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After the Cure

Anna O. is famous as the first person to benefit from psychoanalysis, but the fascinations of her life don't stop there.



The doctor is called. It is fall 1880 and the father is dying of tuberculosis in the family's big apartment in Vienna. The 21-year-old daughter has been nursing him. She tends to him at night and her sleeping schedule is awry--she has nodded off when sitting at his bedside, and once in the summer country house she thought she saw snakes crawling from the walls, out to get him. Terrified, she tried to push one away and found that her fingers had turned into little snakes themselves. The next day, outside playing a ringtoss game, she happened upon a stick and that too turned into a snake. Now she has "absences" where she drops out of consciousness--drops out of time--and then rejoins the conversation or activity at hand. She's also bored, so bored that she makes up stories in her head, her own "private theater," while her body stays there, where it should be.

But that's not why the doctor's been called. She has a cough that won't go away, and her mother is worried. The family doctor listens and finds a "typical nervous cough." Europe and America are full of hysterical women whose wombs have wandered to other parts of their bodies, causing symptoms ranging from fainting to choking to paralysis. As fall turns to winter she develops more symptoms. She takes to her bed from December to April, every so often raging or having "caprices" like not taking off her stockings or pulling off the buttons of her dressing gown or throwing pillows. She squints, hallucinates, has facial pains, paralyzed limbs. The symptoms worsen after her father's death. Her doctor prescribes morphine for pain and chloral hydrate to help her sleep. She forgets her native language, German, and speaks in English, French, Italian, or a mixture of all three. The doctor massages her, hypnotizes her, visits once or twice a day. During hypnosis she tells him fairy tales, after which she appears comforted. When able, she helps the poor and sick, which gives her satisfaction. The doctor discovers that if he gets her to remember certain key events, her symptoms disappear. She has stopped drinking fluids, for example, getting her liquids from fruit instead. Under hypnosis he draws her back to a memory of seeing her governess's dog drinking out of a glass. She was disgusted but too polite to say anything. Once she articulates this, she is able to drink a glass of water.

The doctor finds out she started coughing when, at her father's bedside in the summer, she "heard the sound of dance music coming from a neighboring house, felt a sudden wish to be there, and was overcome with self-reproaches." After that, whenever she heard music she coughed. But after she tells him about it, the symptom disappears.

Eureka! A clean incision--he can reach in to remove the offending symptom triggered by an event. As satisfying as extracting a thorn embedded in a lion's paw.

If this sounds familiar, it's because this is the story of the birth of psychoanalysis. Sigmund Freud credited the woman, a patient of his colleague Josef Breuer, with inventing the method. She herself, who was referred to as "Miss Anna O." in a case study, called it, in English, "chimney sweeping."

In the Library of Congress's traveling exhibit, "Sigmund Freud: Conflict and Culture," which will stop at the Field Museum in the fall, there are placards that pay homage to Anna O. and her discovery of the "talking cure."

In Studies on Hysteria, written in 1895 by Freud and Breuer, we are told that Anna O. recovered and went about the rest of her life in "perfect health."

Ernest Jones, who worshiped Freud and wrote the first biography of him, blew Anna O.'s cover in 1953. She was, he wrote, a young woman named Bertha Pappenheim who grew up to become a distinguished social worker, writer, and feminist. People in Freud's social circle already knew this--he often treated his acquaintances, and Bertha's father had been Freud's wife's legal guardian. Martha Bernays Freud and Bertha Pappenheim visited one another occasionally. It's even said that Anna O.'s identity was common knowledge in Vienna. Breuer's father was a Jewish scholar and religious teacher trained in Pressburg, Hungary (now Bratislava, Slovakia), which was where Bertha's father had grown up. The families may have met there.

Pappenheim, by midlife, was "the most famous Jewish woman in Europe," says Melinda Given Guttmann, author of the recently published The Enigma of Anna O.: A Biography of Bertha Pappenheim, the first full-length treatment of her life. A passionate social reformer, Pappenheim became the head of a Frankfurt orphanage, founded a home for unwed mothers and illegitimate children, cofounded and headed the first Jewish feminist organization in Germany (to complement existing Protestant and Catholic ones), and traveled the world to fight the "white slave trade"--forced prostitution.

Freud reportedly found grim amusement in Pappenheim's vocation and is said to have told one of his patients, Princess Marie Bonaparte, "She never married. And she has found great joy in life. Can you guess how? What she does?... She is active in societies for the protection of white women. Against prostitution! She speaks out against everything sexual."

Freud told Jones that Breuer told him (if much of Freudiana sounds like gossip, it is) that Breuer had decided to discontinue Bertha's treatment because it troubled his wife. She was growing bored and jealous hearing her husband talk about this troubled young woman. On the day in 1882 that he ended her treatment, Breuer arrived home but was soon summoned back to his patient's apartment. He found her writhing in false childbirth. According to a letter Freud wrote in 1923, she said, "I'm having Dr. B.'s child."

