A Revolutionary Approach

Anna O. Case Study

by IG
Anna O

Anna O.

Anna O. is a famous case study in the history of psychoanalysis. It was published in the second chapter of the book Studies on Hysteria by Sigmund Freud and Joseph Breuer.

Anna O. is the pseudonym of a patient of Dr. Breuer. Her real name was Bertha Pappenheim. She was born on February 27, 1859 in Vienne (Austria) and died on May 28, 1936. Bertha Pappenheim was the founder of the “Jüdischer Frauenbund” (League of Jewish Women).

Anna O. (Bertha) was twenty-one years old when she came at Dr. Breuer. She developed several physical and psychological symptoms, such as: severe cough, paralysis of the extremities on the right side of her body, disturbances of vision, hearing, and speech, hallucination and loss of consciousness.

Anna O. was diagnosed with hysteria. There were moments when she experienced “absences”. In other words, in certain moments she became another person, she was quite confused. Dr. Breuer observed her for a long time and he discovered something: when Anna O. experienced “absences” she muttered some words.

The doctor started to write all the words and phrases the girl was muttering. When Anna O. came back to the real world, Dr. Breuer decided to induce her into a state of hypnosis. While the girl was under hypnosis, the doctor kept telling her the exactly words she said when she was “absent”.

Anna O. decided to stop hypnosis but continue to say whatever comes to her mind. This is the start of free association, an important technique in psychoanalysis therapy. The patient was encouraged to say whatever comes to mind, without thinking if her ideas are rational or not.

After several meetings and discussions, Breuer found out the cause of her illness. Bertha’s father was very ill. During a night, while she was sitting at his bed, she experienced hallucinations and a state of anxiety. Since that moment, she started to develop more and more symptoms including language disorders (aphasia), eating disorders and amnesia.

The Anna O. case reflects the existence of the transference process. Transference is the experience of feelings, drives, attitudes, fantasies, and defenses toward a person in the present which do not befit that person but are a repetition of reactions originating in regard to significant persons of early childhood, unconsciously displaced into figures in the present.” (Greenson, G. G. (1967). The Technique and Practice of Psychoanalysis, International University Press).

During sessions, at a certain point, Anna O. started to imagine that she is pregnant with the doctor’s baby. She experienced pregnancy symptoms, including nausea. Starting with this moment, Joseph Breuer stopped the treatment.

Anna O. case remains one of the major studies in psychoanalysis. We may say that Anna O. is the first patient treated through therapy. Today, the phenomena of transference and free association are still the major techniques used in psychoanalysis therapy.


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