Appignanesi and Forrester (1992) offer an interesting hypothesis as to what may have happened, if Freud’s version is correct (there is no independent verification of this version from anyone other than Freud, so take it with a grain of salt). Specifically, they speculate that during this time Anna was reliving the previous year (June of 1881 as opposed to 1882) in her altered state. June 1881 was nine months before Dora’s birth. Thus, the “baby episode” may have been a reliving of events in Breuer’s personal life, and he found this to be “an unacceptable intertwining of his personal with his professional life” (p. 84). According to this interpretation, Breuer was frightened at this point when Anna now seemed to be marching into his marriage and family life.
To me, the best explanation of the story offered by Freud is that it was a metaphor for the beginning of psychoanalysis, and is consistent with Freud putting himself in the best possible light. Thus, I believe it likely did not occur, but be aware that this is simply speculation on my part and cannot be factually proven. Specifically, the story can be interpreted to symbolize the “birth” of psychoanalysis. However, Breuer let the birth of psychoanalysis “drop,” and was too frightened to continue as he abandoned his patient. Thus, it took someone with greater courage to recognize what had occurred, to become the father of the birth. That individual was Sigmund Freud.
Without additional historical documents, exactly what occurred during that final day with Anna will never be known. Since others have offered their speculations, I’ll offer mine as well. Breuer’s letters to Binswanger provides further evidence that needs to be considered to make a judgment on Breuer’s final day of treatment with Anna, June 7, 1882. In a letter dated November 4, 1881 (this letter was preceded by previous correspondence which has not been found), which is 7 months before Breuer’s treatment with Anna would officially end; Breuer is attempting to make arrangements for her treatment to be taken over by Bellevue (Hirschmüller, 1978). Further correspondence from mid-June 1882, just after Breuer had stopped treatment, indicated that Anna’s mother was unsure if she should be brought to Bellevue or not, and a letter dated June 19, 1882, shows that Anna’s mother ultimately decided to take Anna to visit with relatives in Karlsruhe (Hirschmüller, 1978). She was seeking the advice of another physician besides Breuer, and was hoping that new surroundings would help Anna’s condition. However, Anna would ultimately be admitted to Bellevue on July 12, 1882.
I would speculate that the sheer amount of time that Breuer was spending with Anna was both negatively impacting his marriage and his other professional obligations. Thus, Breuer was ultimately looking for a way out, especially since there was no end in sight for the termination of treatment. Anna had developed a pattern of getting better for a short period of time, but would always relapse. Breuer also realized at this point she was addicted to chloral and morphine, and needed to be treated for her drug addiction, which would require more intensive treatment than he was willing or able to give. If Anna did announce that she wanted treatment to end on her one year anniversary of being moved to the country house (June 7, 1882), Breuer may well have used that as the opportunity to terminate his involvement in the case. Anna checked into a sanatorium shortly after, and I would speculate that Breuer could anticipate this occurring once the symptoms of drug withdrawal began. While I believe it is unlikely that the “Dr. B.’s baby” episode occurred, but some final dramatic scene with Anna would not shock me because she was not cured of her psychological problems, was addicted to drugs, and was prone to the dramatic. Unfortunately, unless new data fragments are uncovered, we will never know the answer to the question of what exactly occurred on the final day of Anna’s treatment as the 21 ½ page report written by Breuer for the sanatorium does not address the final day of her treatment.
Why Would Breuer Agree to Publish Anna’s Case History?
Finally, one last issue deserves comment. Freud told James Strachey (who edited The Standard Edition of the Complete Psychological Works of Sigmund Freud) that when treatment had concluded, Anna “made manifest to Breuer the presence of a strong unanalyzed positive transference of an unmistakable sexual nature” (see Breuer, 1895/1957, p. 41, footnotes). Freud believed that this was the reason Breuer held back the publication of the case of Anna O. for so many years as well as Breuer’s ending his collaboration with Freud’s subsequent research. This notion that Breuer delayed publication because of the sexual feelings that Anna may have possessed for him, or sexual feelings he may have had for her, has also become part of the legendary interpretation surrounding this case, and is told by Jones (1953). Yet, here we find a discrepancy between what Breuer has written, and what Freud would subsequently write. For example, as Breuer reports about Anna, “The sexual element is astonishingly undeveloped; I have never once found it represented even amongst her numerous hallucinations” (cited in Hirschmüller, 1978, p. 277). Moreover, she had “no element of sexuality throughout the entire illness” (cited in Hirschmüller, 1978, p. 295).