According to Jones, Breuer ran out the door, and was soon off on a second honeymoon with his wife in Venice.

Freud wrote later that Anna had developed "transference love," and that Breuer did not understand it. Breuer, in turn, recognized how well he had come to know Anna, but noted that in her case, "the sexual component was astonishingly undeveloped." Scholars tend to agree that the two were emotionally intimate; Guttmann calls it "soul-love." In Irvin Yalom's 1992 novel, When Nietzsche Wept, Breuer is in love--and lust--with Anna and tries to rid himself of his obsession with her. The hysterical pregnancy also appears in the novel, though Yalom notes that it has recently been thought to be a myth.

Amendments to the case study do not end there. Pappenheim was in and out of sanitoriums from 1881 to 1887, for symptoms that ranged from loss of language to severe jaw pain, as well as addiction to morphine and chloral hydrate. In between stays she visited with cousins who encouraged her to write down her fairy tales and short stories. She published them anonymously, audited a nursing course, and in 1888 moved with her mother to Frankfurt, her mother's native city, and began volunteering to help the waves of eastern European refugees fleeing pogroms and poverty.

Anna/Bertha is intriguing. Much is known of her interior life when she was a certain age, and much is known of her public life at a certain age, but little is known of her later interior life, and there's a gap during her period of institutionalization. In her professional life she was severe, witty. She translated Mary Wollstonecraft. She set up her home for wayward girls with no uniforms or corporal punishment and tried to teach the girls useful skills such as housekeeping and cooking. She had among the orphans and workers her "daughters," whom she doted upon, and would invite a favored few to her home every Tuesday for conversation and contemplation of her antiques and jewelry.

People still care deeply about Anna O. In 1984, Anna O.: 14 Contemporary Reinterpretations was published, in which both Freudians and non-Freudians assessed her malady. In recent years, schizophrenia has been proposed as the source of Anna's problems, as have lesions from meningitis, though Breuer himself rejected that diagnosis. Epilepsy? Nightmares connected with narcolepsy? Or were the hallucinations a product of false memory, conjured up during hypnosis?

By disagreeing with Freud--the Great Father--writers assert their own worldviews, speaking for the dead, the underdogs, the women, the misunderstood. His followers continue to examine the case as well. Psychoanalysis, says Marian Tolpin of Chicago's Institute for Psychoanalysis, "is so immersed in its own past....We're always going back to some of the early cases to test out current thinking against them."

More than a decade ago, Guttmann, a professor of speech, theater, and media studies at John Jay College of Criminal Justice at the City University of New York, became interested in Anna O. A colleague--a Jungian, it so happens--told Guttmann about the way Anna appeared to have healed herself by telling fairy tales. "I have always had a passion about the healing powers of art," says Guttmann--"art as healing, theater as healing. I believe in the primacy of the imagination over the real, the imagination as a portal of the divine." When Guttmann first read a Pappenheim story about a sprite who escapes from a pond and dances with a man, then is unable to return to the water because it has frozen over, she wept. "It almost reified the relationship with Breuer, and the yearning for transformation," she says.

What do women want? Freud famously asked.

Relief from boredom.

It is easy now to say that Pappenheim was bored. It's an observation bolstered by Breuer's assertion that she had "a keen, intuitive intellect, a craving for psychic fodder, which she did not, however, receive after she left school." In Austria at that time girls were barred from a university education. Pappenheim went as far as she could, graduating at 16 from a Catholic girls' school, where she learned languages, music, needlework, and other "useless" things, she said later. Historian Marion Kaplan, author of a history of the Jewish feminist movement in Germany, writes that Pappenheim's suffocating life as a proper upper-class daughter led to the creation of Anna O.

A freer life was available to less coddled young women in different times and places. In 1890, at 20, Rosa Luxemburg, a daughter of the Polish Jewish middle class, was taking university classes and arguing and theorizing with other radical emigres in Zurich. In 1889, Lillian Wald, 22, having grown tired of parties and teas and waiting for marriage in upstate New York, entered nursing school and later opened the Henry Street settlement house. Emma Goldman arrived alone in New York City at 20, in 1889, after running away from her husband and family in Rochester. On her first night in Manhattan she went to hear a German anarchist deliver a fiery sermon. Six months later she was delivering her own.

Maverick researcher Mikkel Borch-Jacobsen claims that Anna created her symptoms out of boredom, encouraged by her doctor and possibly influenced by a knowledge of hypnosis. Tolpin, who has written on Anna O., says that's possible, but "anybody who fakes it to that extent and who would be that good at it--that would be the disorder."

