Books

Sigmund Freud and the History of Anna O. Reopening A Closed

Case by Richard A. Skues (Basingstoke and New York: Palgrave
Macmillan, 2006); reviewed by Albrecht Hirschmüller
‘Anna O.’, Breuer’s patient in the Studies in Hysteria, the ‘primal work
of psychoanalysis’ (Grubrich-Simitis), features to this day in every history
of psychoanalysis and every introductory seminar to medical psychology.
This case history revealed for the first time how hysterical symptoms in
speech could be traced back to their source and eliminated by bringing their
unconscious affective content to consciousness and ‘abreacting’ it. Since
Jones it has been known that the published case history left out the fact
that the patient was not completely cured by Breuer’s treatment and was
treated for several more years in sanatoria, and that nevertheless in later
years she led a full and productive life as a Jewish social worker. In 1972
Ellenberger revealed details of her life after Breuer’s treatment and of a
stay in Binswanger’s clinic, and her case history for 1882 in Kreuzlingen was
published in my dissertation in 1978.1
Freud later stated that Breuer took flight in the face of a massively
sexualized transferential situation and renounced treatment of the patient.
Jones seized on this, elaborated it and thus created a new legend. I presented
the development of this legend – one might call it a historical fantasy –
and termed it a deferred reconstruction influenced by the development of
Freudian theory.
Since then specialists from various schools of thought have presented the
case history as a proof of totally differing theories. Whereas psychoanalysts
tended to trace the incompleteness of the treatment back to the fact that
Breuer missed the significance of sexuality in Anna O.’s case and that,

1. Albrecht Hirschmüller (1978) Physiologie und Psychoanalyse in Leben und Werk

Josef Breuers. Bern: Hans Huber. The Life and Work of Josef Breuer. Physiology and
Psychoanalysis. New York and London: New York University Press, 1989.
This review has been translated from the German by Michael Molnar.

ALBRECHT HIRSCHMULLER is a psychotherapist and medical historian at the

Institut für Ethik und Geschichte der Medizin, University of Tübingen. His publications
on the history of psychoanalysis include Freuds Begegnung mit der Psychiatrie: Von
der Hirnmythologie zur Neurosenlehre (Tübingen: Ed. diskord, 1991) and his edition
of the Sigmund Freud–Minna Bernay’s correspondence (Tübingen: Ed. diskord, 2005).
Address for correspondence: Prof. Dr. Albrecht Hirschmüller, Institut für Geschichte
der Medizin, Universität Tübingen, Goethestrasse 6, 7400 Tübingen 1, Germany. [email:
albrecht.hirschmueller@uni-tuebingen.de]

Psychoanalysis and History 10(1), 2008

© The author 131
132 PSYCHOANALYSIS AND HISTORY (2008) 10(1)

among other things, this was a result of the hypnotic elements in the therapy,
and that only fully developed analytical theory and the technique of free
association could have resulted in a better outcome, their opponents, on the
other hand, argue that at the very outset of psychoanalysis one can already
see its theoretical untenability and the dishonesty of its practitioners who
have omitted or falsifed essential facts about the treatment.
Richard A. Skues, a social historian from London who for several years
has studied the early years of psychoanalysis from a critical standpoint,
has now brought out a book claiming to re-open the ‘closed case’. Since
Skues had partially followed the speculations of Swales or Israels in his
previous publications, one had reason to be curious how he would present
the case of Anna O. The result is surprising: Skues’s book is a meticulous
stock-taking of what can be historically verified, of the development of the
established facts, of the contributions of the important authors and their
respective internal integrity and tendentiousness. Skues painstakingly and
methodically tracks the secondary literature in English, German and French
down to the latest publications, and some more peripheral ones have also
not escaped him (however, he does not take into account the wealth of
literature now emerging on the later life of Bertha Pappenheim, nor a
recent, well-written biography by Brentzel2 ).
It is to his credit that Skues subjects the arguments of the various authors
to meticulous critical analysis and reveals their weaknesses. He manages
clearly to unravel how the idea that Breuer’s treatments ended in failure
was used by both camps, on the one side as a proof of the inadequacy
of pre-analytical methods of treatment, and on the other to discredit
psychoanalysis itself.
Skues has rendered us the service of taking the historical documentation
seriously and of approaching the matter without prejudice. That is more
than many other authors have done. In addition his meticulous chronology
in the appendix is useful. Skues comes to the conclusion that in the
published case history Breuer did not promise more than he actually
achieved. He does not consider the surviving symptoms (trigeminal
neuralgia and addiction to medication as well as occasional hypnoid
states and inability to speak German) to be directly connected to the
hysteria itself, and consequently to have been justifiably omitted from the
publication. He has no new facts to adduce; however, he leaves it explicitly
open whether judgement of the case may not change in future, should new
documents come to light.

2. Marianne Brentzel (2002) Anna O. – Bertha Pappenheim. Biographie. Göttingen:

Wallstein. The paperback edition (Leipzig: Reclam, 2004), for marketing reasons, no
doubt, altered the title to Sigmund Freuds Anna O. despite the fact that Freud did not
even know the patient personally.
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His conclusions are not new to unbiased historians of psychoanalysis.

For those, however, whose verdict on the case bears the stamp of their
respective ‘school’, the book may perhaps prompt them to a reassessment,
even though its subtitle Reopening A Closed Case is somewhat overstated.
All in all the book is commendable and worth reading.

DOI: 10.3366/E146082350800007X