Thus, why did Breuer agree to publish her case history with Freud in Studies on Hysteria? Especially the version that he put forth (i.e., a successful outcome) which is inconsistent with the patient he wished would end her own life to stop her suffering, and inconsistent with the patient he had left addicted to choral and morphine? I would speculate that Breuer likely agreed to publish this case history to help out his friend. Breuer was the much more highly respected researcher and clinician at the time compared with Freud. Likewise, Freud’s reputation had recently suffered because of his publication about the benefits of cocaine (see Chapter 5). Breuer’s name appearing on the manuscript would give it much more credibility than if Freud had published the other case histories on his own. This practice still occurs today, as having a senior and well established researcher, such as Elizabeth Loftus, as a co-author on a journal article can give it much more prestige than would otherwise occur.
Second, Breuer likely only agreed because Freud had told him of his own successes in treating patients using the methods Breuer had developed with Anna. Thus, Breuer may have rationalized that even if the “chimney sweeping” did not completely cure Anna, perhaps it did work with others so the case history had some benefit. Finally, Breuer and Freud did not publish Studies on Hysteria until a full 13 years after the Anna case ended. Perhaps the simplest explanation for the long delay in publishing the case is that Breuer wanted to ensure that Anna did not have another severe episode and wind up back in a psychiatric hospital. This would have been extremely embarrassing given that a successful outcome was reported, and potentially harmful to Breuer’s professional reputation. Yet, these are speculations on my part and should not be confused with historical fact. Anna’s productive life really began when she moved to Frankfurt in 1888. For the reader interested in learning more about Bertha Pappenheim (there are many available resources), I would recommend starting with Kimball’s (2000) article, “From “Anna O.” to Bertha Pappenheim: Transforming Private Pain Into Public Action.” What seems clear is that Bertha leading such a productive life appears to have little if anything to do with Breuer’s treatment, which occurred years before and did not effectively cure her hysteria.
Chapter 5: SEPARATING HISTORICAL FACTS FROM HISTORICAL FICTION (PART 2): FREUD’S “MAGICAL SUBSTANCE”
In 1884, Freud, like many young physicians in Vienna at the time, was searching to discover something which would bring him instant name recognition within the local medical circles. Recognition would not only bring professional accolades, but allow him to be able to increase his economic standing and marry his fiancée Martha Bernays and ultimately support a family. Unlike today, when marriage occurs at a variety of stages, the custom at that time was that marriage should be delayed until economic prospects were stable.
Freud came across a paper written by a German army surgeon, Theodor Aschenbrandt, which he believed showed promise and could be exactly what he was searching for to make the important discovery that would gain him the much needed professional accola
des. Aschenbrandt, prior to becoming a military officer, had worked at the Pharmacological Institute at Würzburg as an assistant where experiments using cocaine to revive exhausted animals had been performed. Subsequently, Aschenbrandt searched for an opportunity to test if cocaine had the same revival properties in humans. He ultimately administered the drug to 6 soldiers in 1883, when they became exhausted while marching in unseasonably hot weather. The results were spectacular, as cocaine had the desired effect. As described by Aschenbrandt (cited in Thornton, 1983, p. 38):
Case L.T., volunteer of one year, collapsed of exhaustion directly upon leaving W. on the second day of a march; the weather was extremely hot, I gave him approximately one tablespoon of water with twenty drops of a cocaine solution (0.5/10). A few minutes later (approximately five), he stood up of his own accord and travelled the distance to H., several kilometers, easily and cheerfully and with a pack on his back.
