatment. Freud first used the cathartic method in either 1888 or 1889. The practical and theoretical conclusions they reached through their collaboration were published in an article in 1893 and as a book (Studien über Hysterie) in 1895. The publication of the book very nearly coincided with the end of their collaboration—and of their friendship. The contribution of Breuer and Freud to the development of psychoanalysis may be stated as follows: (a) Breuer discovered that neurotic symptoms arise from unconscious processes. (b) Breuer discovered that neurotic symptoms disappear when the unconscious processes become conscious. (c) These major discoveries were communicated by Breuer to Freud. (d) The first serious attempt to explore the implications of these discoveries was made by Freud and Breuer working in close collaboration. (e) Breuer was not anxious to pursue these studies, and the major development must be attributed to Freud after he separated from Breuer, during a period when Breuer apparently did not seek another collaborator but dropped the subject. (f) If by psychoanalysis we mean a discipline relying on the technique of free association, psychoanalysis was solely Freud’s discovery.

Breuer, in writing the oretical chapter of the Studien über Hysterie advanced a number of very important concepts, among them one rejected by Freud but now regarded as very important: that the hypnoid state and varying levels of consciousness are of great importance in normal and abnormal mental functioning. Other theoretical concepts usually attributed to Breuer include the distinction between the primary and secondary processes, the concept of hallucination as a regression from imagery to perception, and the suggestion that perception and memory cannot be performed by the same psychic apparatus. The “principle of constancy” was first mentioned by Breuer, but he attributed it to Freud. This concept is fundamental to the development of psychoanalytic theory, and one cannot but wonder whether Breuer did not in fact play an important role in formulating it. Breuer after all, formulated the notion of “feed–back” in the respiratory cycle and studied the sense organ that plays a key role in postural balance in animals; and the homeostatic devices involved in those systems are very reminiscent of the “principle of constancy.”

In his obituary of Breuer, Freud spoke with regret of the fact that Breuer’s brilliance had been directed toward the problems of psychopathology for only a brief time. Although Breuer actually dealt with that subject during a period of nearly fifteen years, he did so in a way that deserves special examination. In the first place, Breuer’s mastery of hypnosis and his readiness to use it in treating Anna O. may, as Professor E. H. Ackerknecht has suggested to me, indicate that Breuer had more interest in psychopathology than the average internist even before the case of Anna O.; this supposition receives confirmation from the time Breuer spent on that case and from the care with which he recorded it. In the opinion of Freud it was the case of Anna O. that also caused Breuer to draw back from psychotherapy for a time, since the case had, near its end, an unexpected and disturbing result: Anna O. formed a strong attachment to Breuer, an attachment that had a definitely sexual quality. Freud believed that this upset Breuer and prevented him from again practicing “deep” psychotherapy. Breuer himself stated that after the case of Anna O. he gave up treating patients in this manner since such treatment could not be carried out by a physician subject to the demands of a busy general practice. The resumption of that sort of psychotherapy, which was to evolve into psychoanalysis, was undertaken jointly by Breuer and Freud about five years after the case of Anna O., but the treatment of patients was solely in the hands of Freud, with Breuer taking part only in discussion of the techniques and the results of treatment.

There were for a time a few “Breuerians,” i.e., physicians who used Breuer’s original cathartic therapy without Freud’s amplifications. Breuer does not seem to have been a “Breuerian” in this sense, although letters by him in the Medizinhistorisches Institut der Universität Zürich indicate that his handling of psychiatric patients remained very so–phisticated. On the whole it is probably correct to say that while Breuer was persuaded intellectually of the validity and importance of the new concepts and techniques that developed from his own work and from the work he did jointly with Freud, he was equally dismayed by the recurrent intrusion of sexuality into the subject. In a sense, therefore, Breuer’s anxiety over Anna O.’s reaction to him may be taken as a symbol of the reasons for his ambivalence toward the subject, but only as a symbol, since he returned, via collaboration with Freud, to the very same subject, and did not finally split with Freud until thirteen years after the Anna O. episode. Whatever the nature of Breuer’s interest in the subject and whatever the reasons for his ambivalence, nothing can minimize the fact that his treatment of Anna O. can convincingly be regarded as the first modern example of “deep psychotherapy” carried out over a prolonged period of time.

