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.

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.

—ALBRECHT HIRSCHMÜLLER

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