PAPPENHEIM, BERTHA (1859-1936)

Bertha Pappenheim was born in Vienna on February 27, 1859, and died in Frankfurt on May 28, 1936. Pseudonymously known as Anna O, she was the patient whose case Joseph Breuer presented in Studies on Hysteria (Freud and Breuer, 1895d).

People who knew Pappenheim and admired her as a pioneer social worker were shocked when Ernest Jones, in the first volume of his biography of Freud, revealed Anna O's real identity.

Bertha's father, Siegmund Pappenheim, was a wealthy Viennese merchant, descended from an old Jewish family from Germany; her mother, Recha Gold-schmidt, gave birth to four children but only two, Bertha and Wilhelm, survived. Born in 1860, Wilhelm would become a famous attorney. Raised in a bourgeois household, Bertha learned English as a child and used it exclusively for a time during her illness; she also read French and Italian.

Reconstructions of Pappenheim's illness and the treatment she received, by such historians as Henri F. Ellenberger (1972) and Albrecht Hirschmüller (1978), reveal many disparities in Breuer's account. When Breuer, a well-known specialist in Vienna, was first consulted in December 1880, Bertha was suffering from facial neuralgia and muscular contractions. These disorders were partly linked to the illness of her father, whom she nursed and to whom she was passionately attached. In a waking dream, her vision of a black snake preparing to kill her father was one of her first symptoms; a cough that Breuer qualified as "hysteric" followed soon after, in November 1880, when he began to see her regularly. The seriousness of her father's disease was concealed from her and Bertha was no longer allowed to visit with or care for him; after learning of his death, at age fifty-seven on April 5, 1881, she suffered a severe and newly debilitating set of hysterical symptoms, including an episode of "negative" hallucinations from which only Breuer was spared. Her family brought her to a country home outside Vienna. Breuer was seeing her regularly by the autumn of 1881, and during evening sessions, while in a state of self-hypnosis, she began recounting stories that she referred to as the "talking cure." Breuer subsequently noticed that her "obstinate whims" disappeared when the fantastic thoughts that originated them could be evoked by this verbal "chimney sweeping," as she called it.

During the summer of 1881, probably in mid-August (although Ellenberger dates it to early 1882), an incident occurred of considerable importance for the future of psychoanalysis. One of Bertha's symptoms was a refusal to drink water. While in an hypnotic state, she revealed that she had been disgusted to see her lady-companion's dog lapping water from a drinking glass; then, awakening from her hypnosis, she asked for a glass of water. From this incident emerged a new treatment aim in the discovery of etiological factors through what became known as the "cathartic method." Breuer attempted to guide her to uncover the memories of events that would elucidate each of her multiple symptoms but which had apparently been forgotten.

Back in Vienna in November 1881, Bertha's condition worsened. She experienced a recrudescence of symptoms that caused her to reexperience events of the previous year. Employing the "cathartic method," Breuer wrote that "[e]ach symptom with such care to detail that she linked each individual symptom in this complicated case was taken separately in hand; all the occasions on which it had appeared were described in reverse order. . . . When this had been described the symptom was permanently removed" (p. 35). Success was such that the date of termination for this treatment can be fixed to the end of June 1882. According to Breuer, "After this she left Vienna and traveled for a while; but it was a considerable time before she regained her mental balance entirely" (pp. 40-41). Indeed, Ernest Jones revealed Breuer's shock when he was called the very evening of his departure from his patient, to be informed that she was showing signs of hysterical childbirth.

Various and contradictory accounts of Anna O's termination of treatment persisted until research by historians revealed her hospitalization from July 12 to October 29, 1882, at the Kreuzlingen Clinic, under the direction of Robert Binswanger. Bertha was then suffering from severe trigeminal neuralgia, which Breuer had been treating for several months with chloral hydrate and morphine, the dosages of which had to be reduced during her hospitalization.

Relatively little is known about the rest of the story. Bertha and her mother, with whom she had a difficult relationship, settled in Frankfurt. Her health appears to have gradually improved, as Breuer noted. She served as headmistress of an orphanage for a dozen years. Under the pen name Paul Berthold (her initials reversed just as her pseudonym "Anna O" [A.O] was formed from the letters preceding her real initials [B.P]), Pappenheim wrote children's short stories and even plays. She also translated the Memoirs of Gluckel von Hameln, a seventeenth-century maternal ancestor who had saved Jews from persecution. Breuer had correctly gauged the quality of Pappenheim's intelligence.

In addition, Pappenheim became a prominent activist and social worker. After founding the Care for Women Society (Weibliche Fuersorge ) to help young women after leaving orphanages, in 1904 she established the Juedischer Frauenbund, and served as its first president. With close ties to the German feminist movement, Pappenheim also fought for decades against the "white slave trade" that preyed on young women, who were often sold into servitude by their parents. She discovered the magnitude of white slavery during a journey to Galicia.

In 1905, upon the death of her mother, Pappenheim was free to travel. She first established a shelter for runaway girls and illegitimate babies near Frankfurt; a year later, she left to visit America. She went to London in 1910, and spent 1911-1912 in Turkey, Jerusalem, Egypt, and Eastern Europe. Pappenheim continued to pursue social work during World War I and its aftermath and wrote numerous articles concerning Jewish women and criminality.

When Hitler came to power, Pappenheim found herself opposed to Zionist organizations that advocated relocation of Jewish children to Palestine without their parents. Suffering from intestinal cancer that forced her to cut down on her social and humanitarian activities, she died on May 28, 1936. That November, Nazis looted her home and destroyed her furniture and belongings. Most of her social worker colleagues died in concentration camps.

In 1945, Germany issued a stamp in a series titled "Helpers of Humanity" to honor her. Her relatives assembled elements for a biography; an initial version by Dora Edinger in 1963 was followed in 1972 by a version of her life, part fiction and part analytical, by Lucy Freeman.

In spite of critics of psychoanalysis, such as Mikkel Borch-Jacobsen, it is a simplification to attempt to falsify the story told in Studies in Hysteria with information subsequently discovered by historians. One should beware of edifying biographies of Pappenheim or of charging Josef Breuer with mystification. Symptoms alone offer insufficient data to a psychoanalyst and questions arise concerning the long-term effects of "mothering" that Bertha experienced in the context of a "fatherly" transference of which no one at the time had the slightest grasp or understanding. Clearly, symptomatic improvement in Pappenheim's case was not immediate; however, her thorough personality transformation after the "talking cure" could be related to her treatment. Nothing is known of Pappenheim's subsequent emotional and sexual life, and none of her friends or relations seemed to be aware of her youthful psychological problems prior to Ernest Jones's disclosures in 1953.

Alain de Mijolla

See also: Anna O., case of; Breuer, Josef; Studies on Hysteria .

Bibliography

Edinger, Dora. (1968). Bertha Pappenheim: Freud's Anna O. Highland Park, IL: Congregation Solel.

Ellenberger, Henri F. (1970). The discovery of the unconscious. The history and evolution of dynamic psychiatry. New York: Basic Books.

——. (1972). The story of "Anna O.": a critical review with new data. In Micale, M.S. (Ed.). Beyond the unconscious. Essays of Henry F. Ellenberger in the history of psychiatry. Princeton, NJ: Princeton University Press, 1993.

Freeman, Lucy. (1972). The story of Anna O. New York: Walker.

Freud, Sigmund, and Breuer, Josef. (1895d). Studies on hysteria. SE, 2: 48-106.

Hirschmüller, Albrecht. (1989 [1978]). The life and work of Josef Breuer. New York: New York University Press.