Although they had been very close for many years, Freud, and Breuer separated in 1896 and never spoke again. Whatever the roots of this break were in the character of the Breuer and Freud relationship, the quarrels that led up to it grew out of their work on psychotherapy. It was a difficult period for Freud, who felt, among other things, that Breuer was ambivalent about the value of their work, ambivalent about publishing it, and ambivalent about publicly supporting him. Interestingly enough, their final quarrel seems to have concerned a matter in which Breuer was right and Freud only later found himself to be wrong, the question of the reality of the memoiresof having been seduced in early childhood, which had occurred in many patients. Breuer did refuse to back Freud in his belief that nearly all their patients had experienced such seductions; when Freud finally realized that such memoireswere memoiresnot of real events but of childhood fantasies, he made one of his most important discoveries.

There is no possibility of meaningfully exploring the dynamics of their relationship at this date. It may be simplest to say that for a long time Freud needed Breuer and depended upon him; he then came to need him less and to depend on him less; and eventually he had a positive need to break with him, which he did thoroughly and in a way that left bad feelings. We cannot say even that much about Breuer; all we can say is that he was very fond of Freud for a long time and deeply wounded by the break. That a relationship between an older and a younger man, first full of warm and close friendship and then of turmoil, should have accompanied the birth of psychoanalysis may have been inevitable. That relationship should not be allowed to obscure the brilliant intellectual and observational contributions each made to the founding of modern psychoanalysis, psychiatry, and psychotherapy, nor should it obscure the fact that their long and close collaboration was an integral part of the creation of psychoanalysis.

Breuer was friendly with many of the most brilliant intellects of his time. He sustained a long correspondence with Franz Brentano, was a close friend of the poet Maria von Ebner–Eschenbach, and was on friendly terms with Mach, whom he had met at the time of their simultaneous work on the labyrinth. His opinion on literary and philosophical questions seems to have been widely respected and often sought. His correspondence with Maria von Ebner–Eschenbach has been preserved as has part of the Brentano–Breuer correspondence. Breuer had a considerable command of languages, and its is interesting to note that his treatment of Anna O. was for a long period conducted in English. The eulogies published after his death all emphasize that the range and depth of his cultural interests were as unusual and important as his medical and scientific accomplishments.

BIBLIOGRAPHY

I. Original Works. No detailed bibliography of Breuer’s publications has ever been assembled, His scientific articles can easily be traced through the usual guides to the medical literature and, in particular, in the Cumulative Author Index to Psychological Index… (Boston, 1960). The Hering–Breuer reflex is described in “Die Selbststeuerung der Athmung durch den Nervus vagus” in Sitzungsb. d. k. Akad. d. Wissensch., Math. naturwissensch. Klasse Abtheilung II, 58 (1868), 909–937. Breuer’s first major articles on the labyrinth were “Ueber die Funktion der Bogengänge des Ohrlabyrinths,” in Medizinische Jahrbücher, 2nd series, 4 (1874), 72–124, and “Beiträge zur Lehre vom statischen Sinne (Gleichgewichtsorgan, Vestibularapparat des Ohrlabyrinths),” ibid., 5 (1875), 87–156. Breuer’s other articles on the labyrinth may be found with the aid of the bibliographic sources mentioned above or in the bibliographics to the article by Roth and the book by Camis cited below.

Breuer’s publications in the sphere of psychopathology, both written with Freud, were “Ueber den psychischen Mechanismus hysterischer phänomene (Vorläufige Mittheilung),” in Neurologisches Centralblatt, 12 (1893), 4–10, 43–47; and Studien über Hysterie (Leipzig–Vienna, 1895). The preliminary communication and the book are readily available in English translation as Vol. II of The Standard Edition of the Complete Psychological Works of Sigmund Freud, James Strachey, ed. (London, 1955).