Goldman believed in free love and anarchy and fresh flowers. Luxemburg referred to her own sexuality as strong enough to "set a prairie on fire." Breuer noted Anna O.'s great love for her father and her seeming asexuality. There were rumors that her mother cut off her engagement to a violinist, that a doctor in a sanitarium fell in love with her. There is speculation that she was a lesbian, because while traveling throughout Europe, Russia, and Jerusalem, where she reported on the conditions of the Jewish poor and Jewish prostitutes, she stopped in Constantinople, met a beautiful prostitute in a brothel, and the next day was surprised she hadn't dreamed of her. Israeli scholar Naomi Shepherd writes in A Price Below Rubies: Jewish Women as Rebels and Radicals that it was an "innovation" for a woman like Pappenheim to remain single and not be part of an arranged marriage. She spent her eligible years in treatment, notes Guttmann. She referred to herself as lonely and not accustomed to love. In response to one particular outpouring of appreciation at her home for wayward girls, she cried.

By the time Pappenheim died of cancer in 1936, 1,500 girls had passed through the home in Neu Isenburg, near Frankfurt. The home's main building was burned down during Kristallnacht in November 1938, and in 1942 adult workers and children were deported to ghettos and death camps. It's unknown whether any survived.

In 1954, Pappenheim's profile graced a postage stamp in West Germany, part of a series titled "Helpers of Humanity." It was a great way for the new Germany to trumpet itself less than a decade after war's end. What could be better: a Jewish woman, who died of cancer at home, buried in a visitable grave. She was an Austrian turned German (like Hitler). She worked with Catholic and Protestant German feminist organizations, a model of interreligious cooperation, back when there were enough Jewish women in Germany to form organizations. The eastern European Jews she helped were victims of pogroms and other ills that originated in the east, not at home.

Unlike Germany, Austria has not beaten its breast about the war, preferring to consider itself a victim, though as Judith Miller reports in One, by One, by One: Facing the Holocaust, some 250,000 people greeted Hitler in Vienna's Hero's Square in 1938, when he proclaimed the annexation of Austria.

Guttmann grew up among "what passes for the upper classes" on the Gold Coast and in Winnetka, attending Francis Parker and the Latin School, and graduating from New Trier. Her ties to the city remain strong--she has friends here, speaks adoringly of "the sacred lake," and has a place waiting for her in the family mausoleum at Rosehill Cemetery. Her milieu growing up in the 1950s was oddly similar to Pappenheim's in the 1860s, she says. Her mother's background is unclear--she was probably half Jewish, from El Paso--but her father's family were Viennese Jews who had converted to Catholicism in order to obtain titles. In her apartment in New York she lives with a collection of tribal art as well as her never used dowry-- Viennese silverware topped with eagles, a huge candelabra. She wasn't aware of her Jewish background until she was about ten years old.

Guttmann's family was formal. They dressed for dinner. Friends and neighbors collected art and antiques, had fabulous ice sculptures and caviar at their parties. She and her parents went to Europe in the summer and had servants. "Everything was about art in my house. Food was art, clothes were art--that was one of Bertha's things too: beauty."

Pappenheim grew up in an Orthodox Jewish household, while Guttmann was raised nominally Christian. Christmas was celebrated with a big tree and mass, Easter by sitting at tables one or two at the Pump Room and showing off new hats. Like many German Jews, Guttmann's family looked down on eastern European immigrants and their progeny, with their Yiddish and working-class origins.

When Guttmann's friends were planning their debutante parties, she was told she couldn't join in because she was Jewish. When her father, a prominent surgeon, heard this, he wept. It was the only time, she says, she ever saw her father cry.

Guttmann emphasizes Pappenheim's spirituality in her book. In her late 30s Guttmann began exploring New Age practices and "started having mystical experiences--a unity with the divine, and I noticed that she had mentioned this in her work." Guttmann calls it "superpersonal love" and talks of experiencing it while visiting a Romanian orphanage.

Before she wrote The Enigma of Anna O., Guttmann did performance pieces about Pappenheim's life; now that the book is published, she combines performance with lecture. She talks about Pappenheim's life and acts out one of Pappenheim's fairy tales using dance learned in Bali. She tells the audience members that they are infinite, just as Pappenheim possessed infinite selves. "Biography itself is fiction," she says, "in that each of us is infinite."

Pappenheim had no children, and said that no one would say the kaddish, the Jewish prayer for the dead, for her, says Guttmann. As part of her performances, she has the audience do a meditation, borrowing from Jewish and Buddhist spiritual practices. She is accompanied by a musician who plays the violin, plies singing bowls, and sings a few lines of the kaddish.

Thus, in America, 65 years after Pappenheim's death, strangers sit in a room and listen to a prayer for a woman they are just beginning to know.

The Enigma of Anna O.:

A Biography of Bertha Pappenheim by Melinda Given Guttmann, Moyer Bell, 2001.

Art accompanying story in printed newspaper (not available in this archive): illustration/Ken Wilson.

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