The spa town of Ischl (now known as Bad Ischl) in Upper Austria became one of Europe's most fashionable resorts in the nineteenth century when it was adopted as the summer residence of Austria's royal family. A less well-known visitor, but one with equal claim to fame perhaps, was Bertha Pappenheim, the "founding patient" of psychoanalysis.
In June 1880, a 21-year-old Jewish woman from Vienna, Bertha Pappenhim, arrived in Ischl with her family for a summer holiday. Within days, Bertha's father had fallen seriously ill with a lung disease and Bertha herself was showing the first symptoms of what would later be diagnosed as hysteria. She was subsequently treated in Vienna by Dr Josef Breuer, a friend of Sigmund Freud. Her case history, described under the pseudonym Anna O, is the first in Studies in Hysteria, published jointly by Breuer and Freud.
Ischl in the nineteenth century
Ischl came to prominence in the early part of the nineteenth century when the Emperor's physician recommended the saline baths to his royal patients. So enjoyable did the Imperial family find Ischl that they established a summer home there.
With the royal stamp of approval, plus the growing reputation of the spa, Ischl began to attract the rich and famous from all over Europe. It was particularly popular with musicians, poets and actors. Johannes Brahms took his coffee daily in the Cafe Walter, Johann Strauss was a regular billiards player in the Cafe Ramsauer, and Anton Bruckner was a frequent visitor in his capacity as court organist. The summer season offered a whirl of concerts, balls and theatre productions, the surrounding mountains and lakes a wealth of opportunities for hiking, swimming and picnicking.
So when the Pappenheims arrived at their beautiful balconied apartment in the Villa Bellevue on the outskirts of town, Bertha would have been looking forward to a summer of pleasure and entertainment. It was not to be. With her father's illness, Bertha became housebound, sharing the nursing with her mother, and soon her own health began to deteriorate.
Bertha's symptoms
Sitting up with him one night while he slept, Bertha started to hallucinate, seeing a black snake appear from the wall and head towards her father. When she tried to fight it off, she found that her arm was paralysed and her fingers had turned into little snakes tipped with death's heads. Struck with terror, she tried to pray but could find no words, not until she remembered some lines from an English nursery rhyme. Then she was able to pray, but only in English.
This was the first of many similar hallucinations, triggered by any snake-like object, and the first instance of a paralysis which would later affect most of her body and confine her to bed for months. The loss of language was the first appearance of a complex form of aphasia which would start with an inability to use grammar correctly. She subsequently became unable to speak German at all, expressing herself mainly in English, at times in French or Italian. For a while even she was totally mute.
Dr Breuer's treatment
Josef Breuer, the doctor called in to treat Bertha in Vienna, spent countless hours with her over a period of 18 months. Between them, he and his patient developed a method whereby Bertha described to him, in chronological order, the various events associated with each occurrence of a symptom. When they arrived at the first such event, the symptom thereafter disappeared. Thus, for example, a cough which had been troubling Bertha for months was eradicated when she described sitting at her father's bedside in Ischl and hearing dance music from a house nearby. The conflicting feelings of longing to be at the dance and duty to her father triggered in her a bout of nervous coughing. Similar chains of remembered events led back to the original snake hallucination and the paralysed arm, resulting in the cessation of both hallucinations and paralysis.
This, at any rate, is the story as recounted in Studies in Hysteria.
Sigmund Freud's involvement
Soon after terminating his treatment, of Bertha, Breuer discussed the case with the young Sigmund Freud, who had an interest in hysteria. Freud later persuaded Breuer to collaborate with him in developing the theory which was to become the foundation stone of psychoanalysis.
Subsequent research findings
In the published case history Breuer claimed to have cured Bertha of her symptoms but subsequent research by Henri Ellenberger and Albrecht Hirschmuller has shown this to be false. In fact, Bertha spent the next five years in and out of clinics for nervous diseases, although she later became a prominent feminist and social worker.
In the late nineteenth century little was known about neurological disease. Hysteria was the diagnosis that doctors often fell back on when no organic disorder could be identified. Since then, various suggestions have been put forward as to the nature of Bertha's illness, ranging from tubercular meningitis to temporal lobe epilepsy to mere invention on the part of the patient. At this distance in time, diagnosis is no longer possible.
And the Freudian connection? Although Bertha Pappenheim undoubtedly lies at the origin of psychoanalysis, there is no record of the two ever having met.
Sources:
- Ellenberger, Henri F., The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry (New York: Basic Books, 1970)
- Hirschmuller, A., The Life and Work of Josef Breuer: Physiology and Psychoanalysis (New York: New York University Press, 1989)
Hilda Reilly - Hilda Reilly has an MSc in Consciousness Studies. She is the author of travel books about Palestine and Sudan.
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