Breuer’s brief autobiography, entitled simply Curriculum vitae, presumably was published in Vienna in 1925 (the actual publication bears no place, date, or publisher’s name). There is a photographic copy of this rare pamphlet in the library of the New York Academy of Medicine.

II. Secondary Literature. Apart from the brief autobiography mentioned above, the most detailed sketch of Breuer’s life is found in Hans Horst Meyer, “Josef Breuer,” in Anton Bettelheim, ed., Neue Österreichische Biographie (Zurich–Leipzig–Vienna, 1928), V, 30–47. Additional useful information is found in obituaries: Sigmund Freud, in Internationale Zeitschrift für Psychoanalysis, 11 (1925), 255–256. translated in The Complete Psychological Works of Signmund Freud XIX, 279–280; A. de Kleyn, in Acta Otolaryngologica, 10 (1927), 167–171; and A. Kreidl, in Wiener medizinische Wochenschrift (1925), 1616–1618. The function of the labyrinth is a difficult and obscure topic. A good survey of it, as well as a clear idea of how pervasive and enduring Breuer’s contributions to the subject were, can be gained from Mario Camis, The Physiology of the Vestibular Apparatus (Oxford, 1930).

Freud’s many comments on Breuer’s role in the history of psychoanalysis may easily be located in The Complete Psychological Works of Sigmund Freud. The evaluation of the contributions of Breuer and Freud to the founding of psychoanalysis follows that in P. F. Cranefield, “Josef Breuer’s Evaluation of His Contributions to Psychoanalysis,” in International Journal of Psychoanalysis, 39 (1958), 319–322; the same article contains an important letter from Breuer discussing his contributions to psychoanalysis. A good deal of information about Breuer and Freud is found in Ernest Jones, The Life and Work of Sigmund Freud (Vol. I, New York, 1953). Jones’s book must be used with care, however, since its impressive quantity of information is not always matched by accuracy either of fact or of interpretation.

The most recent detailed biographical article on Breuer is E. H. Ackerknecht, “Josef Breuer,” in Neue Österreichische Biographie ab 1815 (Vienna–Munich–Zurich, 1963), XV, 126–130. Other recent articles include J. E. Gedo et al., “Studies on Hysteria; a Methodological Evaluation,” in Journal of the American Psychoanalytic Association, 12 (1964), 734–751; N. Roth, “The Place of Josef Breuer in Medical History,” in Comprehensive Psychiatry, 5 (1964), 322–326; N. Schlessinger et al., “The Scientific Style of Breuer and Freud in the Origins of Psychoanalysis,” in Journal of the American Psychoanalytic Association15 (1967), 404–422; and J. Sullivan, “From Breuer to Freud,” in Psychoanalysis and the Psychoanalytic review, 46 (1959), 69–90. The Gedo and Schlessinger articles attempt to evaluate Breuer’s scientific and “cognitive” style via a consideration of what little is known of his life and via an analysis of a few of his publications. In these articles one finds a rather mechanical analysis of psychological propositions in terms of their “remoteness from concrete clinical data.” The authors’ remark that Breuer’s work was “limited by deficient scientific reality testing” suffices to show the dangers of the use of unsophisticated ideas about the nature of scientific reasoning and creativity.

For help in obtaining previously unpublished information contained in the above biography of Breuer, I am deeply indebted to the later Dr. Walter Federn, to Professor Erwin H. Ackerknecht, to Professor Erna Lesky, to Dr. Kurt Eissler and to Breuer’s granddaughter, Mrs. Felix Ungar.