Freud subsequently found a paper in a relatively obscure American journal (The Therapeutic Gazette of Detroit), which provided some preliminary evidence that cocaine was also successful in weaning morphine and alcoholics from their addictions. Freud subsequently ordered cocaine for himself and began taking it on a regular basis for depression and indigestion, and had dramatic results. He was so impressed with the positive benefits that he sent some cocaine to his fiancée Martha, and “he pressed it on his friends and colleagues, both for themselves and their patients, he gave it to his sisters. In short, looked at from the vantage point of our present knowledge, he was rapidly becoming a public menace” (Jones, 1953, p. 81). Freud and his biographer Ernest Jones indicate that Freud’s use of cocaine ended in 1887, and he never became addicted to the drug himself. Yet, Jones (a devoted supporter of Freud), who was allowed to see many of Freud’s letters not made available to others, wrote in a letter, “I’m afraid that Freud took more cocaine than he should though I’m not mentioning that [in my biography]” (cited in Isbister, 1985, p. 35). Letters written from Freud to Wilhelm Fliess provide evidence that Freud continued to take cocaine into middle age (Masson, 1985), and Thornton (1983; Freud and Cocaine) makes a compelling case that Freud’s use of cocaine directly influenced his theory of personality, especially the emphasis on sexual drives.
In a letter to Martha in 1884, Freud told her he was “now busy collecting the literature for a song of praise to this magical substance” (quoted in Isbister, 1985, p. 34). Freud’s tribute to his “magical substance,” which he now believed had many uses (e.g., stimulant, aphrodisiac) and the potential to cure many ills (e.g., stomach disorders, cachexia, asthma) was published in the July 1884 edition of Centralblatt für die Gesammte Therapie, titled “Über Coca.” This paper was subsequently translated into English, and appears to have played a role in the subsequent cocaine epidemic that began in the 1890s in the United States, which started with medical professionals that experimented with cocaine, but were unaware of the addictive properties of the drug.
Freud’s Third Scourge of Humanity
In addition to the other “magical” properties described in the paper, Freud discusses a successful use of cocaine as a safe and non-addictive substitute for morphine. This case was almost certainly Freud’s friend and colleague Ernst Fleischl von Marxow. Fleischl started taking morphine to control pain in his right hand, which had to have the thumb amputated and had several operations performed on it. Unfortunately, Fleischl became a morphine addict. Freud, based upon what he had read in the Therapeutic Gazette, as well as his own positive experience, had given his friend cocaine as a substitute for morphine. In his “Über Coca” paper, Freud wrote that “after ten days he was able to dispense with the coca treatment altogether” (cited in Thornton, 1983, p. 40). While the cocaine had successfully broken Fleischl’s morphine addiction momentarily (he would subsequently need morphine again for the pain in his hand), by early 1885 Fleischl was taking huge amounts of cocaine. He was a cocaine addict.
Freud in March, despite knowing that Fleischl was now an addict and did not stop taking the drug, read a paper to the Vienna Psychiatric Association in which he claimed that cocaine was able to break morphine addictions without threat of subsequent addiction to cocaine. This paper was subsequently published on August 7, 1885. Keep this date in mind, as it will be important shortly, and will provide another concrete example that Freud was not above being less than fully honest in his professional publications to make his clinical cases appear more successful than they actually were.
