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Story of Anna O

Bertha PappenheimThe case of Anna O., reported by Josef Breuer and Sigmund Freud in their1895 book Studies on Hysteria, provides the initial evidence for the effectiveness of psychoanalytic treatment. The patient’s actual name was Bertha Pappenheim (Gay, 1988; Jones, 1953). For the case study, her initials were shifted one letter earlier in the alphabet, and she was given the pseudonym Anna. Since the publication of her story, so many people have given their opinion of what was wrong with her that truth is difficult to determine in the welter of interpretation (recent review by Skues, 2006).

In 1880, at the age of 21, Bertha Pappenheim became the patient of Josef Breuer. Breuer was 38-years old, a respected Viennese physician, famous for his earlier work in physiology. In 1868 he had shown that inflation of the lungs trigger pulmonary stretch receptors which through the vagus nerve then inhibit the inspiratory centers of the lower brainstem (Hering-Breuer reflex). In 1874 he had shown how the vestibular system was related to the sense of balance and not hearing (Mach-Breuer hypothesis). After his researches, Breuer had become a conscientious and caring physician. He described his new patient:

She was markedly intelligent, with an astonishingly quick grasp of things and penetrating intuition … She had great poetic and imaginative gifts which were under the control of a sharp and critical common sense … Her will-power was energetic, tenacious and persistent  (Freud Standard Edition Volume II, p. 21)

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