Paul F. Cranefield

BREUER, JOSEF (1842-1925)

Josef Breuer, an Austrian doctor, was born January 15, 1842, in Vienna, where he died on June 20, 1925. Breuer, the son of a liberal Jewish professor of theology, studied medicine in Vienna and obtained his degree in 1864. He served as an assistant in internal medicine to Theodor Oppolzer, and worked on heat regulation and the physiology of respiration (Hering-Breuer reflex); upon becoming a practitioner in 1871, he set up his practice in Vienna. He also conducted research on the function of the inner ear (Mach-Breuer theory of the flow of endolymphatic fluid) and, although he became a specialist in internal medicine in 1874, he returned to his research in 1884.

He was the friend and family doctor of several members of the Vienna Teachers College and of Viennese high society. He maintained a correspondence with artists, writers, philosophers, psychologists, and colleagues in his field, and in 1894 was elected a corresponding member of the Academy of Sciences. Well versed in philosophy, Breuer was interested in the theory of knowledge and the theoretical foundations of Darwinism (1902 conference, exchange of letters with Franz von Brentano). He was an active participant in discussions on the foundations of politics and ideology, and discussed issues of art, literature, and music. As an assimilated and enlightened Jew, he adopted a kind of pantheism that he derived from Goethe and Gustav Theodor Fechner. His favorite aphorism was Spinoza's suum esse conservare (preserve one's being). He was gripped by a form of skepticism and spoke, following William Thackeray, of his "demon 'but'," which forced him to question any newly acquired knowledge. Because of his detailed knowledge of the history of ideas and social history, his appreciation of the political conditions of his era, as well as for reasons having to do with his own life, he believed it was nearly impossible for him to undertake a questionable action.

Underlying Breuer's research on physiology was the quest for the relation between structure and function, and thus for a form of teleological query. He was particularly interested in regulatory processes in the form of self-control mechanisms. Unlike a number of physiologists in the so-called biophysicalist movement, inspired by Ernst Brücke, Hermann von Helmholtz, and Emil Du Bois-Reymond, Breuer believed in neovitalism.

In 1880-1882 Breuer treated a young patient, Bertha Pappenheim (Anna O.), for a nervous cough and a multitude of other hysterical symptoms (mood swings, alterations in states of consciousness, visual disturbances, paralysis and contractions, aphasia). During the many long interviews, doctor and patient saw that some symptoms disappeared when the memory of their first appearance returned and could be reproduced, and the associated affects could be awakened and abreacted. This occurred at specific times of day, during spontaneous auto-hypnotic states. Based on these observations, initially accidental, patient and doctor developed a systematic procedure whereby the individual symptoms were gradually recalled during their appearance in reverse chronological order, until they disappeared for good following a reproduction of the original scene. Sometimes artificial hypnosis was used during therapy if the patient was not in a state of auto-hypnosis. The patient, who at times "forgot" her native language and understood only English, jokingly referred to this therapy as the talking cure, or chimney sweeping.

During the therapy, a stay at a clinic near Vienna was required because of the patient's heightened risk of suicide. In spite of the apparent and surprising success of the method, certain manifestations remained. These included the temporary loss of her native language and violent neuralgia of the trigeminal nerve, which required morphine treatment, leading to addiction. Because of her symptoms Breuer had his patient admitted for further treatment to Dr. Ludwig Binswanger's Bellevue sanatorium in Kreuzlingen in July 1882. She left in October, improved but not fully cured (Histoire de la maladie, in Hirschmüller, A. 1978). She lived until 1888 in Vienna, was treated on several occasions, then moved to Frankfurt, where she had an active life as a writer, social worker, defender of women's rights, and a leader of the movement of Jewish women in Germany (Jensen, E. 1984; Tisseron, Y. 1986; Heubach, H. 1992).