Fleischl’s case came to a crisis on June 4, 1885. When Freud found his friend, Fleischl was in such a bad state he went to fetch other doctors (his friend Joseph Breuer among them). Fleischl was exhibiting classic symptoms of cocaine intoxication. For example, he was hallucinating that white snakes were crawling all over his body. Freud would recall that this was the most frightening night of his life (Jones, 1953). Freud wrote to Martha (June 8), and warned her against acquiring a habit, although he continued to send her the drug (Thornton, 1983). Sadly, Fleischl would live in a miserable state another 6 years, both in agonizing pain and addicted to cocaine. Thornton (1983, p. 45) notes that “having been witness to these terrible scenes, knowing that Fleischl was still taking morphine as well as cocaine and having warned his fiancée of acquiring the habit, Freud allowed the 1885 paper to go forward for publication in August.” In all fairness to Freud, he gave his friend cocaine before it became widely known about the addictive properties of the drug and was trying to break his friend’s morphine addiction. On the other hand, Freud’s failure to mention what he had witnessed firsthand to the Vienna Psychiatric Association is extremely disturbing. Perhaps these types of actions by Freud help to explain why he destroyed so much of his personal papers and correspondence. They are fragments of historical evidence that will never be recovered.
Ironically, it was not long afterward that Freud would wish he had never published his 1885 paper, which claimed that cocaine could safely wean morphine addicts from their addiction without fear of subsequent addiction to cocaine. Earlier that same year, Albrecht Erlenmeyer had published an article cautioning about the addictive properties of cocaine, and subsequently reports started to come in from around the world about the highly addictive properties of the drug. Erlenmeyer, in a second paper about the addictive properties of cocaine in 1886 named Freud personally (Ellenberger, 1970), and it was Erlenmeyer that would accuse Freud of unleashing “the third scourge of humanity” (i.e., cocaine) on the world (the first two were alcohol and morphine).
Freud would attempt to defend himself in a July 1887 paper against Erlenmeyer’s charges. In this paper, Freud blamed others for first suggesting that cocaine could be used as a treatment for morphine addicts. Freud also stated that the hypodermic needle was the real source of the danger when taking cocaine, and he had recommended taking the drug orally. Yet, in the 1885 paper, Freud supported injections as a method to administer cocaine (Jones, 1953). In Freud’s 1897 list of publications he prepared when applying for the title of Professor, the 1885 paper was not included. Likewise, Freud did not keep a copy of the paper in his personal collection of reprints. As Jones (1953) points out, Freud seems to have totally suppressed his paper about the benefits of his magical substance.[2]
Chapter 6: FREUD COMES TO AMERICA!
The purpose of this chapter is to discuss Freud’s first and only trip to the United States in 1909, in which he was invited to give a series of lectures at Clark University (Worchester, Massachusetts). Freud himself described the trip as the first formal acknowledgment of his work (Jones, 1955). The trip was extremely important because it ultimately introduced Freud to a much larger academic audience than would have otherwise occurred.
While some American psychologists were familiar with Freud’s work prior to his trip to the United States, many were not. There is no guarantee that this would have changed without Freud lecturing at Clark University, especially given that most American psychologists in the early 1900s were experimentalists performing research, not clinicians
treating mental illness (see Chapter 1). Because of financial concerns Freud almost never made the trip to America, which likely would have altered the history of psychology in many ways. As pointed out by Schultz and Schultz (2008, p. 421), on this trip, “Freud met prominent American psychologists such as James, Titchener, and Cattell. Freud’s lectures were published in the American Journal of Psychology and translated into several languages… . The APA discussed his work at the annual convention. The American Psychoanalytic Association was founded in 1911, followed by psychoanalytic societies in New York, Boston, Chicago, and Washington, DC.” Freud’s trip to America was the initial impetus to introduce his work to a much larger academic audience both in America and Europe than he previously had or could have imagined.
Filling in the Blanks: Freud’s Work during 1895-1909
Prior to discussing Freud’s American visit, I will fill in some pertinent missing information not yet covered. Specifically, what occurred in between the publication of Studies on Hysteria in 1895, which only sold 626 copies in 13 years (R.I. Watson, 1978), to 1909. Likewise, relevant issues will be examined. First, in 1895, Freud completed a Project for a Scientific Psychology, which attempted to create a neurophysical model of the mind. He ultimately discarded the biological model and turned towards a psychological approach. Publication of this work did not occur until the 1950s, in which it was initially published in German and then in English.
Freud, Murder, and Fame: Lessons in Psychology’s Fascinating History Page 7