In 1882 Breuer discussed the case with his colleague Sigmund Freud, fourteen years his junior. Freud tested Breuer's method on patients after he began working as a neurologist. Starting from the theories of Jean Martin Charcot, Pierre Janet, August Ferdinand Möbius, Hippolyte Bernheim, and others, they jointly developed a theoretical framework for the operation of the psychic apparatus and for their therapeutic procedure, which they called the "cathartic method" in reference to Aristotle's ideas about the function of tragedy (catharsis as the purification of the spectators' emotions). In 1893 they published a preliminary report entitled "On the Psychic Mechanisms of Hysterical Phenomena". This was followed two years later by the Studies on Hysteria, the "cornerstone of psychoanalysis" (Ilse Grubrich-Simitis), establishing the foundations of the field. There was a chapter on theory (Breuer), a chapter on therapy (Freud), and five case histories (Anna O., Emmy von N., Katharina, Lucy R., Elisabeth von R.).

Freud continued to develop the theory and technique as they developed the work jointly (defense neuroses, free association). Breuer was not convinced by the exclusive emphasis on sexual factors and Freud saw Breuer's caution as a sign of aloofness. In 1895 the distance between the two men increased, resulting in the end of their collaboration. Breuer continued to take an interest in the development of psychoanalytic theory but abandoned cathartic therapy. Freud later proposed the hypothesis that Anna O.'s treatment had been suddenly interrupted because of a violent erotic transference, accompanied by hysterical pregnancy and childbirth. This version of events, constructed retroactively by Freud and spread by Ernest Jones, among others, cannot withstand historical scrutiny. More recent attempts to show that the description of the case of Anna O. was a "fraud" (Mikkel Borch-Jacobsen) are a form of unsubstantiated polemic.

Albrecht HirschmÜller

See also: Anna O., case of; "Autobiographical Study, An"; Autosuggestion; Cathartic method; Conversion; Free energy/bound energy; Hypnoid states; Hypnosis; Hysteria; Memory; On the History of the Psychoanalytic Movement ; Pappenheim, Bertha; Psychic energy; Remembering; Reminiscence.

Bibliography

Breuer, Josef. (1986). Die krisis des Darwinismus und die teleologie. Vortrag, gehalten am 2.5.1902. Tübingen: Diskord.

Ebner-Eschenbach, Marie von; Breuer, Josef. (1969). Ein briefwechsel, 1889-1916. Vienna: Robert A. Kann.

Hirschmüller, Albrecht. (1978). Physiologie und psychoanalyse in leben und werk Josef Breuers. Bern-Stuttgart: Hans Huber.

Jensen, Ellen M. (1970). "Anna O: A study of her later life." The Psychoanalytic Quarterly, 39, 269-93.

——. (1984). Streifzüge durch das leben von Anna O.-Bertha Pappenheim. Ein fall für die psychiatrie. Ein leben für die philanthropie. Dreieich.

Pappenheim, Bertha. (1992). Sisyphus. Gegen den Mädchen-handel Galizien: Bertha Pappenheim, die Anna O. In Helga Heubach (Ed.), Freiburg im Breisgau. Le Travail de Sisyphe. (1986). Paris: Des femmes-Antoinette Fouque.

Josef Breuer

1842-1925
Austrian physician, physiologist, and a founder of psychoanalysis.

Josef Breuer made the crucial observations upon which early psychoanalytic theory was based. He discovered that neuroses could arise from unconscious processes and, furthermore, that the neurotic symptoms could disappear when these underlying causes became part of the conscious mind. He communicated these findings to Sigmund Freud and the two men entered into a collaboration. Breuer emphasized hypnosis . He also believed that differing levels of consciousness are very important in both normal and abnormal mental processes. Although Freud eventually rejected this concept, it is now believed to be of great significance. Breuer also was among the most important physiologists of the nineteenth century.

Breuer was born in Vienna, Austria, in 1842. His father, Leopold Breuer, taught religion in Vienna's Jewish community. Breuer's mother died when he was quite young, and he was raised by his maternal grandmother and educated by his father until the age of eight. He graduated from the Akademisches Gymnasium of Vienna in 1858 and then studied at the university for one year, before enrolling in the medical school of the University of Vienna. He passed his medical exams in 1867 and went to work as assistant to the internist Johann Oppolzer at the university.

Studies physiological processes

Breuer's first important scientific work was published in 1868. With Ewald Hering, a physiology professor at the military medical school in Vienna, he demonstrated the reflex nature of respiration. It was one of the first examples of a feedback mechanism in the autonomic nervous system of a mammal. Their experiments changed the way scientists viewed the relationship of the lungs to the nervous system , and the mechanism is still known as the Hering-Breuer reflex.

In 1868, Breuer married Matilda Altmann, and they eventually had five children. Following Oppolzer's death in 1871, Breuer entered private practice. Still, he found time for scientific study. He worked in his home, with funds derived from his medical practice. Turning his attention to the physiology of the ear, he discovered the function of the semicircular canals. This work provided the foundation for our modern understanding of how sensory receptors detect position and movement. In all, Breuer published approximately 20 papers on physiology over a period of 40 years. Although he joined the faculty of internal medicine at the University of Vienna in 1875, his relationships there were strained; he resigned his position in 1885.

The story of Anna O.

It was in 1880 that Breuer first observed the development of a severe mental illness in one of his patients, "Anna O." Breuer found that he could reduce the severity of Anna's symptoms by encouraging her to describe her fantasies and hallucinations . He began using hypnosis to facilitate these sessions. He found that when she recalled a series of memories back to a traumatic memory , one of her many symptoms would disappear, a process that Breuer called cathartic. Soon, Breuer was treating Anna with hypnosis twice a day and eventually all of her symptoms were gone. Breuer drew two important conclusions from his work with Anna: that her symptoms were the result of thoughts that were buried in her unconscious and that when these thoughts were spoken and became conscious, the symptoms disappeared. Breuer's treatment of Anna O. is the first example of "deep psychotherapy" carried out over an extended time period.

Breuer did not publish the results of Anna's treatment. However, he taught his methods to Sigmund Freud and, together, they began to develop this new form of psychotherapy . Breuer did not continue to treat patients such as Anna. Although he claimed that the demands of his busy medical practice prevented him from pursuing psychotherapy, Freud believed that he was upset by the strong attachment that Anna developed for Breuer towards the end of her treatment, a phenomenon that became known as transference . When Freud began to use Breuer's methods of psychoanalysis , Breuer and Freud discussed Freud's patients and the techniques and results of their treatments. In 1893, they published an article on their work and, two years later, the book which marked the beginning of psychanalytic theory, Studien über Hysterie. At about the same time, their collaboration—and their friendship—came to an end. Apparently Breuer's ambivalence concerning the value of their work fueled their discord. However their final break came about over the question of childhood memories of seduction. At the time, Freud believed that most of his patients had actually been seduced as children. Only later did he realize that Breuer was correct in believing these to be memories of childhood fantasies.

Breuer dropped his study of psychoanalysis, whereas Freud continued to develop his theories independently. However, among other concepts, Breuer usually is credited with having first suggested that perception and memory are different psychic processes and with having developed a theory of hallucinations. Breuer's background in physiology had a profound influence on the development of his theories and it is likely that his influence on the work of Sigmund Freud has been underestimated. Some physicians, the "Breuerians," continued for a time to use Breuer's original cathartic techniques without adopting Freud's modifications and amplifications.

Breuer was regarded as one of the finest physicians and scientists in Vienna. In 1894, he was elected to the Viennese Academy of Science. Breuer died in Vienna in 1925. His daughter Dora later committed suicide rather than be deported by the Nazis. Likewise, one of his granddaughters died at the hands of the Nazis. Other members of his family emigrated.

Margaret Alic

Further Reading

Cranefield, Paul F. "Breuer, Josef." In Dictionary of Scientific Biography, edited by Charles Coulston Gillispie, vol. 2. New York: Charles Scribner's Sons, 1970.

Hirschmüller, Albrecht. The Life and Work of Josef Breuer: Physiology and Psychoanalysis. New York: New York University Press, 1989.